Local physicians donate their medical expertise in humanitarian missions abroad, serving those in need and rejuvenating themselves in the process.

"I get a lump in my throat all the time when I tell this story," says Sudeep Kukreja, MD, a neonatologist at Children's Hospital of Orange County and a UCLA assistant professor of pediatrics, recalling his most memorable experience as a medical volunteer with Operation Smile, treating disadvantaged patients in a foreign country.

In the large coastal city of Fortaleza in northeastern Brazil, Dr. Kukreja and colleagues watched as about 1,800 mothers, fathers and children from the surrounding area learned who would undergo cleft palate surgery the next day, from a list posted outside the hospital. "They're waiting to see their child's name on that list," recounts Dr. Kukreja. "When they see their name, there are people who are just screaming with joy, tears in their eyes. And there are people who are crying--again tears in their eyes--because their kid's name is not there."

As Dr. Kukreja stood watching the scene play out, a young woman approached him from out of the crowd to thank him through a Portuguese-speaking interpreter. She had just seen her 5-year-old son's name on the list of patients who the medical team felt were strong enough to take anesthesia. The boy was slated for surgery to correct his cleft lip and palate on the very next day. In a cracking voice, Dr. Kukreja recalls the woman's next words: "We traveled 300 miles. From the same village, there's a girl with me who is 16 years old. She does not have any friends, because of her facial deformity, because of the cleft lip and cleft palate. Nobody wants to talk to her; nobody wants to be friends with her. And probably, she will never get married because of her facial deformity."
The girl's name was not on the list. "What if I take my son's name off the list," offered the woman, "can you do surgery for her?"

"I said, 'Lady, God bless you,' and this really brought my heart to the bottom--to my boots, really," Dr. Kukreja says. "And guess what? We call it 'God,' that's where the 'God' was. [The girl's] name was wrongly spelled there. And she also had the surgery done."

The heartrending and poignant aspects of volunteering one's medical services outside the United States don't deter physicians--they actually attract participants. Those who go abroad to give first-world medical care want to help people who might otherwise never receive treatment. These medical volunteers treasure their experiences and even find the intense labor refreshing. Dr. Kukreja, for example, apparently cannot get enough. After more than a dozen expeditions with the organizations Operation Smile, the International Relief Team and Project Vietnam, he created his own such group, called Arpan Global Charities, three years ago.

According to the medical volunteers themselves--sometimes called "medical missionaries"--they are motivated by reasons both altruistic and selfish, but above all they want to help. And in the process, some feel they become better doctors as they experience the essence of the profession.

The impact medical volunteers have upon the public health in foreign lands is surprisingly difficult to quantify, but it's clear that they make a difference in the individual lives of people who might not have anyone else to turn to.

Remembering Others
"I'm from Burma--Myanmar--which is considered one of the poorest countries now, with 50 million people. It's very depressed, very oppressed," says Aisha Simjee, MD. An ophthalmologist based in Orange, Dr. Simjee recently returned from an October medical mission to Colombia with CHOC colleague Dr. Kukreja and his group, Arpan Global Charities. "I left [Myanmar] 37 years ago, and I thought, 'As soon as I stand on my feet and I have enough resources to go out of the country and do it ... I will.' That time arrived in 1991," she explains.

For many doctors who managed to escape deprivation, medical volunteerism offers a way to throw a lifeline to people who weren't so lucky. "I was able to get out of the country; I was able to come to America; I was blessed to go into a field that I wanted to go [into]," Dr. Simjee says. "I have everything I need: a house; a car; three meals a day. I don't need anything more than what I have, so I have to find time to go out and help."

After more than 16 years of medical volunteerism, Dr. Simjee has visited 21 countries, including El Salvador, Ethiopia and Afghanistan, and she has stories to tell about each of them. "There's something memorable about every country I've been to," she says. For example, traveling with Roger Ohanesian, MD, and the Armenian EyeCare Project, Dr. Simjee was stopped in the airport of Yerevan, the capital city, by customs agents who were suspicious of her box of frozen corneas. "They said, 'We'll let you have it in two to three days,'" she recalls. "I said, 'No way--I'm running out of my dry-ice time, and I must take it with me.' They were confused, so they left the box outside the customs [office], and all the officers went in for a meeting to see what to do with me. So I took the box and I left!"

Vien Doan, DO, a family practitioner in Riverside, offers similar motivations. Born and reared in Vietnam, he came to the United States at 16 years old after the end of the war. "I felt very lonely and lost, then I found a direction for my life," Dr. Doan says. "When I began college in 1977, I thought that if I were to go back to Vietnam one day to help take care of the people I left behind, that would also give them the peace that I got when I was here," he says. "I felt that although I didn't deserve it, I got a much better life than the people who I left behind."

So, when an influx of Vietnamese immigrants came to Orange County, he helped found Nhan Hoa Clinic in Garden Grove, and served there until 1994. By 2000, he had put together a team of four volunteers for his first medical mission to Vietnam under his group, the Good Samaritan Medical Ministry. Two teams now go to Vietnam every year, a team of about 70 primary care doctors and a separate team of specialists. Since 2005, his teams have trained local doctors at Hue Medical College in Imperial City in emergency medicine, and now aim to start a residency program.

Answering the Call of Missionary Work
Volunteering helps physicians express the drives that first propelled them to go into medicine. "Medicine always called me to make a difference in people's lives, and to bring an opportunity for health, energy and well-being to people," says Gordon Phillips, MD, a primary care practitioner in Redlands who flies with Liga International in small, private planes to clinics in Tijuana, Mexico, and further south to the area surrounding El Fuerte, a city in the state of Sinaloa. "We often get caught up in a lot of monetary things here in the United States," he says. "To be able to volunteer time and see that it makes a real difference and [that] people are so appreciative of it, it's just very rewarding."

Dr. Phillips first became interested in Liga International as an eighth grader, when he flew on one of its trips to the state of Sonora, Mexico. Roughly four decades later, he took his first trip as a physician. "Seeing people willing to stand outside, sleep outside and just wait to be seen by a doctor--it struck me what a need there was," he says. In the past four years, he has been on about a dozen trips, and he visits two to four times a year. Each weekend, a group of about 70 Liga volunteers flies to the El Fuerte area to see about 1,000 patients. The volunteers include a dozen or more doctors, as well as nurses, translators, dentists, medical students, psychologists and others.

Dr. Kukreja describes his motives for going on medical missions as paradoxically selfish. "We say it's a volunteer mission, but that defeats the definition of volunteerism, because volunteer means when you give something or do something without getting paid or getting a benefit," he says. "But here, there's always a benefit--one no money can buy you. It's for your own satisfaction. That's why it's not volunteerism."

Finding Inspiration and Energy
Medical missions are part of Dr. Kukreja's vacations, and he describes them as hard work, with some shifts as long as 16 hours. But somehow, it's not like just another day at the office. "You feel really rejuvenated after coming home from this kind of mission," he says. "And that's just because you like it, because you love doing these things. It's an immensely rewarding experience, really. It's really fantastic."

"I feel wonderful," proclaims Dr. Simjee when asked whether she finds her work in third-world countries tiring. "Every time I have gone, I have felt that every minute I spent and every cent I spent was worth it--no regrets whatsoever."

Dr. Phillips describes his feelings about medical missions similarly: "Actually, they're very refreshing." While the work is often hard, it's for a good cause that he finds reinvigorating. Also, the volunteers can do adventurous things with their free time, such as visit local restaurants and go on day trips. "[We've] gone to the large bay about halfway down on the Baja Peninsula where the whales all spend the winter and calf," he says. "Sometimes we'll spend an extra two days and go into the Copper Canyon [in Sinaloa] to just relax and enjoy, spend the night and do some hikes."

Focusing on Medicine's Essence
Treating patients in foreign countries not only helps doctors satisfy their interest in serving humanity, it cultivates an appreciation for what they have and changes their perspectives in unexpected ways. Dr. Doan recalls seeing a shoeless elderly woman patient who took the day off from working in the fields to visit him. "I sat in my chair at that time, looking at her, and it could've been the reverse if I had not left the country," he says. "[Patients] literally travel on foot for four hours to come and see me. Knowing that they've been there for such a long time, that they've taken time out to come and see me, my desire is to do everything I can for patients right there."

Dr. Doan's patients in the United States aren't so different, he says. "I've changed my attitude completely. I do not want my patients to wait any longer than necessary in the office. When they come to see me that day, I want to make sure that I take care of them--I give them everything I can."

In Santa Ana, El Salvador, Dr. Simjee treated a group of unusual patients who she later found out were political prisoners. "Local ophthalmologists, for whatever reason, didn't want to operate on them. A number of them were very young people, and with traumatic cataracts," she says. "That motivated me to work even harder, because I wanted to take care of them as much as I could."

For many medical volunteers, practicing in a foreign country is a chance to treat patients without spending a disproportionate amount of time on paperwork or financial and regulatory concerns. The trips afford "not a little freedom--a lot of freedom," Dr. Simjee says. "We do exactly what we must do--the very best we can," she says. "Still, if something goes wrong, which can happen, they're not going to come after you and sue you. But that's not the case in America. I don't have to spend $2,000 to go to Ethiopia. I can go to Southeast Los Angeles and do as much work, but if something goes wrong, I'm liable."

"It's a business in the United States," Dr. Phillips says. "There's always the time constraint--not that we don't get rushed in Mexico, but there's nobody saying, 'You've got to see so many people per hour,'" he says. "You don't have to practice all this defensive medicine that we end up wasting a lot of time and effort on in the United States--not that some of it isn't good, but we have a lot of waste in our system from that kind of thing and from excess testing to cover yourself." The challenges of working in the third world also exercise neglected skills, he says. Without X-ray machines or CT scanners, "you're having to actually listen to the patient and make a diagnosis and treat," Dr. Phillips says.

Fostering Professional Collegiality
The camaraderie that develops among medical professionals during these missions is another big benefit to volunteers, Dr. Phillips says. "One of the neat things about going with Liga is that 70 to 80 people [participate]," he says. "There is a huge variety of unique, talented and gifted people. They are not all doctors; there are psychologists, veterinarians and other people with all kinds of interests. And it's just fun. You get to know them and see how they are really dedicated to making whatever difference they can in the world. I think that's the commonality among all of us."

Some medical volunteers find that they can have the greatest impact by training local doctors and improving their facilities. John Horstmann, MD, a family practitioner in Colton, visits a 10-bed hospital in a poor district of Tijuana once a month, outfitting it with supplies, conducting training and trying to encourage greater collegiality. "When I go down now, I don't see patients," Dr. Horstmann says. "My involvement is in getting material. Redlands Community Hospital has given us a number of things and Beaver Medical Group has given us a defibrillator," he says. "I also help through medical education in the hospital. I'm a wound-care specialist, so I've given some lectures." Such seminars help to break through the difficult atmosphere prevailing in the region and develop a collegial medical culture among local doctors, he says.

Local doctors in host nations can also teach visiting U.S. physicians a few things. "They train us how to do things with limited resources," Dr. Kukreja says. "A few things they do, we cannot even think of doing here--that it is [even] possible--and they're doing it."

It's difficult to measure the impact of professional exchanges among doctors across the globe, because proof of a job well done usually comes in the form of an invitation to a family meal, a smile or a few heartfelt words. Dr. Kukreja concludes: "You get e-mails back from the local physicians and hear how much they appreciate what they learned from you--but no numbers."

WE INVITE Your Comments. Share your feedback on this article. E-mail Chris Womack at chrisw@socalphys.com or call 213/226-0325.

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FEATURE ARTICLE SIDEBAR

Organizations to Help You Help Out
There are plenty of U.S. medical volunteerism organizations that are ready and willing to organize a trip for you. Here are several groups affiliated with doctors interviewed for this article, or that have a local connection.

Arpan Global Charities--Founded by Sudeep Kukreja, MD, organizes two to three trips a year for a total of about 65 volunteers. Leans toward pediatrics, but includes several specialists, especially surgeons and physician educators.
E-mail: sudeepmd@yahoo.com
Phone: 714/585-1920
Web site: www.arpanglobal.org

International Relief Teams--With a focus on disaster relief, organizes an average of 25 to 50 medical volunteers a year, serving more than 40 countries with supplies or personnel. With a recent greater interest in neonatology, IRT also needs ophthalmologists, otolaryngologists, anesthesiologists, primary care physicians, or whichever specialty a particular disaster demands.
E-mail: info@irteams.org
Phone: 619/284-7979
Web site: www.irteams.org

Liga International--Responsible for sending about 650 to 700 medical volunteers to Mexico and the Philippines every year. Needs family practice physicians most, but encourages all types of doctors to volunteer.
E-mail: pat@ligainternational.org
Phone: 909/875-6300
Web site: www.ligainternational.org

Operation Smile--Sends out approximately 4,000 volunteers a year to 25 countries. Focused on cleft lip and cleft palate surgery.
E-mail: credentialing@operationsmile.org
Phone: 888/677-6453
Web site: www.operationsmile.org

Orbis International--Organizes approximately 200 volunteers a year in visits to 15 countries, particularly ophthalmologists, ophthalmic nurses and biomedical engineers. Concentrates on glaucoma, causes of childhood blindness, corneal transplants, cataracts and diabetic retinopathy.
E-mail: sally.whitton@orbis.org
Phone: 305/829-0133
Web site: www.orbis.org

Project Vietnam--Organizes two expeditions a year to Vietnam for a total of about 200 plastic surgeons, pediatricians and physician educators.
E-mail: qkieu@projectvietnam.net
Phone: 714/641-0850
Web site: www.projectvietnam.net

Surgical Eye Expeditions (SEE) International--Sends approximately 500 ophthalmologists to about 26 countries each year. Concentrates on cataract surgeries.
E-mail: seeintl@seeintl.org
Phone: 805/963-3303
Web site: www.seeintl.org