A World Away

2014 - 1 February – Critical Care in Underserved Areas
SCCM member Christine Toevs, MD, FCCM, and her husband share their outlook on volunteerism in underserved areas.
Christine Toevs, MD, FCCM, never foresaw that her work as a trauma and critical care surgeon at Allegheny General Hospital in Pittsburgh would need to be planned around her commitment to healthcare in Mongolia and Belize. But since 2009, she and her husband Brian have been doing just that. Critical Connections asked them to share their story and their passion for volunteering a world away.
CC: How did you begin volunteering abroad?
Christine: There is an enormous amount of training that goes into becoming a surgeon, and I had always wanted to use those skills to do mission work. I did part of my residency in Guatemala, where my school [the University of Minnesota] has a long-standing relationship with a secular public health organization. Ultimately though, I determined that I needed to do faith-based work. I discovered Mission to the World and went to Belize annually from 2002 to 2008. I wanted to go somewhere with a real need for surgery – and where Brian could join me.
CC: Brian, how did you volunteer in Belize?
Brian: As a computer science expert, I provided information technology (IT) support to the missionaries, including rewiring the local high school’s IT network. I also drove the patient transport van, dug a trash pit for the medical center and installed an x-ray machine.
CC: What did you learn from that experience?
Christine: In the United States, we tend to be tech-dependent, but you realize that you can provide a lot of care without every bell and whistle. Most hospitals in Belize don’t have an intensive care unit or ventilators, and usually just a single operating room. [Local providers] just want basics, like solid triage skills. Rather than going in with the Western belief that everyone should “do it our way,” we found it better to go in with a “you have a lot to teach us” mentality.
CC: What took you to Mongolia?
Christine: I am a member of the Christian Medical and Dental Association, and in 2009 they were looking for physicians to go there. We saw it as an opportunity to go somewhere neither of us had been before. I perform surgery at the trauma hospital and the general surgery hospital, but my primary focus is medical education. I give lectures at the Health Sciences University of Mongolia, as well as to hospitals, government and private companies. I lecture on ethics, trauma, critical care and palliative care, professionalism and system improvement. I’ve also visited hospices in Ulaanbaatar, including home hospice visits.
CC: What are the biggest needs you see?
Christine: Most doctors around the world who participate in mission work want reassurance that they are providing the best care that they practically can. So, as U.S. physicians, we will say, “Here’s what we would do with the resources you have.”
CC: What Society of Critical Care Medicine resources have supported you?
Christine: I took the Fundamental Critical Care Support course a few years ago. Right after that, the Society of Critical Care Medicine (SCCM) took [the course] to Belize, so that was very helpful for me in teaching critical care skills to those without a lot of exposure to them.
CC: Brian, what is your work in Mongolia?
Brian: I am a visiting professor at the university with a doctorate in information security, so last year I lectured on the ethics of information security – and fixed all the physicians’ laptops. I also spent several days at V.E.T. Net, a U.S. veterinarian organization that provides services and training to local herdsmen.
CC: How do you balance your volunteer work with the demands of your surgery practice in the United States?
Christine: We go for two weeks at a time, but since we go every 18 months, it’s possible to plan ahead. Fortunately, my [practice] partners understand how important this work is to me.
CC: What advice would you give to a colleague interested in volunteering abroad?
Christine: Start with geography and determine if there are any places you are not willing to go. Next, decide why you want to go and what skills you want to use. There are a variety of secular and faith-based organizations out there with a full spectrum of needs. SCCM can help locate opportunities, and most major medical organizations have some form of mission work as well. And many providers work through their church.
CC: What are the biggest lessons you have learned in volunteering your time overseas?
Brian: If you’re going somewhere because you think it’s cool, stay home. They don’t need you. But if you’re going to do something that the community and the profession needs, those are the right motivations.
Christine: It has been a profound experience. The first thing I did when I got home from my first trip was to clean out all my closets – we have entirely too much stuff in this country. I have been blessed to be an American and a critical care surgeon, and I feel an immense calling to give back, both in my daily life and in the world.