Association of Women Surgeons

Introduction:

If you are looking for a surgical career that is professionally challenging, filled with the unexpected, confronted by doors of opportunity, and offering tremendous job satisfaction, missionary surgery is the answer. This article will describe the practice and work in an overseas setting, preparation necessary, and some of the obstacles that may be encountered.

The current American concept of a general surgeon does not define the general surgeon working in a mission hospital, usually located in a developing nation. The clinical practice may include urology, orthopedics, thoracic surgery, and obstetrics-gynecology, as well as other surgical subspecialties. Often technology for diagnosis and management is lacking and clinical skills must be honed and further strengthened. This type of practice allows the surgeon the excitement and challenge of learning new procedures and management.

The primary responsibility of the missionary surgeon is patient care. The facility may be the only one or the best one serving a large population. Therefore some patients present very complex problems. This is compounded by the fact that the people may have difficulty in accessing the care, have a low level of education, and come only with advanced disease.

Teaching is another aspect of the professional challenge. There is great need for training and mentoring national surgeons who may be young and inexperienced. Some mission hospitals have residency training programs and undergraduate teaching as well. The effectiveness of the missionary surgeon is multiplied as he trains others.

In the overseas setting, the unexpected is an almost daily experience. The surgeon will assume roles that he did not anticipate and for which he is not prepared. Administrative responsibility is common. Other jobs may include counseling, construction and maintenance supervisor, equipment mobilization, fund raising, community leadership, and coordination of volunteers. Innovation is required in every area. The missionary surgeon is key not only in his own professional area but also in the functioning of the mission hospital as a whole.

The doors of opportunity are always there though some doors open and close rapidly. There are opportunities to enhance surgical practice standards in the community or nation. There are clinical research opportunities that will become evident. The wide variety of pathology seen gives opportunity for documentation and reporting. But greatest is the opportunity to invest in people – patients, national colleagues, young professionals and the community.

The surgeon may engage himself in missionary surgery as a long-term career choice or on repetitive short-term trips with practice based in the USA. Those working long term sustain the work, administer the hospital, and invest in the development of the institution. The volunteers who come for a few weeks are vital to train missionary and national physicians, to encourage the staff, and to provide future support in money, equipment, and prayer.

Preparation:

When considering a career that includes work internationally, preparation begins early. An awareness of world events, geography, and social and political issues provide more understanding of needs. Short-term experience as a medical student and as a resident may be important in clarifying the career path.

The residency should be done in a busy surgical training program giving a broad base of experience that will better prepare the surgeon for the variety of cases that will be encountered often in an isolated place with little equipment. Board certification in general surgery should be completed prior to going overseas. This may be required for visa or work permit or local license. Maintaining licensing and certification in the USA is also important when the missionary surgeon returns home.

Any prior cross-cultural experience will help the missionary to be more comfortable in the new culture and environment. Reading books and articles about communication and work in other culture is also helpful. Once the country for work has been identified, the reading becomes focused on the people, religion, and culture in that place. Language acquisition will be essential for the long term missionary surgeon and should be initiated either before going or upon arrival in the country.

Sending Agencies and Support:

Many mission societies or agencies operate hospitals or have the ability to place surgeons in positions overseas. This can be researched thoroughly on the Internet. A general Website with information is www.rightnow.org. Religious denominations have overseas mission boards with medical work and may be contacted through the church. Other contacts include the following:

Africa Inland Mission, PO Box 178, Pearl River, NY 10965
SIM USA, PO Box 7900, Charlotte NC 28241-7900
World Medical Mission, Samaritan’s Purse, PO Box 3000, Boone, NC 28607
Christian Medical and Dental Associations, PO Box 7500, Bristol, TN 37621

Most agencies provide a network of prayer support but not financial support for the missionary. Therefore the missionary is responsible to generate his support from churches and individuals that can be sustained for the period of service overseas. A few agencies do provide subsistence salary and benefits such as insurance and retirement programs for personnel. It is usually required that debts be cleared prior to departure.

Project MedSend may offer loan repayment grants to career overseas medical personnel after reference and documentation from the sending agency.

Difficulties:

There are some difficulties inherent in a medical missionary career. These will vary from place to place, and even from time to time. A few of these are listed below in no particular order of priority.

Communication: Even with language facility, communication cross culturally is an ongoing learning experience that is life long.

Continuing medical education: In a remote place with a very heavy work schedule, this is difficult but is possible online and by correspondence. The Christian Medical and Dental Associations offer excellent meetings annually either in Africa or Asia.

Government restrictions: Obtaining medical licensing in the country may be difficult. Strong nationalistic attitudes affect policies. In some places there are examinations in the local language that must be passed. Some even require the internship to be done in the country. The missionary should be aware of the requirements before going.

Limited equipment and supplies and infrastructure: The real challenge is to adapt and adjust without ever compromising standards of care.