Volunteers Have Big Impact in Small Ways
When Clinician Reviews Editorial Board Member Freddi I. Segal-Gidan, PA, PhD, talks about her trip to Cambodia with Arizona-based Peacework Medical Projects, her enthusiasm is infectious.
“It was amazing,” she says of the two weeks she spent as an international medical volunteer in January 2009. “We were very well received, and I think by the time we left, we all wanted to go back. And I believe the community would welcome us back.”
Segal-Gidan is such an eager participant that when she says, “You should come with us next time!” even a nonclinician who fears camping is at least a bit tempted to sign on. Perhaps her experiences, and those of other clinicians, will encourage readers to contribute their professional skills to a worthwhile project.
A Sustainable Model
Peacework Medical Projects (not to be confused with Peacework International) is the creation of Pamela Burwell, MS, PA-C, a woman for whom volunteering has never been a choice; it’s always been something she just does. Her efforts in Ghana and Honduras earned her the 2008 Humanitarian PA of the Year award from the American Academy of Physician Assistants; this year, she added Cambodia to the list of places Peacework visits.
When Segal-Gidan began looking for an organization to volunteer with, she had a list of criteria: it had to be PA-friendly, short-term, and not religiously or politically affiliated. As she says, “The list got pretty narrow pretty fast.” But when she found Peacework Medical Projects on the Web and began corresponding with Burwell, she sensed that she’d found a winner.
“[Pam] works well with the local resources, which is very important, and she’s very respectful of the culture,” Segal-Gidan says. “It wasn’t like, ‘We’ve got the answers and we’re going to come and solve your problems.’ She goes in with the idea of ‘I’m going to see what we can do to help you.’”
Around the same time that Burwell launched Peacework in January 2000, criticism of short-term medical missions began to appear in the medical literature. Editorials and essays in journals such as BMJ and JAMA questioned whether these efforts actually do more harm than good and how clinicians can expect to treat chronic illnesses in a single visit. There have also been queries about whether such “medical tourists” cause disruptions and strain the local communities they purport to help.
Burwell understands the criticism but has worked to develop a sustainable model that integrates as much as possible with the local infrastructure. She has a five-page document outlining the process of putting a project together, from identifying needs and host country nationals with whom to collaborate, to assembling teams of health care providers for the trip. And she never, ever takes a team to a location she hasn’t vetted herself on what she calls her “scouting trips.”
“I think the big—and rightful—complaint about short-term projects is that you go in, you drop a bunch of medicine, and you leave,” acknowledges Burwell. “The way I try to combat that is to create long-term commitments in a given area, and I build health education into the program.”
Focus on Education
Each Peacework volunteer carries about 70 pounds of medications into a country (a fact that slightly concerned Segal-Gidan, until she realized Burwell had done her homework with the Cambodian authorities to ensure that no one would be detained at Customs). Even so, Burwell’s commitment to health education means those medicines “are simply the carrot on the stick that brings so many people to us,” as Burwell says.
Once patients arrive at the Peacework clinic, the focus becomes health education. “We want them to understand the relationship between their own behaviors with personal hygiene and clean water and their own good health,” Burwell says. “We’re not going there and treating long-term diabetes or hypertension. We can treat those things in the short term but more importantly, teach people how not to get them in the first place.”
“If we can teach someone to keep their water clean, it might decrease their chances of being ill 10 times a year,” says Shelley Vaughn, RN, BSN, who is currently enrolled in the family nurse practitioner track at Northern Arizona University.
Something as simple as a five-minute discussion might be enough to improve someone’s life and health; this is part of what keeps Vaughn, who has participated in three Peacework projects in northern Honduras, going back. For example, Hondurans drink a lot of coffee, which contributes to their high blood pressure levels. “Even helping them to understand that if they only had one cup of coffee a day, instead of that being their only beverage all day long,” Vaughn says, might make a difference in preventing or controlling hypertension.
