For as long as I can remember, I have been fascinated by the world at large. Even as a young child, I felt compelled to learn as much as possible about other cultures. Dreams of “seeing the world” have long filled my mind, and not surprisingly, this love of adventure collided head-on with my love of science somewhere around 1995, when I sat, enamored, viewing the film “Outbreak.” From that moment on, I dreamed of pursuing a career in medicine and hopefully working with hemorrhagic fever viruses in Africa. As they do, my dreams evolved throughout medical school, where I ultimately switched from an interest in pediatric infectious diseases into general surgery. I pursued my residency with plans to focus on pediatric surgery, guided once again serendipitously by multiple encounters with surgeons who spent a large portion of their careers living and operating across Africa. Recognizing that a career in surgery could be compatible with global health, and that these two together provided a unique opportunity for true adventure, I ultimately spent a month of my general surgery residency living in Kenya and working alongside local surgeons-in-training at Tenwek Hospital. This incredible experience laid the foundation for my current career in academic global surgery, and remains the part of my job that “gives” as much as it “takes.”

I’ve spent a reasonable amount of time over the last few years researching surgical care in resource-poor settings and I developed an interest in wellness research before it was a particularly mainstream topic. In early February 2020, long before we knew what tragedy awaited the world with the impending COVID pandemic, I spoke at a medical mission conference about wellness, burnout, and compassion fatigue, and how work in global surgery can, at times, be either the cause or the cure of these issues. Burnout, compassion fatigue, and as we’ve since learned, sustained emotional trauma from health care catastrophes, are pervasive in health care. The cumulative damage caused by the daily stresses of our jobs is severe. We bear witness to all manner of suffering in our patients, and sometimes in our colleagues, and must somehow muster strength to carry on and “get the work done.” As we’ve learned in the last few years, any one of us can only take so much chronic accumulation of stress before we begin to break. Thinking of how routinely exhausting (physically, mentally, and emotionally) our work can be, many people have asked me how and why I choose to spend some of my much-needed time away performing surgeries in low-resource settings and how this could possibly be “refreshing.”

Wellness speakers often espouse the benefits of things such as exercise, rest, mindfulness, time away, and other explicitly non-work-related efforts to mitigate things such as burnout. For me, I have found a huge component of my wellness within the work I am fortunate to do. No doubt that our day-to-day grind of healthcare here in the US can be frustrating at best, and is often demoralizing and full of inequity. In an endless cycle of mouse-clicks of the electronic medical record and bureaucracy of insurance and administration, I have found that one key to wellness and fulfillment for me lies in the “helping.” Rendering aid to those in need was the core “WHY” of my desire to become a physician, and as many leadership experts have noted, the “how” we do a job we love may change dramatically but the “why” absolutely must remain central to our focus. The “why” equates with purpose.

My global surgery endeavors often find me in rural Western Kenya, working with Kenya Relief and a team of 15–20 other medical professionals, many from the US but increasingly more local Kenyan providers. Over the course of 4 clinical days, we complete a 1-day ambulatory preoperative clinic examining up to one hundred potential surgical patients, and then operating for 3 subsequent days on those identified as the most in-need and appropriate for surgery in this setting. My expertise is in thyroid surgery, and many of the patients we see have extreme examples of large, symptomatic goiters. Our surgical days often see each surgeon operating on 5–7 patients daily, with rapid turnover and long hours. Surgeons on our teams work with limited supplies and conserve resources meticulously, all the while ensuring top quality care and outcomes are provided to patients. Over 4 billion people in the world lack access to even the most basic surgical care and working to change this disparity is the most fulfilling part of my surgical career.

The days are long, but with each patient we operate on in this clinic, I am reminded of the reward of a job well done, and the internal fulfillment of challenging myself to find solutions to seemingly insurmountable challenges. There are heartbreaks, of course, as we often see disease states far beyond what can be cured or even treated and can feel helpless in the face of so much need. I am often reminded of one of my favorite quotes, from the Talmud, stating “Do not be daunted by the enormity of the world’s grief. Do justly now, love mercy now, walk humbly now. You are not obligated to complete the work, but neither are you free to abandon it.”

In addition, I have been privileged to share this experience with friends and trainees alike and have made many new connections along the way. The teams I have joined for these efforts have included many old friends, and I’ve never served on a team that didn’t result in multiple new friends, united in purpose and working through adversity for the common good. Each individual patient I meet, each new colleague I work with, and each surgery performed provide personal connections that fill my spirit and keep me going….there and back again.

Working in Harmony

  • Heather Gibson 

Ever since I was a young child, I have always wanted to pursue a career within the realm of science. I first dreamt of a career as a marine biologist, having a fascination with marine life. This developed into wanting to heal people, leading me into a career as a physician assistant. I was always interested in traveling and having new life experiences and wondered how I could use my skill set and knowledge to help on a global scale.

In my first few years of work, I was able to meet numerous health professionals that did global work and was finally convinced to travel to rural Western Kenya with an organization called Kenya Relief. At first it was overwhelming, and I was unsure of how I could actually make a difference with the insurmountable number of people that needed medical attention. Some cases were heartbreaking in that what they needed was far beyond the capability of the clinic in which we worked, but there were plenty of other patients that benefited greatly from the care provided by the team. With limited resources, it was a challenge to address all patients needs while conserving resources with the team. Even though the days were long and the number of patients needed to be seen never seemed to decrease, it still “filled up my cup” and provided me with a recharge that was needed for the daily grind back home. There were no multiple clicks, long documentation processes, and needing insurance pre-approval to get the job done, just people obtaining the care they needed, and a team of both local providers and visiting team members working in harmony to fully serve the patient.

A Promise…

  • Mohammad J. Deen 

It was a promise to a total stranger made roughly 12 years ago. A promise to give back to those who have lost everything. A promise to help those who have nothing. This is my response when I am asked “Why do you do what you do?”. Roughly fifteen surgical/medical missions later, I still feel like I have yet to fulfill this promise. I truly can’t recall the number of missions to be exact, just the stories. I don’t recall the diseases, just the people. I struggled for some time post-mission because every place I go, I leave a piece of my soul there, and I always come back feeling a bit empty. I end up wanting to find this piece somewhere else, which is what leads me to my next destination, only to leave another piece wherever I end up.

Having done three missions in the harsh waters of the Mediterranean Sea as a medic on a rescue boat, I have encountered people who have fled a fast death via war, to potentially experiencing a slow death via the sea. You learn to appreciate life, and often, you learn to not take anything for granted. I have learned to live life through what I have seen. Through their eyes. To appreciate the small things. The smile. The hug. The greeting. The laugh. You learn to appreciate this over anything else because you realize these emotions are valuable and often these days, not felt so often. I witnessed these people show me these emotions despite everything they have been through, and this has really changed my mentality on life and how I go about my day. They have taught me much about life while they struggled to live, and for that, I am forever thankful. They left a piece of their soul within me, and I no longer feel as empty as I once felt.