Tips To Live By On A Medical Mission

Grat Correll M.D.

Focus on the Family’s “Physician Magazine” July/August 2001

The average American physician on his or her first medical mission trip, when encountering unfamiliar diseases and a foreign culture, often feels like an intern on the first night of call. The following principles can help even a first-time volunteer from feeling like a neophyte.

“We are not in Kansas anymore.”

Paramount to practicing medicine overseas is an understanding of how different the people we serve abroad are from our patients back home. Since villagers in a remote location may have no concept of time, much less own a clock, the saying “one pill every eight hours” is meaningless to them. But living in an agricultural society, they do understand the movements of the sun, which you can reference in your instructions.

Keep it Simple

Most villagers have no understanding that when it comes to medication, the “more is better” philosophy is flawed. You must give them simple, explicit instructions regarding their medicines and anticipate their creativity for noncompliance. I often say something like “one pill a day-no more, not less-until all the pills are gone.” I will have them repeat my instructions verbally, since many are illiterate and can’t follow written instructions.

“One to a customer, please.”

As a general rule, I limit prescriptions to one per patient. Each patient may additionally receive a bag of vitamins or analgesics. Most villagers know little about pharmacodynamics and microbiology, and they can easily confuse two sets of little white pills, inadvertently taking the wrong medicine. We can hinder their ability to harm themselves by limiting our treatments to one medicine.

“First of all, do no harm”

Don’t employ medicines that require close supervision or follow-up lab work. Once the missions team leaves, there often is no one who can monitor for side effects. Don’t leave villagers to deal with adverse drug reactions.

Remember quantity

An average day at a clinic brings more patients than a doctor can see. Many people have traveled great distances and may not have another opportunity to receive treatment. To help the greatest number of people in the shortest amount of time, it’s imperative to keep up the pace. Stay focused on your history-taking and physical exam. Don’t get bogged down in a 30 minute contemplation of a disease you can’t treat when you can see 10 people with diseases you could treat in the same half hour. With proper triage skills, each doctor should be able to see 75 patients a day.

Remember quality

While each patient encounter can’t last 30 minutes, the reason for clinics is not to generate numbers but to change lives. Occasionally God will move you to get involved deeper. I remember one patient presented to a clinic who complained of depression. Central to her problem was guilt over being the town prostitute. The physician and translator were able to lead her to Christ, and she left the clinic a well woman-something no SSRI could have done.

(We honor God by doing the best job that we can within the limitation under which we are working. Colossians 3:17 "…do it all in the name of the Lord Jesus"…as His representative.)

Remember pharmacokinetics

Many of the people we see abroad are of small stature, have a low percentage of body fat and (without a lifetime exposure to OTC pharmaceuticals) don’t have a revved-up P-450 system. Most villagers are pharmacologically naïve and will respond to simpler treatment or a lower dose than in a comparable American patient. For instance, an otitis media may respond to 250mg of Amoxil in South America, whereas you would use 500mg of Augmentin in the United States.

“Common things are common”

This little phrase has helped me a lot in my career, whether at home or abroad. Just because you’re in a tropical environment doesn’t mean that a stuffy nose is a case of Hemorrhagic Fever.

Read up on anticipated problems

Resign yourself to seeing more cases of intestinal parasites, scabies and lice in your mission’s clinic experience than you have in the last 20 years of practice. A little focused reading beforehand can go a long way diagnostically.

Remember the basic tenets of medicine

Though you may not be able to do an MRI scan in a village without electricity (or have access to an MRI scanner for that matter), the basic elements of the medical evaluation, the history and exam, are still your best tools in assessing the patient. Your strength as a doctor today is still the same as it’s been for centuries-the bond of the doctor-patient relationship.

Treat the complaint that matters

Patients in a missions clinic will overwhelm you with a litany of complaints. Since they haven’t seen a doctor in so long, they will want to tell you everything and will have unrealistic expectations that you can magically fix everything (not unlike our patients back home). Pick out one problem that your skills and formulary limitations will allow you to treat competently. Ignore the rest. The temptation to treat everything leads to more harm than good for reasons already discussed. Christ left many diseases untouched, focusing instead on a few things that He could affect significantly.

You can’t go wrong with anti-parasitics, vitamins and analgesics

In the pediatric clinic, parents often bring their children for “checkups”-they just want assurance that their children are healthy. This is understandable when you live in a village where the infant mortality rate if 50 percent. You will frequently hear parents say their children are too small, weak or not growing enough, while you perceive an otherwise healthy child. In this situation, give each child a supply of vitamins. The parents will feel you’ve really listened and cared.

Every patient in the adult clinic will complain of pain-understandable, when you consider they’ve spent a lifetime doing backbreaking manual labor. You can’t go wrong with an analgesic.

Learn to say no

You will be barraged with impassioned please for everything from requests to do the miraculous to monetary donations to the occasional marriage proposal (to help them immigrate to the United States). Although not a problem for my toddler daughter, most physicians on their first mission trip have a hard time saying no. Remember you’re only human and can change only a little bit of the misery they will encounter living in an impoverished nation. Most of the time, they will accept a diplomatically phrased no with fatalistic resignation.

If a significant conflict develops, let the team leader deal with it.

“Thanks for coming, but…”

When a medical/dental brigade comes to town, it’s as if the circus has arrived. People will clog the clinic trying to see the spectacle, which will impede the patient flow. Limit access to the clinic, and encourage them to exit when the visit is over.

Don’t create beggars

In many medical missions clinics, a nominal fee is charged of the patients-often done so at the request of national co-workers. I once asked why they wanted to charge people who are so poor. The response was, “Our greatest natural resource is our people. If you give it to us free, you make us beggars. If we pay for the clinic services, however, our dignity remains intact.”

Take a break!

Don’t forget that Christ left the crowds of needy people in order to rejuvenate. Since we aren’t divine, we shouldn’t expect our endurance to be any better. Often first-timers are so moved by the poverty they see, they want to do as much as possible in the little time they have in the clinic. However, they will actually get more done if they take regular breaks to recharge their batteries.

Don’t show favoritism

Even on the way to the outhouse, you will be bombarded by people asking to break in line or for a clinic ticket for someone who didn’t register. Just because someone is the local schoolteacher or politician doesn’t inherently give him or her a greater right to health care. Showing favoritism can spark a crowd to riot-literally.

Treat only the patients you see

Patients will request that you send them home with extra medicine for a sick relative who couldn’t make it to the clinic. As a general rule, this is as bad an idea in a developing country as it is here at home. Without taking the patient’s history and doing an exam, it’s hard to get an accurate diagnosis, let alone prescribe an adequate treatment. Studies in the United States have shown that even for common conditions (e.g. candida vaginitis, UTIs and the like) patients usually make the wrong diagnosis. The potential for doing harm to a patient you’ve never seen is great, and that could undermine the testimony of the entire clinic.

Remember, only Christ will make the difference

I see doctors who sing up for a missions trip with great aspirations for curing the ills of the world’s poor, only to become horribly frustrated and disillusioned as to how little of an impact they really had. Everyone they treat for parasites will get them again. For every tooth a dentist pulls, another will become rotten. Realistically, what we do in a short-term missions clinic is very limited and very temporary.

In truth, it is the volunteers who gain more from the experience than the villagers they help. But the purpose of such a trip is not to revolutionize the country’s health care infrastructure; even the most extensive humanitarian efforts can impact an individual only so far. Christ, however, can have a permanent impact on a village in a way no prescription can.

As a physician in the United States, I take care of some of the richest people in the world, but find that they struggle to no lesser degree with the deeper issues of life, too often labeled as a mental health diagnosis or as an expression of psychosomatism. Ultimately many of their problems are spiritual and require a spiritual solution. People in the developing world are often more receptive to spiritual discussions than our regular patients. Often we can do our best healing with a kind word and empathetic prayer.

Grat Correll, M.D., a family physician, has traveled around the world on medical missions. He lives with his family in Bristol, Tenn. http://wellmont.newsroom.meltwaterpress.com/news/dr-grat-correll-devotes-25-years-to-medical-missions-includes-photo-link-869

From Dr. Drew

The national partners working with you are your brothers and sisters in Christ; treat them with respect, kindness and appreciation. Part of your 'mission' is to build (cross-cultural) relationships, and learn. Your ministry partners are part of the culture - be humble enough to ask for and follow their advice, if it is safe and reasonable. If you see something that you do not understand, ask “Tell me about that” rather than criticizing. You may be forced to take a stand based on Biblical principles; do so with gentleness and respect, and use the opportunity to reflect Christ.

“Ethical Obligations Regarding Short-Term Global Health Clinical Experiences”, An American College of Physicians Position Paper, 2018 https://www.acpjournals.org/doi/full/10.7326/M17-3361