Whether in response to acute incidents, such as the devastating earthquakes in Nepal or the recent terror attack in Tunisia, or to support countries facing chronic shortages of medical resources, many doctors from the UK are moved to volunteer abroad each year.
Providing acute relief work or educating healthcare professionals in other countries can be a hugely rewarding experience; not only in terms of ‘making a difference’, but it also has the potential for personal and professional growth. The exchange of knowledge and ideas goes both ways and it can be a privilege to experience other cultures and other ways of working.
If you can cope whilst working under fire in a war torn country, or when triaging hundreds of sick patients - many of whom will not survive – then it is likely that you will be able to cope anywhere.
Potential employers may also view humanitarian work experience favourably as it demonstrates many of the skills they would hope to see in their colleagues and employees, including kindness, autonomy, lateral thinking and strength of character.
It is difficult to accurately estimate the number of UK doctors currently undertaking humanitarian work. Medecins Sans Frontieres (MSF) UK sends around 250 UK doctors abroad each year, and in addition to large multi-national organisations, some doctors find placements privately or through smaller independent programmes.
Preparing for humanitarian work
However, there remains little support for doctors undertaking humanitarian work. If you are interested in providing assistance or taking part in a disaster relief program, it is best to be prepared for some of the difficulties which you may face.
London-based GP Dr Laura White spent a year working in a remote African hospital with Voluntary Service Overseas (VSO). She recalls that one of her most startling observations on arrival was the difference in expectations to what she was used to at home.
‘One of the things which struck me most was the gap between what was expected of me and what I could realistically provide.’
There can be significant differences between the training of doctors in the UK and other countries. For example, in some countries all doctors will be trained to undertake a number of surgical procedures that would only be performed by specialists in the UK.
Before travelling, it is essential that you know exactly what will be expected of you and that you have the necessary skills. It may also be a good idea to take some time to get up-to-date with health issues that are specific to the area you are travelling to, for example, infectious diseases, trauma or malnutrition.
Working in isolated areas
Whilst all the decisions we make as clinicians can have major consequences, we are generally well supported in the UK, can ask our colleagues for help, and an ambulance is rarely more than minutes away. However, when working in some communities, the level of isolation can mean that you may find yourself having to make challenging decisions without any back-up or support.
Dr White’s role in Africa involved transferring patients from a base to the nearest hospital in the back of a truck for several hours. Performing this role alone, she had no colleagues to ask for second opinions. A decision between stabilising a gravely ill patient before transferring them, or transporting straight away them could have therefore been fatal.
‘On one occasion I was treating a patient with post-partum haemorrhage. I tried to stabilise her on the base, but ended up having to move her in a critical condition. She had a number of young children and I was terrified that I would lose the patient. Fortunately we reached the hospital in time and the patient recovered well, but the sense that the responsibility would have rested solely on my head stayed with me.’
If you arrange a trip through a large organisation, they may provide a central base that can be contacted for advice and support. If not, you may want to consider setting one up. Mobile technology can be invaluable in certain situations and you may be able to arrange telemedicine clinics with centres in other parts of the country.
Navigating the local bureaucracy in some countries may be complex. Dr White recalls that whilst registering with the local medical council was relatively straightforward, other decisions relating to funding or governance required face-to-face meetings and were often time consuming.
It is important that, if time permits, you do as much research as possible on the country you are travelling to so you have an understanding of any processes and customs that may impact on your work, as well as any specific travel warnings. The Foreign and Commonwealth Office website may be a good place to start.
Medical indemnity for work overseas
Make sure you have sufficient indemnity in place for your trip. Whilst non-governmental organisations and charities may provide access to cover for negligence claims, they are unlikely to provide cover for all professional risks, such as investigations by the regulator.
If you are interested in volunteering, it is important that you contact your medical defence organisation in advance with the details of your proposed travel so they can confirm whether or not you will be protected and make any required arrangements.
- Dr Richenda Tisdale is a medicolegal adviser at Medical Protection