# Missionary Medicine



## FriarEMT (May 5, 2012)

I am Franciscan friar studying for my WEMT.  I was recently in Kolkata, India, and did some work with the Missionaries of Charity (Mother Teresa's religious order).  In a place with so much need and so few resources, both material and human, somebody with basic medical training can be a big help.  This is basically my reason for trying to achieve WEMT and hopefully WAEMT.

Does anybody have any advice as to what skills to learn over and above W(A)EMT that would be beneficial in an austere environment.  I have been collecting books on the topic and have started with Wilderness Medicine: Beyond First Aid and Ditch Medicine.

What sort of resources are available to a person who is not intellectually disposed for medical school and has taken a vow of poverty?


----------



## Steam Engine (May 5, 2012)

FriarEMT said:


> I am Franciscan friar studying for my WEMT.  I was recently in Kolkata, India, and did some work with the Missionaries of Charity (Mother Teresa's religious order).  In a place with so much need and so few resources, both material and human, somebody with basic medical training can be a big help.  This is basically my reason for trying to achieve WEMT and hopefully WAEMT.
> 
> Does anybody have any advice as to what skills to learn over and above W(A)EMT that would be beneficial in an austere environment.  I have been collecting books on the topic and have started with Wilderness Medicine: Beyond First Aid and Ditch Medicine.
> 
> What sort of resources are available to a person who is not intellectually disposed for medical school and has taken a vow of poverty?



Having always been on the pre-hospital side of things, I'm basing my answer more on conjecture rather than experience, so bear that in mind. However, I would imagine that most of the work you have done, and will do in the future is less about emergency medicine, and more along the lines of long-term care.

Courses in sanitation, hygiene, infection control, and microbiology would likely be helpful. A CNA-type course may also be beneficial, and will give you some basics on long-term care such bathing, feeding, wound-care, and the like. These courses can often be had relatively cheaply, and can be found at vocational schools, community colleges, and private training institutions.

Take a look for volunteer EMS services or Fire Departments in your area as well once you have your EMT certification...it will help you to further develop your skills, and keep them sharp.

I've always had an interest in the type of work you've described...would you mind saying a bit more about your experience?


----------



## FriarEMT (May 5, 2012)

Sure, I can explain a little more of what I did.  But I can only go so far because for me it was an intensely spiritual experience and.. not to sound weird or anything.. I think it would mar the experience if I described everything that I did.

Basically I worked in Kolkata (Calcutta is how they used to spell it) at one of the MoC's missions called Prem Dan for five days.  It was one of Mother Teresa's favorite places to work.  There are people there who have been abandoned by their families and left to die on the streets.  Many have deformities of some sort: broken bones that had set badly, open sores, amputations, mental retardation, and other problems that I had never seen or heard about.  One guy has a massive head, another had two LARGE growths in his neck (visualize massive bull or horse testicles), stuff the average westerner doesn't see.  These men were well fed by the Missionaries of Charity but they had gone without food for much of their lives and it was very evident.  There are no pot-bellies there (I felt very self-conscious).  There was a clinic in the same building that had a volunteer nurse from Australia.  She had gone there over 10 years ago for a short visit and decided to stay there.  She does things there that doctors do here and everybody loves her for it.  The city hospitals don't take patients like that because.. well I'm not exactly sure why, but I know it has something to do with the people being "hopeless" cases.

First we did laundry for the residents, then spent time shaving them if they wanted a shave, putting lotion on them, massage (their bodies are racked with pain), spent time with them even though we didn't have a common language.  Many times just smiling at them and listening to them go on about something or other in Bengali.  We brought them tea and a snack and then lunch which was prepared for them by the sisters which, if was to be bought at an Indian restaurant here would be a gourmet meal.

My day with them ended after lunch because of the heat, bad air quality and jetlag, it was all I could do.  But leaving on the last day was one of the most heart-wrenching experiences of my life and I want to go back and do more for them.


----------



## triemal04 (May 5, 2012)

It sounds like you need less of a background in EMS and more in public health/preventative medicine/rehab.  At the very least something more akin to being a CNA or a nurse than an EMT.  Maybe try contacting the Red Cross; they probably don't have an actual course, but maybe you could reach someone who could lead you in the right direction.  For what it sounds like you'd be doing, maybe try and see if you could get into a local hospital/rehab center and shadow someone there who is dealing with people on a long-term basis.  That would at least let you get a look at what people in that type of situation need.

Kudo's for what you are doing.

I do have one question though, and I don't ask this to be offensive at all, it's just something that I'm curious about.  How much proselyetizing goes one in that type of setting, if any?  Feel free to send a PM if you want; it'd help keep this thread on track.


----------



## FriarEMT (May 5, 2012)

No proselytizing whatsoever goes on.  Mother Teresa always wanted her sisters to preach by example (as did St. Francis).  She said that a Christian should be a good Christian, a Hindu a good Hindu, and a Muslim a good Muslim.  The Missionaries of Charity see Christ suffering in humanity and treat everyone as if they were Christ.   

I was speaking to a Hindu resident there and he "adopted" me as one of his gods and whenever he would see me he would chant mantras to me.  The man had a simple and beautiful faith.

CNA sounds like a good idea.  It would be beneficial to pick up some things from that as well but I want to go even beyond that.


----------



## Aidey (May 5, 2012)

Google 'missionary medical training'. There appear to be several organizations that offer training classes on various medical and health topics.


----------



## Akulahawk (May 5, 2012)

Beyond CNA, you should look at community/public health and those other courses referenced above. Also the wilderness EMT courses should give you some additional education as to providing care in more austere environments. If you want to go beyond that (as you have said), you may want to look at LVN/LPN or RN education, however the training for that can take 1-2 years, not including prerequisite coursework. 

I do agree with the recommendation for contacting the Red Cross. They do disaster work and may be able to provide you with some of the training you're looking for.


----------



## EpiEMS (May 5, 2012)

Sounds like wonderful work!

I did my EMT and WEMT with the intention of operating in austere locations, as well. I think that you'd be extremely well served by reading a few public health textbooks. Also, consider contacting SOLO and/or WMI, they may be able to help you out –:censored:I'm fairly sure SOLO runs lots of medical aid trips where you could both gain experience and help out.


----------



## Veneficus (May 6, 2012)

Hesperian 

http://hesperian.org/

Which has compiled a wealth of knowledge and refined it over time by providers who have actual field experience.

I think you may find that EMS classes, especially those that rely on previously written protocol, have effectively questionable interventions, and end with "transport to a medical facility or call a paramedic" will generally not be very useful for the environment you speak about.

Actually it is one reason that disaster and austere medical organizations aren't overly thrilled to get calls from US EMS workers.

In the environment you speak of curative medicine needs to be simple and always available. Which often it is not. 

You might also want to explain your situation to some healthcare agencies and see if they can lt you participate in some of their operations for experience and knowledge.

What to do is the simplest part of medicine. It is the "why" that is really complicated.


----------



## mycrofft (May 11, 2012)

Ask people who are or were where you are going about the most common illnesses and injuries, and local remedies and resources.

But be warned

A former co-worker went to rural India on a similar deal and couldn't readjust to the limitation placed upon him in America. He was a LVN and started wanting to suture, give me orders (as a RN and his senior),and order meds.


----------



## airbornemedic11 (Jun 20, 2012)

Study up on infectious disease, field sanitation and hygeine. Also, keep in mind our western medicine is often avoided by some Asian and African cultures. You may have to look at natural or homeopathic interventions.


----------



## FriarEMT (Jun 20, 2012)

Good suggestion, thank you.

I just got my Wilderness EMT-B and I have learned quite a bit.  There is something called MED-PIC (medical person in charge) and that looks like it would be good too.


----------



## Handsome Robb (Jun 20, 2012)

My hat is off to you. I couldn't do the work you do.

MPIC or MED-PIC, depending on who you ask, is more centered towards Marine settings from my understanding. Such as being a crew member on a fishing or shipping vessel. With that said the information and skills included could very well be useful. 

Personally I don't see CNA taking you anywhere you want to go but at the same time RN seems like it may be a little over the top for your situation unless you are willing to spend the next two to three years of your life in school for the sole purpose of volunteering overseas. I never thought I'd say it but LPN/LVN may be a decent option for you. I'll withhold my personal opinions but I don't see a CNA cert helping you a whole lot. 

ARC disaster courses could be a good option, not quite centered on your specific mission but let's be honest, there aren't many courses out there that will be centered towards what your ultimate goal is. 

I'll ask you this: Do you plan on doing this for the rest of your life or are you interested in coming back to the US and working in a healthcare setting? If you do want to come back RN may be a very plausible and good option for you and would definitely be worth considering. 

Along with the above things that people mentioned I could see a nutrition course or two doing you well even though you aren't directly involved in making their meals. 

Another thing I will tell you outright is a Paramedic cert will not be of much use to you and quite honestly sounds like it would be a total waste of time for your end goal. Personally I wouldn't suggest anything past your WEMT, maybe EMT-I/AEMT if you have extra time and money but you could probably get away with a phlebotomy/IV cert if you are going to be in situations where you may be helping establish IV access. At the same time starting an IV isn't rocket science, it just takes practice. Knowing why and when is a different story but just to be able to assist a higher level provider you could probably learn it by watching someone over there and asking questions.


----------



## mycrofft (Jun 20, 2012)

Second NVRob. And many more pts will be malnourished or i_n extremis_, so starting on little dehydrated people (like babies and kids too) will be a plus.
A cohort was on medical mission in east Africa. Each day the aid was dropped off, the guerrillas came out of the woods and took their share (about 80%). His first time there he tried to face them off and was struck in the belly with a rifle stock for his pains.


----------



## firetender (Jun 21, 2012)

Get training in anything that licenses you in some way to treat people beyond the basics. That's your ticket. (I'm thinking something that covers wide areas in healthcare like LPN. 

I believe it hardly matters what you learn "here". Once you're "there" you will be utilized according to the level of your adaptability. You will likely be thrown into the deep end of the pool way out of your experience time and time again, and you'll learn, you'll learn!


----------



## WestMetroMedic (Jun 21, 2012)

I think the idea of focusing on nursing spectrum concepts is more useful than EMS education.

Not to say that EMS never deals with it, but in a remote seeing, you deal with long term issues, not as often acute issues.  Proper wound care is paramount for anyone from diabetics to amputees and rudimentary wound care and education of patients in this task is probably more valuable than anything.  Learn to clean wounds, learn to sew (sutures are not much more than difficult than hand stitching a missing button), learn to evaluate a wound.  

Undoubtedly, your faith community has connections that can get you hooked up with a physician (our equivalent) that would be willing to teach you this kind of stuff.  I would suspect that there aren't huge "scope of practice" issues in a country that is willing to abandon disabled people from unsavory castes.

with limited resources, you will have to do a lot of adapt, overcome, improvise and although you may not initially take on the education to fully understand the processes at work, with immersion, you will.


----------



## VFlutter (Jun 30, 2012)

Oops wrong thread


----------



## CMHills (Jul 8, 2012)

FriarEMT said:


> There is something called MED-PIC (medical person in charge) and that looks like it would be good too.



MPIC can be pretty handy to have, depending on where you go. If you find yourself working in a place where scope of practice isn't really an issue, MPIC will expand your abilities by a pretty significant margin (i.e. IV, suture, Foley cath). A lot of places will just ask you what you've been trained to do regardless of the various scopes you have to worry about.

A buddy of mine (EMT-B/WEMT/MPIC) just got back from Haiti and spent almost all of his time doing wound closure, which he would NEVER do in the States. If you've got the time and money, I'd pick up an MPIC for sure.


----------

