Julie Choueiki, a nurse, remembers going on a medical aid trip with Colorectal Team Overseas (CTO) to Greece. While there, the mother of a young boy with a complicated anorectal malformation in need of surgery came in for a consultation. She didn’t speak English and decided she wasn’t ready to have the surgical team operate on her child when she didn’t know anyone on it.

The Founder and President of CTO, Marc Levitt, MD, a surgeon and expert in the surgical care and treatment of anorectal disorders, was there.

“And I remember Marc saying, ‘that’s your decision to make, but I’m here now, so if you want the surgery, I don’t know when I’ll be back in this country,’” Choueiki recalled him telling the mother.

The next day, the mother changed her mind and returned to the clinic telling the CTO team that she wanted her son to have the surgery after all. But CTO no longer had space in their operating room schedule. The group petitioned the private hospital across the street where they were heading the next day to do the case for free. The hospital agreed, but upon admission, the child tested positive for COVID and could not get the surgery.

“…I remember leaving that country thinking ‘I wonder if we’ll ever get the kid fixed because we’re not going to be doing it now,’” said Choueiki, who is the senior program manager at CTO. That case occurred over 3 years ago, and she still keeps his picture on her desk.

“…I’m still waiting for him to come,” she said referring to Children’s National Hospital in Washington, DC, where Choueiki and Levitt both work, she as the senior program manager in the Division of Colorectal & Pelvic Reconstruction and he as the chief of that division.

“…Those are the cases that break your heart when we can’t take care of everyone there,” she said.

CTO is a medical aid group that travels the world providing corrective surgeries for pediatric patients with specialized colorectal needs including anorectal malformations, Hirschsprung disease — a large intestine condition that causes difficulty passing stool — and other conditions of the pelvis. The group also teaches surgeons and nurses the best practices for treating patients with these conditions.

There are plenty of opportunities for interested clinicians to go on medical aid trips either with CTO or another groups such as Operation Smile, International Medical Relief, or one of the many houses of worship that organize these types of trips.

Healthcare providers who go on such a trip may learn new skills that they would likely not need in the US, such as how to sanitize and reuse medical equipment. And they are likely to see things they wouldn’t see in the US.

If you are considering taking a medical aid or mission trip, there are factors to keep in mind such as where in the world you are willing to go, how best to prepare for the trip, and what to consider when you return.

Work Hard and Adapt

If you are interested in going on a medical mission trip, expect long days and possibly more patients to show up than planned.

CTO does a lot of work planning patient care ahead of time, Choueiki said, including creating charts for children and organizing Zoom meetings with healthcare providers to best plan and prepare for patients’ surgeries and care. Clinical volunteers on a CTO mission trip will generally work 15-hour days 4 days in a row, Choueiki said. And even then, “we’re always surprised because there’s usually 5-10 kids that we never planned on or even knew about,” she said.

There are all kinds of things you can’t predict, she added, and as a volunteer you must be ready to adapt. For example, Choueiki, who previously worked as an emergency room nurse, is now learning how to be a scrub nurse because that is what the team needs at the moment, she said.

A typical day on a CTO trip starts around 7 AM with the team starting to review patient charts, pathology slides, and radiological studies, Choueiki said. Then the team meets with each patient’s family to outline how the surgery will work on their child and the aftercare needed. Then, after a long day of surgeries and postsurgical assessments, there is usually a quick team dinner.

There’s also a lot of learning when you’re talking at night such as discussing what the team could have done differently in a certain case or what they might try next time. “…It’s good because you do bond with these people,” Choueiki said of her teammates on each trip.

A big part of CTO’s mission is teaching other providers in host countries. Sometimes other surgeons in the host country hospital can Zoom in and watch the surgeries and the CTO surgeons make a point to teach them, she said.

A variety of different types of healthcare providers go on CTO trips, Choueiki said, including surgeons, nurses, nurse practitioners, anesthesiologists, and nurse anesthetists. CTO also allows clinicians from different specialties and those outside of medicine altogether to come along as volunteers.

Clinicians who go on a medical mission trip need to be prepared to jump in and help in an area outside of their specialty area, Choueiki said. “So I think make sure you’re comfortable being a learner so that if you’re not doing something that’s normally in your wheelhouse, you’re comfortable being a novice and learning and asking for help and studying and preparing yourself.”

You also need to be prepared to work hard.

“…Understand, it’s not going to be like the US…you’re going to go as long as you need to go to see the patients you need to see,” she said.

And with that mindset come rewards.

“It’s the most aligned work effort I have ever experienced,” Levitt said. “Meaning everyone is on the same page.”

Yet the emotional toll of doing this type of work should not be underestimated, Choueiki said. Some trips are harder than others.

“It just guts you,” she said. “You’re just like ‘Oh my gosh, we have no idea how good we have it.”

Make Friends

“It is important to establish a working relationship — and friendships with — the people on your team,” Michael Grady, DO, a volunteer doctor with International Medical Corps — a global first responder that provides emergency medical and related services to those affected by disaster, conflict, and disease — said in an email.

International Medical Corps is different than CTO in that it provides care amid man-made or natural crises. Grady, for example, worked for 5 weeks in Gaza where he helped manage the emergency department at an International Medical Corps field hospital. He has also served as an emergency responder during the wildfires in Los Angeles and flooding in central Texas.

“We look out for each other on these trips,” he said of his colleagues. “That means we keep an eye on each other’s physical and emotional well-being.”

Whether you decide to go on a short medical aid trip like those offered by CTO or a longer trip like Grady’s experiences, try to keep in touch with the other clinicians on your trip once you get back, said Jill John-Kall, MD, senior advisor for International Medical Corps.

“…Every once in a while, you just might want to talk about something that happened,” after you return home, she said. “And it’s really maybe not relatable for everyone in your household.”

However, before you sign up to go on one of these trips, make sure that you are comfortable with the travel logistics, Choueiki said. For example, CTO covers the cost of hotel rooms if participants share a room (if they want a single room, they must pay for it). Some people aren’t comfortable sharing a room or are used to turning in receipts for reimbursement, she said. You are serving others on this trip and expenses are kept to a minimum to maximize funding for CTO and its mission to help children, Choueiki said.

Next, make sure you are familiar with and willing to take any vaccines or medicines needed for the specific country you are going to, such as the Yellow Fever vaccine if needed, experts say. And do your research about which diseases are endemic in the given country too, John-Kall said, in case you are treating a patient with malaria, for example, and you are not familiar with it.

“My advice to a clinician who has never gone on a medical aid trip would be to start small,” Grady said in an email. “Your first trip should not be to be to a war zone. These types of trips can be challenging on both a physical and emotional level and they are not for everyone.”

The worst parts of these kinds of trips are watching children get needlessly hurt in a war zone. The best is to see medical staff from less “well developed countries begin assimilating what we have taught, and to take on leadership roles as a result of our interactions with them…” he wrote.

John-Kall advises clinicians who are interested in either a short medical mission trip or a longer volunteer experience to really think about their motives. “You shouldn’t go if you want to be a tourist…” she said.

“…The people that you’re going to see there, they are enduring some kind of suffering, just like people at home. And they really deserve to be treated with dignity,” John-Kall added.

Lastly don’t underestimate what you might get out of it.

“You will have to go out there with some level of humility and empathy…and when you come back, you might learn that you’re, you know, I don’t know a better person than you were before you left,” John-Kall said.

Once You’re Home

Depending on the type of medical aid trip that you take — whether you’re going to perform surgeries and train other healthcare providers or whether you’re going into a conflict zone for an extended period of time — there might be an adjustment period when you return home.

The first medical aid trip John-Kall took was to Uganda and she was there for about 7 months. When she came back home, she didn’t “get” what her own friends were talking about because it didn’t seem relevant anymore, she said. She felt out of place because her experience in Uganda had been depressing, and she wasn’t comfortable sharing it with others.

Unless a therapist is specifically trained in posttraumatic stress disorder, military experience, or something similar they might have no idea what you are talking about if you seek help from them, John-Kall added.

“When I spoke to therapists, like they really had no idea what I was going through,” John-Kall said.

That’s a good reason to keep the lines of communication open with other people from your medical aid trip, she said.

“I don’t think a lot of people in the US know what it’s like to see Ebola patients die, right? So just because of that, it’s good to keep in touch with other people who have some familiarity with what you’ve been through personally,” John-Kall said.