The perception of medicine as a noble pursuit is felt as much by patients as it is by the doctors inspired to serve. For centuries and centuries, doctors, nurses, and all manifestations of these roles through time have been held up as heroes who heal, alleviate, and save.
It’s not surprising that so many medical professionals—particularly younger professionals—identify with this ideal and want to give back to humanity in the grandest and noblest way possible. And when that idealism is not wiped out by medical school and residency (and the work and debt that go into them), professionals who survive those obstacles come out looking for exciting and impactful ways to serve.
You can picture it: a young doctor wakes up at dawn for an early shift. She starts the coffee pot and turns on the news. Another hurricane has hit Puerto Rico and affected other islands in the Caribbean, too. The footage is absolutely devastating. The doctor can’t help but feel moved, and she vows to spend her two weeks of annual vacation on the ground in Puerto Rico, helping any way she can.
Many times, emergency responders aren’t shipped in from far away. Disaster can strike anywhere, and frequently, doctors and nurses who step up for humanitarian aid are doing so in their own country or a neighboring one.
Much of the humanitarian aid seen around the world is comprised of medical professionals volunteering their time. Other efforts include specially-trained emergency physicians (EPs) who are uniquely capacitated to provide care in these crisis situations. That training includes an astute familiarity with working in high-pressure environments and under the thumbs of several problems that are common in humanitarian settings.
That is to say, even with the best intention to help, a medical professional traveling to a new setting to provide humanitarian aid will absolutely come up against these common problems. They’re a reality of crisis situations and a reflection of the state of our world. Being prepared for them starts with awareness, and that’s what this article aims to promote.
Problem #1: Bureaucracy and healthcare systems with organizational gaps
If a country has a healthcare system in place, it will have systemic hurdles due to bureaucracy. Any nurse or doctor traveling to a different country to provide care will have to research what they can beforehand about that system. And after arrival, professionals must learn quickly and ask questions to navigate the regulatory landscape of wherever they are.
The more developed a country’s medical system is, the more likely it is to encounter bureaucracy in the clinic and in related political structures, too. For instance, in many countries with heightened bureaucracy, pharmacy benefit plans come under fire. Before shipping off to another country, the question for any medical professional wanting to help should be: what do I need to know so that I can serve the population I want to aid?
After identifying system particulars and remaining obstacles to the delivery of aid, doctors in these environments then have to tap into the same passion that drove them to help in the first place. This energy is necessary to look for efficient and effective ways to move past barriers and make a positive difference, both in patient care and in paving a pathway to greater access.
Problem #2: Limited time
Let’s come back to our example of the young doctor moved by the devastation of another Caribbean hurricane. The idea that this doctor would only have two weeks she could devote to assistance is hardly an exaggeration. In fact, many medical professionals rushing to help in international emergencies have less than two weeks available to devote to travel and care.
Not only is this counter-productive to nurses and doctors making a bigger impact, but it also means they often deploy with whatever group will take them for a short-term window of time. This ultimately means that the group deploying them might be inefficient or poorly-organized, as it’s burdened with excessive onboarding for the constant influx of new practitioners.
The greatest danger of this phenomenon is what ends up being a large number of under-experienced professionals in a crisis area. Even the most experienced doctors in the world—without specific knowledge and practice in the areas they travel to—will contribute to the problem.
The organizations sending professionals for these shorter windows are often part of the problem, too. Some are under-funded academic medical centers, faith-based groups, or even private organizations with a profit motive. Multiple organizations of this description have caused more harm than good across dozens of recent examples.
Case in point: after the 2010 earthquake in Haiti, a large number of for-profit and faith-based medical groups sent aid, in particular from the United States as a product of its proximity. The majority of these groups, however, had limited understanding of low-income healthcare systems and of working within the framework of international humanitarian aid in general.
A forum for aid development called the Inter-Agency Standing Committee wrote a report after the period immediately following the earthquake speaking to this. Their paper identified the negative impact of what they called “impulsive intervention,” with findings suggesting that many of these groups did not have even basic understandings of the role and requirements of U.N.-based coordination mechanisms for effective humanitarian responses. This lack of training meant overlapping and competing efforts across groups that lead to wasted resources all the way to examples of absolute chaos.
Problem #3: The state of humanitarian principles
Public Radio International also spoke to the problems that came about from aid groups and individual practitioners who gathered in Haiti after the 2010 earthquake without adequate training. With little-to-no previous humanitarian experience previously, and in some cases a lack of any backing from formal organizations, what could have been invaluable human resources were instead wasted. The radio story spoke of surgeons who arrived without bringing anesthesia or even verifying if it was available in Haiti, or in what quantities. Many people underwent amputations and other surgeries without any anesthesia at all. Other surgeons found anesthesia or other medications only to later realize they had expired, or no longer worked due to improper storage. Small and under-prepared humanitarian groups did not coordinate with the U.N. mechanisms in place and had poorly-executed supply chains and methods, too.
Worst of all, when these groups left, there were thousands of patients left without adequate post-operation follow up. The already-devastated local health system was left overwhelmed.
It’s been many years, now, that humanitarian principles have been under fire. The protests have come from all sides. The public and private sectors have both heard these horror stories and have opponents speaking out. Experienced emergency providers have published reports, given interviews, and offered solutions. And yet the problem persists.
Today, governments and the U.N. are often cited recommending a co-opted humanitarian response that can be woven into other political objectives. The U.S., for example, sees humanitarian responses as part of their larger “war on terror.” And the U.N. has begun integrating humanitarian responses into peacekeeping efforts and other political negotiations.
The most vocal critics against the status quo of humanitarian aid, on the other hand, point to the current system’s failures as well as how these small, profit or religiously-based organizations have made matters worse. They even go so far as to say that this uncoordinated aid has prolonged conflicts and crises.
And yet, for the trained humanitarian providers on the ground, the questions have become:
- How can security be balanced with neutrality?
- And how far should humanitarian workers go to negotiate with non-state actors?
Many of these same providers argue that “pragmatic humanitarian aid” is too challenging today, and that any ideals beyond the simple provision of care to those in need must be secondary.
Problem #4: Depression and frustration among providers
Perhaps depression seems like a personal problem, but it can also be systemic and affect the performance of individual doctors and nurses—ultimately affecting the benefits of the care these professionals are able to provide.
Many medical careers tend to pay well, which is a driving force for at least some practitioners. And certainly, in popular culture it’s considered a “perk” the public is well aware of. This is not, however, the driving motivation for most medical professionals.
Working as a doctor or nurse does come with many personal benefits outside of money, including authority and respect. The white lab coat, after all, is a revered uniform. These perks do not, however, distract from the fact that medicine is a stressful and challenging industry. In fact, physicians have a higher average suicide rate than other professions. In the U.S., the suicide rate for female doctors is 2.3 times higher than the national average and for male doctors is 1.4 times higher than the average. On a global level, doctors also tend to have higher rates of alcoholism and drug abuse.
On top of the stress factors that exist inherently when practicing medicine, working in a humanitarian crisis is even more stressful. These professionals are accustomed to working 80 hours or more on a weekly basis with remarkably little time spent with patients, as most time today is devoted to compliance and technology training (not to mention the economic side of their practices). But then, when arriving to an area in crisis, humanitarian efforts suddenly require even more time from doctors and nurses, leading to fast burnout and frustration on top of the other hurdles discussed above.
The essential thing to remember for providers aiming to help
This article isn’t intended to discourage qualified candidates from providing humanitarian aid where it’s needed. In fact, this article is meant to champion those professionals who don the white lab coat with the intention to contribute in this way. These situations where humanitarian aid is needed, however, are inherently dangerous, frustrating, and lacking in organization. The doctors and nurses who travel to places in need, thus, simply need to be prepared.
The world will continue to need doctors and nurses invested in the greater good. The need for humanitarian aid is staggering, and professionals who do their part are praiseworthy. They key is to manage expectations by all the people and organizations participating so that these medical professionals can live up to the ideals that drove them to serve in the first place.
For one, organizations and individual doctors and nurses need to be prepared for a crisis setting. This includes not only being well-versed in traditional infectious diseases but also with displaced populations, sexual violence and reproductive health, non-communicable disease management, and the healthcare structure of the place they’re traveling to.
In addition, thoughts before traveling should always be around supplies. Surgeons need to consider anesthesia, practitioners of all specialties need to consider equipment and pharmaceuticals for their practice, and all professionals need to remember protective equipment and basic materials. Many of the doctors on the ground might not even have the protective labwear to keep them safe and to help identify doctors in a crisis situation with thousands of new faces.
Ultimately, with the right training and supplies, these medical professionals can make an incredible impact.
For those interested in educating themselves as an emergency practitioner, the scope of this specialization requires dedicated training. There are well-established humanitarian organizations that offer this training to nurses and doctors willing to travel for a cause, and this training is often indicative that the organization is better-organized and compliant with U.N. humanitarian channels. Humanitarian studies courses can range from a few weeks to a two-year masters’ degree depending on the intention of the professional.
What is the last humanitarian effort that stood out to you? How did you want to help? What are you prepared to do in the case something happened where you live? Start the conversation with us today. And where you see an opportunity where Dr. James can make our own contribution in the form of professional lab coats, be sure to reach out directly to our team.