by Lauren M. Simon , M.D., M.P.H.
Assistant Director, Loma Linda University Family Medicine Residency Program
Treating a pediatric patient at a mission clinic in Albania (courtesy Joel Mundall)
“In Africa, we wash and re-use the gloves,” said one of our resident physicians who was doing clinic procedures with me.
When he graduates from our Family Medicine Residency Program at Loma Linda University, he is planning to work in the mission field in Africa where he spent time as a medical student. We had been discussing principles of “universal precautions” and discussing the use of medical gloves.
I looked at him as he was wistfully staring at the boxes of gloves that line the exam rooms in our Family Medicine clinic at Loma Linda University in California. Gloves that are ubiquitous here in the United States are so precious in the mission field. I remembered seeing mission photos, from our doctors who went to Africa and Papua New Guinea, showing gloves drying on clotheslines ready to be re-used. All day, I thought about medical gloves and the hands that wear them, the hands that are extensions of the doctors we are training to care for patients in the United States and around the world.
At Loma Linda University School of Medicine, students are encouraged to take elective rotations at mission hospitals and clinics around the world. The program, called Students for International Mission Service (SIMS) exemplifies the university’s commitment to global service. It empowers students to become compassionate, socially responsible health professionals and helps to promote the health of global communities. SIMS offers students opportunities to do mission work of various lengths. There are weekend interdisciplinary trips to mission clinics in Mexico and longer trips to various other countries. Students can also participate in an International Service Learning program (I-Serve) in which they do a month long observational or hands on clinical experience at a mission hospital. There is funding available through the Dean’s office to help defray travel costs. The students are usually housed at the mission site.
Mother with newborn at clinic in Nigeria (courtesy Joel Mundall)
Resident physicians at Loma Linda University (LLU) are also encouraged to do a mission elective either domestically or overseas. Some of our residents have recently returned from mission work in Malawi, Mexico and Nepal.
When resident physicians (at our institution or other institutions) plan an elective rotation, they must consider if their salary, malpractice insurance and benefits such as health insurance will carry over during their elective. At LLU, residents can choose from the “big book” of approved mission clinics around the world which will allow their salary and benefits to be uninterrupted.
Resident physicians and other health professionals often face the dilemma that they want to enter mission service but they are concerned about how to pay their student loans. For non–medical students who wish to serve in the mission field, they can apply for the Global Service Scholarship Program (administered by the Loma Linda University Global Health Institute in conjunction with SIMS) and they can get their student loan indebtedness amortized while they volunteer in an international setting.
At Loma Linda University Family Medicine Residency Program, several of our residents have chosen to participate in the Deferred Mission Appointment (DMA) Program. This program enables medical or dental students to work in overseas mission service with financial stability. During medical school they receive a stipend to cover room and board. After graduation they are placed in one of the Seventh–day Adventist Church’s many health care organizations world wide. In the DMA program, they receive a salary and competitive benefits such as health insurance, licensure fees, one month furlough (vacation time) plus continuing medical education time each year, and a percentage of their student loan indebtedness is amortized each year they serve in the mission field.
“The DMA program was an obvious choice because it makes it possible to work internationally without any delays after residency for repaying my loans,” said Dr. Joel Mundall. “Without this program, if I were to try to work for a little while to repay my loans before going, I would be at risk for never leaving this country or going where God wants me to be.”
The mission hospital in Nepal (courtesy Aaron Sartin)
Most of our residents will serve a six year term in the mission field and they may choose to stay on afterwards. At their mission site, they staff medical clinics or possibly a hospital and train indigenous people to provide health care services. This program is administered by the World headquarters of the Seventh-day Adventist Church in Silver Spring, Maryland.
As Dr. Aaron Sartin, a third-year resident in the DMA program explained: “A large barrier to doing mission service after residency is the enormous medical school debt, which grows exponentially after years of in-school and residency deferments. That barrier is removed with this program as the medical school debt is amortized over a six year mission term overseas. At the time I signed up for the program it seemed like seven years was so far away and would seemingly never arrive. Now in my third year and last year of residency in Family Medicine this reality is less than a year away.”
Although our residents in the DMA program may be placed around the world, most of them will be heading to Asia or Africa. They can request their first choice but they will not know until they complete their residency where they will be going.
“Recently, my wife and I returned from a three week mission elective to Nepal where we witnessed first hand the poverty and great need (physical, emotional and spiritual) as well as the beauty of the people,” continued Dr. Sartin. “We were awakened as never before to how blessed we are in the United States and reminded of our responsibility to use these gifts to be a blessing to others, both here and abroad. Where will we end up? That remains to be seen but as a Christian physician I am confident that God will direct us to the right mission field.”
As I put on my gloves for the next procedure, I couldn’t help but wonder where the skills I was teaching my residents would be used to provide health care around the world.
For more information, access http://www.llu.edu.
This was an amazing and inspiring article. It is really great that there is a program that takes into account massive debts from medical school and wanting to do international service. I think that doctors form rich countries do have a responsibility to help care for/train doctors in other parts of the world suffering from warfare, instability etc. . . Six years is amazing though, much longer than average MSF deployments.
It would be interesting to see if the same hospital(s) is used by the residents in Africa, Asia, with enough resident and student interest, the program could almost run a whole hospital itself.
It’s so comforting to hear that there is a school out there that has programs like these. I want to do mission work myself, and reading this makes Loma Linda SOM very attractive to me. I’ve been torn with this exact issue- how do I participate in international medical mission work while paying off my student loans? This is awesome! I’m excited about it!
In response to Matt’s comment, I know that there are quite a few Adventist hospitals in Africa. I would bet that many of the residents from llu go to these hospitals.
gingerale
I’ve given some thought myself to doing medical missions trips with the Christian Veterinary Fellowship during my free block preceptorships coming up. With so many dying of zoonotic disease (30,000 to rabies a year worldwide) and new/emerging foreign animal disease, there’s a real need for this. Good article!
As a member of the National Pharmacist Response team, part of FEMA in 2005, then part of Health and Human Services, I was deployed to New Orleans during Operation Katrina. I worked with other medical responders and dispensed medication froma mobile medical unit. In 2004, as part of a medical mission with my Church medical members, I dispensed medications to over 2000 patients in Xining China. In 2008, the Same medical team provided care to over 2,500 people in Thailand and Laos. We are planning to return in Feb 2010.
Medical Missions are a good opportunity to see other areas while practicing your medical expertise.
I am offended by the Doctor comment’s on how in “Africa” he washed and re-used gloves. My father is also a doctor in “Africa” as well and I can tell you that he never re-uses gloves.
I rather people provide name of the country and the political and economic context of that country. My father was a Nigerian doctor and we are an oil producing nation, hence we have the resources to afford these basic “universial resources,” whereas in say Sierra Leone during the peak of the civil war, gloves would certainly have been a luxury.
So please, put aside your pity Africa comments; It is a continent with over 50 countires with diverse histories, cultures, languagues and economies.
I was surprised about how the article described doctors washing gloves to reuse them. This could potentially spread dangerous bacteria and viruses . . . I would assume that they are somehow sterilized, however, regular latex gloves wouldn’t stand up to this type of treatment.
I would if someone could invent gloves for poorer nations that could be sterilized easily, perhaps in a machine, and be tough enough to last through several operations . . .
One could argue whether it is ethical to practice at a level of care well below what is done in richer countries.
Nnenna, I see your point, but am sorry you were offended in the way that you were. As you have reported, Africa is a diverse continent and what was reported may be completely unrelated to your country. Since you know this, why does a matter of fact description of life in another country where your human brothers live cause you to choose to take offense? We are all one human family. There are two major modes of living — living for self and living for others. Happiness comes from the latter. Who are you trying to defend — yourself or your brothers and sisters in Africa and around the world?
Seeing the poverty of our brothers and sisters should cause us to realize the good things we enjoy and be thankful for them. Even more, it rightfully should cause us to be offended. But, this offense is opposite of what you might think. The offense that we should take is one from personal introspection. It should cause us to be offended at ourselves for not doing more to help our brothers and sisters who are in need.
We all have neighbors. Are we being neighborly?
On a side note, I have personally seen the great diversity within countries (including Nigeria), and see that naming a country would also probably not be entirely helpful because there are varying conditions even within country boundaries. This also applies to wealthier countries, such as the United States, where there are many places (for example, inner-city areas) where living conditions can be very poor. No matter what country we live in, there is a need for each of us to learn how to be good neighbors. Am I being a neighbor? Are you? This is what missions is all about.
“‘So which of these three do you think was neighbor to him…?’
And he said, ‘He who showed mercy on him.’ Then Jesus said to him, ‘Go and do likewise.’” Luke 10:36,37 (NKJV)
I definitely agree with missions being very important and helpful. However, I also agree with Nnenna because sometimes people just lump Africa as a whole country while it consists of a lot of countries that vary. It helps when you want to be good neighbours to know who your neighbours are and what they stand for. I always cringe when people talk of missions in for instancs albania, india…and Africa. The intent is good and right on, but more still needs to be done in educating people about the place the are so desperate to help.
LLU also offers these mission trips to their dental students, if anyone is wondering. What a great opportunity to gain valuable clinical experience and help out those who may not have access to essential medical/dental care.
I must agree with Nnenna’s argument. However, unlike her, I am not only offended by such stereotypical descriptions but am also angered by them. I detest the idea of Afrika being painted as a needy and helpless continent constantly awaiting “the western savior” to come and make things better. What’s most amazing is that no one seems to be as willing to discuss the historical exploitation of mama Afrika by the west which continues to place her in economic misery as they are to fly down there and “save the day”.
Joel,
I think that in my haste to take offense, I may not have expressed myself thoroughly. I certainly empathize with my brothers and sisters around the world who live in abject poverty. I certainly think you are doing admirable work, going far away from your home, culture, comfort zone to a new country, a new place where there may be incomprehensible suffering.
I took offense to a trend I see in various forms of media, in which non-Africans define a whole continent with a single story: one of despair, hunger, wars, and barbarism.
In this single story narrative of Africa the country not the continent, they fail to recognize the leaders within each society. The doctors, the lawyers who run NGOs, the economists, the bankers, engineers, collge professors and non professional alike who contribute immensely to their countries.
I want non-Africans to understand that Africa is a continent with different countries, climates, languages, cultures and as such, different stories. We are a dignified people.
I guess Chy and Nnenna are correct, Africa is great and lovely doing things alone. It’s offensive that you slap any hand that is offered in friendship. I know many residents and physicians that devote much of their lives to work in poverty, not for glory or exploitation, but merely to help “someone” and “anyone” who is less fortunate than they. For them to show their heart and tell their stories to many people who take boxes of new gloves for granted, only to be scolded by you two is ridiculous. As a continent, Africa is different economically than Northern America. There are rich places in Mexico, also, but there is also much poverty and distress. If we shut-up about our experiences and efforts to help those less fortunate, from Africa to the Appalachian, then nothing will be done. Out of sight, out of mind. I applaud the article and I applaud the media attention. Chy, until you do something to help your brothers and sisters, reserve your anger for yourself.