The Rewards and Dilemmas of Surgical Missions

Dr. Buckmiller is associate professor in the department of otolaryngology, University of Arkansas for Medical Sciences, and director, Vascular Anomalies Center of Excellence and Cleft Lip and Palate Team at the Arkansas Children’s Hospital in Little Rock.

Q: Are there times, due perhaps to incomplete screening procedures, lack of adequate resources or appropriate follow-up care, when you must tell patients and their families—who might have traveled hundreds of miles to see you—that the surgery they want cannot be safely done?

K. Christopher McMains, MD: I have done surgical trips to Peru, Nicaragua and Iraq, in association with non-governmental organizations as well as those co-sponsored by the State Department and the in-country Ministry of Health. I do mostly rhinology, which is an equipment-intensive activity in the U.S. Often, you do not have all of those medical devices at your disposal in the host country. You feel the pressure of all eyes looking to you, especially when you also know that you cannot reschedule the surgery for another day. Sometimes you have to say, “Given what we have at our disposal, I cannot in good faith undertake this [procedure].” And that’s both humbling and disappointing to everyone involved. The same is true for a procedure that requires follow-up: Unless there is someone with whom you’ve established a partnership, trust and ability to communicate, it’s best, in my mind, to just not go there surgically.

Dr. McMains, MD, is clinical associate professor at the University of Texas Health Science Center in San Antonio, and chief of otolaryngology at South Texas Veterans Health Care System.

Q: How do you keep from feeling overwhelmed by the need for your help in these countries?

Susan R. Cordes, MD: There is so much need when you go on a surgical trip. You always feel good about the patients you’ve taken care of, but you also feel bad about the ones that you don’t. I’ve now traveled to Kenya six times, as part of AMPATH, a reciprocal partnership between North American academic centers led by Indiana University, working in concert with the Moi Teaching and Referral Hospital in Eldoret, Kenya. Although the AMPATH program has been in existence since 1989, I was the first ENT to go.

We have established a relationship with the otolaryngologists there to build up their department and have a more lasting impact. For me, that is very professionally rewarding, and a lot easier for me mentally to be able to look at the long-range picture. We work side by side with the Kenyan otolaryngologists; we raise money to bring them here for additional training; and we let them guide us about the areas they want to work on. For example, for one visit they wanted to work on sinuses. So we brought equipment, they recruited patients and we left the equipment there. More importantly, we left them with the training to use it. What keeps me going is thinking that if we keep this momentum going, we will get to the point where we can narrow down the number of cases they need us to do.