I am writing this blog in the back of a small bush plane leaving the Democratic Republic of Congo on my way to Uganda. I was visiting CHSC missionaries Dr. Warren and Dr. Lindsey Cooper serving at Nyankunde Evangelical Medical Center. Warren is a general surgeon and Lindsey is a pediatrician. I am amazed at the work the Lord is doing through them.
In this post, I wanted to talk about something Warren reminded me of, that being a missionary surgeon may be rewarding, but it is also a difficult, complex job. As a former surgical ICU nurse and now missions mobilizer, I cannot speak from direct experience as a surgeon, but I can share from the perspective of a medical person who places surgeons in bush hospitals. Essentially, a general surgeon in Africa means doing all of the surgical subspecialties that would never be done by a general surgeon in the US. I saw Warren take care of so many subspecialty surgeries that I was a bit amazed. In my time at Nyankunde, he had to be a neurosurgeon, oral/maxillofacial surgeon, plastic surgeon, pediatric surgeon, neonatal surgeon, and orthopedic surgeon.
This wide variety of surgery is why I am a little concerned when a general surgeon in the United States approaches CHSC wanting to serve as a missionary surgeon “to teach surgery in Africa.” There seems to be a growing passion for educating and discipling national healthcare professionals to serve the rural areas of their own country. We love this concept, and it has become central to the identity of CHSC; most CHSC missionary physicians are involved with clinical education in one form or another. But jumping from being a US-trained general surgeon to an African bush surgeon is an arduous process. US-trained surgeons do have a lot to offer in terms of both practicing medicine and teaching local practitioners in Africa and other places in the developing world. When starting out, however, few surgeons trained in the US are up to the challenge of navigating the complexities of medical treatment in the resource-poor environment of the developing world. For most surgeons, the first term of missionary service will likely be at least as much about learning as about teaching. Any Western-trained surgeon practicing in the developing world can attest that this is a difficult transition with a huge learning curve.
My friend and missionary surgeon, Dr. Jefferson McKenney, who founded Loma De Luz Hospital in Honduras, gives a talk on what it looks like to be “The Surgeon Alone” that addresses these issues. He will be doing this presentation at the May 2018 Medical Missions 101 Gathering in Dallas-Fort Worth.
I noted during my time of following Warren in the Congo that most of his work as a general surgeon is orthopedic work, pinning and nailing long bones and placing external fixators, often using systems and methods specifically designed for work in the developing world. The huge numbers of motorcycle and car accidents in these regions make orthopedics a much-needed skill set for a general surgeon in this context. There is rarely an orthopedic specialist available. This is one example of the contrast between the work of Western and non-Western general surgeons.
I also noted that being a bush surgeon requires a willingness and ability to be very creative, adapting instruments and tools in ways many would not think possible. In my time following Warren and other CHSC surgeons, I have seen some very creative adaptations. Recently in Ethiopia I saw an amniotic sack from an obstetrical patient used to cover the wounds of a patient with burns over 50% of the surface area of her body. I have seen homemade electrocautery devices, welding and metal work used to create needed plates, and pins and rods for surgical procedures. I have also seen pieces of bone taken from one place in the body used to create implants for other parts of the body instead of plates that could easily be purchased in the US. I have also seen the development of off-label uses for most medical equipment and devices.
We tell new missionaries their first three-year term is about learning: learning culture, learning language, learning how to minister and witness cross-culturally, learning how to practice in a resource-poor setting, learning how to work as part of a team, and learning how to lead an intercultural/interprofessional team. Often surgeons must also learn how to do procedures they have never done before. We strongly recommend that family practice physicians learn how to do C-sections if they were not trained previously.
So how does a Western medical professional figure all this out? There are two ways to learn new skills: trial and error (which is never the best option when people’s lives are at stake) or by being mentored by an experienced missionary.
If you are a surgeon planning to go to the mission field, find at least one person who can guide you through the first few years on the field, and remember your first three years are about learning. Try not to be the lone surgeon starting out, but work alongside an experienced missionary surgeon to gain experience in needed procedures. If you are working as a lone expat surgeon, make sure you have a network of experienced missionary surgeons with whom you can consult, even if by email or skype. We recommend all new medical missionaries find a mentor (or several mentors) who can help them through this learning process. I use the plural “mentors” because having multiple mentors can be very effective (for example, one clinical mentor and one for cross-cultural ministry). This may be someone on your new mission station, or it may be someone at another station with whom you connect remotely. In either event, finding someone to share struggles and concerns, in both the cross-cultural transition for your family and clinical practice, is essential. It is essential for mental and emotional health as well as speeding up the learning process for practicing in the resource-poor setting. Meetings with your mentor need to be consistent, so make sure to schedule them, or you will likely not follow through in the busy context of life in the developing world hospital.
If you are praying about serving as a missionary surgeon, remember few healthcare positions can have a greater impact on people physically or spiritually. The brutal reality is that 93% of sub-Saharan Africa has no access to safe surgical services. This is true in much of the developing world with more than 5 billion people globally lacking access to safe surgical services. If you feel called, do not shy away from the challenge. God will make a way. He will bring the people to guide and mentor you as well as the organization to send, support, and care for you and your family on the field.