reasons for participation
Participants have cited many ways in which their experiences in OH have been invaluable. Many have found their lives changed in the process.
Most indicate that they valued the humanitarian aspect of providing surgery to patients that would not otherwise receive a high standard of care – most of which would not receive any care at all. The health workforce is depleting in low-resource countries, with only 1-10 doctors per 100,000 people, and a poor national budgets for medical training. Many patients have hernias over fifteen years old that extend to their knees, and operations can be life saving. Many are manual labourers that live in very impoverished conditions.
Surgeons may be challenged by operating on long-standing hernias that regularly grow to more than 20 cm, after becoming accustomed to routine repairs on hernias at home that rarely exceed 2-5 cm. Sections of mosquito net mesh are used instead of manufactured varieties, and surgeons find the opportunity to perform low-technology operating room techniques that sometimes transfer to practice in their home countries in emergencies.
The first surgical teams to arrive in Ghana through Operation Hernia were greeted at a formal reception by the British High Commissioner and intense media exposure. Reducing the global burden of surgical disease is cited as one of the key objectives of the Disease Control Priorities in Developing Countries Project of the World Health Organisation and the World Bank. Initial evidence suggests that hernia repair compares very favourably to other medical interventions in terms of cost-effectiveness and other political decision making criteria.
The programme provides career development opportunities for trainees to learn new skills that have practical application to important scenarios in the operating room and workplace back home. The ability to operate in intense unfamiliar conditions, while respecting cultural boundaries and consulting with patients through a translator is both a difficult and rewarding experience. The value of training in these environments is well recognized. The American College of Surgeons created a Surgical Volunteerism award in 2003 for outstanding leaders in the emerging field, and has documented a growing area of research on its Operation Giving Back website: www.operationgivingback.facs.org
Previous teams have commented on the friendly and hard working staff and true appreciation of the patients that they treat. One surgeon reported that never in his life have so many people prayed for him for so many days. Most teams consider the experience a tremendous privilege and return home with an inevitable sense of loss, wanting to return for an additional mission.
Surgeons value the international experience and students value participation in a programme as part of their undergraduate education. Medical students, residents and physicians not only share the same enthusiasm for experiential learning in a new place, some actively look for ways of remaining a part of the programme long after their experience is over. The West African environment is ideal for learning and not having too many distractions around makes for an excellent atmosphere to concentrate. In addition the experience often allows students opportunities they may not otherwise have to develop their skills under the supervision of consultant surgeons - reviewing the procedures and asking questions after each operation. Initial surveys of resident interest conducted by the American College of Surgeons indicates that residents are highly motivated to acquire international experience and plan to volunteer in the future.