Emily Berry, MD, assistant professor of obstetrics and gynecology and gynecologic oncologist at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University in Chicago, recalls her most memorable experience during a brief trip to Honduras last year: She supervised 2 of the youngest residents of a local hospital as they performed a hysterectomy on a woman with uterine cancer. “They were so eager to learn,” she said. “It was fun to teach the basics of a procedure that I do all the time and to see them enjoying a bit of independence.”

In 2010, the American Society of Clinical Oncology (ASCO) teamed up with Health Volunteers Overseas (HVO) to facilitate oncologists’ visits to low-resource countries overseas. Known as the International Cancer Corps (ICC), this partnership matches ASCO members who are interested in volunteering with opportunities in Honduras and Vietnam.

In existence for more than 25 years, HVO is a humanitarian organization whose primary focus is the education of medical practitioners in the various international sites that it serves.1 Melanie Thomas, MD, program director of the HVO-ASCO Honduras program; medical oncologist, hematologist, assistant professor, and associate clinical director of the Hollings Cancer Center; and Grace E. DeWolff professor of medical oncology at the Medical University of South Carolina in Charleston, quoted the Chinese proverb to underscore its mission: “Give a man a fishand you feed him for a day. Teach a man to fish and you feed him for a lifetime.”

In the Honduras program, oncologists working in various specialties have completed more than 39 assignments. “Honduras has fewer than 20 trained oncologists in the whole country, which has a population of 8 million people,” said Dr. Thomas. 

The goal of the program is to teach and train staff, residents, and students in areas such as pathology, cancer control, and radiation through hospital rounds, treating patients, giving lectures and assisting in curriculum development. Oncologists can volunteer in 1 of 3 hospitals based in the capital city of Tegucigalpa, Honduras. The typical length of stay for volunteers is between 1 and 4 weeks, but due to schedule restrictions, most oncologists can only commit to a 1-week visit.

With such a short visit, it is hard to imagine how volunteers can make a real impact, but because the focus of HVO’s program is not so much on treating the patient as training the caregiver, a lot can be achieved with careful preparation.

“We had more impact on the residents than on any patient that we would have met,” said Dr. Berry, who participated as a member of the Society of Gynecologic Oncology, which also sponsors HVO programs.

 “We believe not only in the treatment [of patients] but in the education [of medical staff]. We teach them so they can take care of more patients,” said Linus Chuang, MD, associate professor of obstetrics and gynecology, and director of gynecologic oncology at Mount Sinai Hospital in New York City. Involved in the ICC program from the beginning, Dr. Chuang volunteered twice in Honduras in 2010 and made his first trip to Vietnam this past February.

“HVO understands how to evaluate a program,” he said. “Everything is set up already at the [host site], so when you get there you are able to start from day 1.”

Trips to Honduras occur every other month and teams, rather than individuals, are usually sent, which opens the door for oncology fellows to work with more experienced professionals.

“Fellows have participated and gained incredibly valuable insights into cancer care realities and challenges in different parts of the world,” wrote Doug Pyle, senior director of the International Affairs Department of ASCO. “They will likely take with them a unique perspective throughout their careers: How is care provided in a resource-constrained environment, what are the key challenges in such an environment and how can those challenges be addressed?” he added. 

Although there is an immense need for training in gynecologic oncology, all disciplines are encouraged to participate. Dr. Thomas recently spent 10 days in Honduras to review the effectiveness of the program and found that the local practitioners were interested in addressing palliative care issues. Volunteers also must have a desire to teach and a particular area of strength so they can create lectures. To maximize the short amount of time spent on location, extensive preparation is key and picking a sharp area of focus is also helpful: “I might have tried to speak more with the hosts before I came to Honduras,” said Dr. Berry, reflecting on her visit, “so I could identify a particular topic or skillset to focus on while teaching there.”

Regardless of which area of oncology is addressed, what’s most important is that volunteers build on the knowledge of local practitioners rather than impose their own methods.2 “The best thing about [the program] is that residents are eager to learn—they’re sponges for knowledge. They have good clinical judgment, they’re dedicated to taking care of their patients and they’re dedicated to their country,” said Dr. Thomas. “To have a good experience, you really have to have an open mind and not think, ‘Oh, this isn’t how we do it in the States,’” Dr. Thomas added.

Volunteers also should be aware that, in order to learn from their teachers, the hosts must give up valuable professional (and personal) time in an environment where resources are already scarce. “A 1-week [stay] is fine because hosts have to offer so much of their time to take us around the hospital,” Dr. Berry said.

Considering that fellows’ schedules are tight to begin with, making the decision to volunteer is a huge commitment of personal time and money, but Dr. Chuang considers it a worthwhile endeavor: “[Fellows will] learn not only to take care of patients but how to volunteer early on in their career. They’ll see things there that they won’t see back in North America. It’s a positive learning experience.”

Applications for 2013 are currently being accepted for ASCO International Cancer Corps and Health Volunteers Overseas

 

References

  1. Healthy Volunteers Overseas. www.hvousa.org. Accessed September 13, 2012. 
  2. Questioning the ‘Global Health Doctor’ Model. http://www.juniordoctorjournal.com/issue-2-global-health/questioning-global-health-doctor-modelAccessed September 13, 2012.