Introduction Every year thousands of people donate their time to help combat disease and suffering in developing countries. Many work at home in support activities such as raising funds and collecting supplies. Some volunteers travel to lend a hand in person. They are a varied group including doctors, nurses, therapists, students, technicians, religious, missionaries and other dedicated persons with non-medical training. Some work independently, but most are at least loosely affiliated with a group or organization. Many come from North America or Europe to team up with local personnel. Many are able to give a week or two at a time, but some dedicate years or even a whole career. Short-term volunteers often travel at their own expense, sometimes even bringing with them donated supplies, money and medicines. Many, especially long-term volunteers, receive food, housing and perhaps even a small stipend while on assignment. The total numbers of individuals actually engaged in these activities and the monetary value of their work is unknown, but in 1990 the International Medical Volunteers Association surveyed 1,000 doctors and medical students and found that 11% indicated that they would strongly consider foreign service. Of those showing such an interest, one third had already had some overseas medical experience. Volunteers may choose from a variety of groups sponsoring medical aid work. They range from tiny informal associations to huge multi-national organizations with multi-million dollar budgets. Many groups have a religious affiliation. Institutions of higher education, national governmental and world governmental organizations such as the World Health Organization support these activities both directly and indirectly through training, research and supplies. The impact of volunteer work varies from country to country. In a country like Haiti, volunteer organizations (principally missionary groups) deliver a substantial proportion of health care to the poor. This site is designed for those contemplating international health service as well as for those already involved. Why Volunteer? Health professionals volunteer for many different reasons, but most often they simply want to help, to do something important, and/or to assist others in need. Many who are aware of the terrible suffering going on in the world feel that they simply must do something to help. Others travel to foreign lands because they find that their work at home has lost some of its appeal or has become routine. They find that even a short break revitalizes them. Religious conviction gives many the strength and dedication to leave their homes and loved ones to work far away under very difficult conditions or to donate money to support these programs. Other reasons people volunteer include: Exposure to challenging new problems A chance to demonstrate commitment to and interest in the underserved A chance to put philosophical convictions into action A chance to overcome new kinds of obstacles Encountering interesting new cultures and customs The adventure of travel to exotic, faraway lands A chance to learn new skills A chance to teach Belief that such work is inherently worthwhile Belief that the volunteer is simply "cut out" for this type of work Belief that volunteering is a good life experience for self and family Feeling guilty that one is comparatively well off Who is Needed to Volunteer? The huge need for health volunteers throughout the globe means that people with almost any skill can find meaningful assignments. The medical personnel most in demand by relief agencies include surgeons, pediatricians, family practitioners, nurses, pharmacists, public health educators, maintenance / repair personnel and laboratory technicians. However, with a little research, people with almost any medical or medical support skill will find productive and rewarding assignments. Who Pays the Expenses? The majority of volunteer-seeking organizations will pay for travel, food and housing only for long-term volunteers, and are usually unable to fund travel for short-term service. However, some groups can and do pay all expenses even for short stints. In contrast, other organizations (particularly some religious missionary groups) will require the volunteer to raise his or her own funds even if he or she will serve for several years at a time. Apparently, they believe this contribution adds to the missionary value of the effort. This whole question may puzzle the volunteer who knows that the equivalent time donated in an affluent country may be worth many fold the expenses under consideration. However, most relief operations have very limited budgets, and they simply can not afford to pay these expenses. If they had more money, they could probably hire some additional local help instead. In reality most short-term volunteers give more than just their time. They often pay their own travel expenses. Some even contribute to the costs of housing and food; many even bring donated medical items with them. Many volunteers find sponsors to defray expenses of volunteering. Colleagues at work, religious groups and families are frequent donators. Is Voluntary Service Tax- deductible? Usually the cost of travel while performing volunteer duties for a tax-exempt organization is deductible. The value of the voluntary service itself is usually not. Professional tax advice is often required to answer this question on a case-by-case basis. For How Long Should I Volunteer? Obviously, the answer to this depends on individual circumstances and time constraints. For many people short-term volunteering is best to begin with because they will have a chance to see if they are suited for this work or whether a particular assignment is a compatible one. Ideally, you find a suitable assignment and try to volunteer for as long a term as possible. Long-term volunteering is better not only because you accomplish more and become more skilled and efficient at what you do, but also because for many agencies, especially those that incur significant expenses in screening, transportation and housing, short-term commitments are not very cost-effective. However, even short-term volunteering is worthwhile especially if you work where there is a severe shortage of help or if you can bring some expertise that isn't locally available like a special clinical or teaching skill. Even short-term volunteering in areas where you cannot speak the language can be productive. Surgeons, optometrists, dentists, and biomedical engineers are among those who can have their work prepared for them in advance of their visit and who can get by with the help of a translator. Regardless of your training and skills, with a little research you can find a way to be useful and make a difference. Sometimes volunteers can temporarily relieve a permanent staff member to allow him or her a much-needed vacation or leave. Providing a colleague with some time-off is not only a welcomed favor, but also can lengthen the career of a permanent staff member who might otherwise "burn out." Helping a colleague in this manner also helps that person feel supported and reinforced in the perception that his or her work is worthwhile. When is the Best Time of Year to Volunteer? Naturally, the best time for an individual depends upon personal circumstances. For example, people bringing along school-aged children may wish to go during the summer vacation months. Overall though, more people volunteer during the northern hemisphere winter. Hence, your services are more likely to be needed from April to October. What is a Career Volunteer? This category includes two major groups of people - those who volunteer long-term (years at a time) and those who perform short-term service repeatedly (sometimes on a regular schedule, such as twice a year). Even those who get a small stipend or who have their educational bills paid by a sponsoring organization are essentially volunteers and are considered as such here. Before committing to a long-term assignment, you may want to try to ensure that the country, people, facilities and coworkers are right for you. A bad experience can deter you from a lifetime of charitable service. Some view a long-term volunteer commitment as akin to a marriage - something that requires careful consideration before entering into and constant work to maintain. Trying a short-term assignment at the site or perhaps just visiting a location before committing to a long assignment may be a very good idea. What About Administrative and Planning Duties? It is common for doctors, nurses, clergy and others who may not have formal training in hospital administration or public health to find themselves responsible significant administrative and planning duties. Even the professional administrator is likely to find unfamiliar and challenging circumstances overseas. Regardless of your previous training, effective management will require some forethought and planning. Many mistakes can be avoided, and re-invention and reduplication of solutions can be averted by a little preparation. Preparations you make before you go can provide a framework to be built upon by extensive in-country consultations. It is important to consult widely, to learn from the experiences of a broad range of local sources and to search continually for opportunities to form partnerships for cooperation. How Do I Find the Right Organization to Volunteer With? Although it may seem a little daunting at first, finding a suitable assignment doesn't require all that much effort if you know how to go about it. This section is designed to help. Some good ways to become started are: Contact volunteer-seeking organizations directly Contact an organization that helps with placements Get leads by word of mouth from friends and acquaintances Inquire through a religious group Attend meetings related to international health Explore Internet resources Inquire in person while traveling abroad Contact Volunteer-Seeking Organizations Directly There are hundreds of organizations based both in the US and abroad that need volunteers to help carry out their humanitarian missions. Most volunteer-seeking organizations can now be contacted by email. Lists of these organizations are occasionally published in medical journals such as JAMA (Vol. 270, No.5, August 4, 1993); Pediatrics (Vol. 82 No.1, July 1988); and American Journal of Tropical Medicine and Hygiene (Vol. 54, No.4, April 1996). The organizations vary greatly in their philosophies. Some have strict religious requirements, but many do not. Some have somewhat intimidating application forms, but most are reasonable. Some have short-term service available while others may require a several year commitment. A few will pay your travel expenses for short-term service, but most will not. Some organizations are tailored to help certain groups of volunteers (e.g. AMSA for Medical Students, or Interplast for plastic surgeons). Contact Organizations That Facilitate Volunteering The IMVA maintains an on-line list of volunteer-seeking organizations, their needs and details of service. The American Academy of Pediatrics also maintains an on-line database of service opportunities which is searchable by country. The Practice Opportunity Line 1-800-233-9330 is a 24-hour toll-free automated telephone service that allows you to search anonymously many international and domestic opportunities. The system prompts you to enter your specialty and geographic preferences and listen to detailed profiles of available opportunities. Groups needing volunteers to fill positions may call: 1-800-423-1229 to discuss this service. A monthly fee is charged for listing each position. Get Leads by Word-of-Mouth Most everyone knows or has heard of someone in his or her area who has done some kind of volunteer work. Sometimes you have just read about someone in a newspaper. If you don't have personal contacts, just ask around and you will surely find a few leads. Then go ahead and make contact (usually best in person or by telephone). You will find that most people are happy to share their experiences and give advice. Often they can introduce you to the proper contact people overseas and help to pave the way for you to make a visit or team up with an organization. Getting in touch with doctors, nurses, health care workers or other people from developing countries who are now visiting or live in your area can also be productive. Often they can connect you with friends or relatives in other parts of the world that might interest you. Another good means of acquiring contacts is through acquaintances in the diplomatic service or through people working in relief and development agencies. A personal introduction from them can help open many doors. Regardless of which approach you use, the key is simply to not be shy! Inquire Through a Religious Group Much of the US -based non-governmental international health care is provided by private religious organizations. Whether or not you belong to such an organization, chances are you can get some information about volunteering with a project they are associated with. For example, Connections, a directory of lay volunteer positions, principally for Roman Catholics, is available online or by calling (202) 529-3330 E-mail: Pallotti01@aol.com. Search the Internet More and more volunteer-seeking organizations are developing home pages on the Internet though details of volunteer service positions are not yet generally listed. The University of Massachusetts Medical School, however, maintains a Web site designed to help volunteers find the organizations that need help. This International Health Care Opportunities Clearinghouse is a searchable database of over 100 service and educational opportunities in international healthcare. The Internet contains many additional sites of interest to the medical volunteer, such as travel and clinical information.We have listed a number of these on our resources page. Inquire in Person While Traveling Abroad A very effective method of finding suitable volunteer positions is to inquire in person while you are traveling. This way allows you to bypass some of the formalities that may be imposed by some of the central offices, to acquire firsthand knowledge of the people and facilities, and to negotiate directly a mutually satisfactory arrangement. The information you collect can then be shared with others. Even if a particular site is not right for you, it may be perfect for someone else. If you are overseas and are unclear where to start your search, simply introduce yourself at whatever health care facilities or churches you come across. They can often steer you to sites and programs that may suit you. What Makes a Successful Volunteer? Once you have decided to go, you will probably want to do a good job. Your chances of performing well on a volunteer assignment will be better if you: are organized and well-prepared have a supportive family are emotionally stable and have a good sense of humor are a good listener are adaptable and able to tolerate some degree of personal discomfort are self-reliant and capable of improvisation when needed are patient, cooperative and flexible are interested in the world and its peoples committed to sharing your knowledge and skills Supporting Overseas Efforts While at Home Many essential supportive tasks are carried out here at home without which many relief operations would suffer. This work, allows people unable to travel to participate actively. Some ways to help are: Donating money Donating supplies and equipment Raising funds Conducting research Logistical support Moral support Communications Special projects Donating Money Donations are crucial to every medical relief project. Monetary gifts are so important because they afford a relief group flexibility. For example, funds can be used to hire local personnel (often at a fraction of the cost of in the US) or to purchase fuel for a generator or truckloads of water for refugees. Money is also rapidly transferable - this is particularly important in disaster situations where items can be bought locally or regionally far more quickly than they can be shipped. Although most of us work hard for our money, it is usually a lot easier to give money that to travel ourselves overseas to lend a hand in person. Monetary donations can be made as lump sums as regular (monthly) contributions or as part of estate planning. Gifts in a variety of other financial instruments are also possible. The value of a contribution can be extended by giving to tax-exempt organizations. This method usually allows the donor to declare a tax deduction. Donating Supplies and Equipment Donated supplies and equipment are a mainstay of many relief operations. The key is to be able to collect only needed items. Useless items only waste transportation costs and become a burden to the recipients. Dialogue with the people on site or with other appropriate personnel is essential to proper planning. In general, worthwhile supply items include: Bandages Medicines - but only those needed for the illnesses at hand, and not outdated Needles Orthopedic plaster and reusable orthopedic splints Re-sterilizable items such as glass syringes, feeding tubes Sutures Surgical gloves Surgical tape Urine/blood test sticks Worthwhile equipment is generally low-tech, durable, repairable and in good condition. Examples include: Autoclaves (basic models) Centrifuges (hand operated or basic electric models) Durable blood pressure equipment Electrical generators Glass thermometers Laundering equipment Microscopes (good quality) Personal items - stethoscope, eyewear, facemasks Reusable surgical or dental equipment (in good condition) X-ray machines (basic models) Appropriate educational material and textbooks can be useful to medical relief projects. Unfortunately, most medical books focus on the problems of developed countries. Most of the more third world relevant material is published in Europe and is a little harder to find in North America. Again knowing just which items to send usually requires direct communication with on-site personnel. If you would like help collect and donate items, but are not currently hooked up with an organization, you may wish to contact some of the following organizations that work in this field. Other Support Activities Most of us can find additional ways of helping to find solutions to world health problems even if we don't join an organization. Political activism, increasing public awareness and encouraging others to become involved are just a few examples. Share what you learn with others.