Surgery and Healing in the Developing World - Dartmouth-Hitchcock

The Impact of a Volunteer Medical Mission
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taxi arrangement for him to catch up with us guided by cell phones in the DR. From
that point on, before any of our group moved to a new location, each would call out
his name, and announce that they had his passport and bags under their control.
In contrast to the few who knew their fellow teammates, and only a couple
before the trip, each responded differently on the post-trip questionnaire B: now the
numbers of the team that each knew “really well’ numbered “seven”—one, “ten,”—
three, “eleven”—five, and “all”—seven, with one commenting that the level of trust
he now had was previously only experienced in family because of the intensity of the
shared inconveniences and the patient problems. In response to the question of how
the experience matched expectations, there was a unanimous chorus of superlatives,
with no one of them neutral or negative. The terms used were: “amazing,” “incredible,”
“far exceeded my grandest expectations,” “tremendous,” “great,” “far more
rewarding than I could have hoped,” “strong,” :”how about ‘overfill’ instead of ‘fulfill?’”
Each one was positive in how the trip fulfilled their motivations for making it,
and all responded that they would do it again, one adding “in a heart beat.” Where
they would wish to go, as a concrete expression of their willingness, over half said
back to Haiti, three fourths added Africa to that return trip, and several added “on
your next trip wherever,” one adding “ASAP, I’m hooked!”
In answer to whether many of the things each was hoping from the outset to do
were done, the typical answer was “no. much more!” All were surprised at the high
volume of supervised hands-on care, and many expressed amazement at the high
quality and intensity of the medical education component. When asked what they
hoped to do that they did not get to do, answers included “meet Paul Farmer,”—
two, “observe or participate in a surgical procedure,”—one, “hike, explore and sightsee
more, (still stuck in adventure tourist mode)—two, and “drive”—one; the others
said they had done all they had hoped and more, and there was no item they had
hoped for that they did not get to do—ten.
At the outset in briefings both before and during the early parts of the trip, I
explained there were three aspects to the mission, and they were in order of priorities:
A) Patient care, which would not be compromised, and that there was no “third
world standard” by which any treatment would be considered “nearly adequate,
considering the circumstances and amateur clinicians;” B) Medical education, which
was a rare and intensive opportunity and not an elective process from which anyone
might absent their participation, and upon which they would also be evaluated; and
C) Adventure travel and living almost in the conditions of our patients, which would
require flexibility and adaptability, with no accommodation for the special requirements
of first-worlder’s consumption “needs.” How this trip ranked according to
the three aspects was asked in three questions, given this up-front list of priorities.
The critical health care delivery part was judged “great,”—fourteen, and “adequate,”—
three. The medical education component over which we had somewhat more control,
however, was a grand slam, all sixteen students professing that this part was
great, with a few stating they had never learned so much. The adventure travel and
cultural accommodation was ranked “awesome,”—one, “great,” –six, “adequate,”—
five, with four complaining that there was too much time being pounded around in
long bus rides.
For those who had changes to suggest in the trip (and six had none), nine said
that the BRA arrangements in the DR suffered by comparison and should be foreshortened
in favor of Haiti, and one thought there should be a longer time period
spent in each. The most important question from the perspective of this researcher
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