More and more DPMs are volunteering their time and considerable expertise to travel abroad to help those in need of medical attention. While the concept of missionary work is certainly not new, the number of opportunities to help others across the globe seemingly grows each year. It is not only the patients in other countries who benefit from the gifts these trips provide. Daniel Lee, DPM, AACFAS, remembers going on mission trips as an elementary school student while living in South America. He currently serves on the faculty of the Baja Project for Crippled Children. Since 1976, the Baja Project has been treating children free of charge at the Mexicali Red Cross Hospital in Baja California, Mexico. The nonprofit corporation is funded entirely through corporate and private donations although Dr. Lee notes a major source of income comes from the annual Baja Project Seminar on Pediatric Foot and Ankle Surgery. Dr. Lee, who also serves on the faculty at the LAC+USC Medical Center, became involved in the Baja Project as a resident in 1999. “As a podiatric surgical resident, I was fortunate to acquire specific pediatric surgical training,” recalls Dr. Lee. “The faculty that I trained with was very supportive toward medical missions. Now, as part of the faculty for the Baja Project, I have been able to apply my education and training, and provide specific medical and surgical services to the people in need.” At year-round clinics, Dr. Lee regularly treats children with conditions ranging from pediatric clubfoot to congenital deformities to acquired neuromuscular disorders of the lower extremities. He describes “the smile of a child being able to walk and the tears of joy of parents watching their child walk for the very first time,” as the most rewarding aspects of the job. According to Dr. Lee, part of the Baja Project’s goal and mission is to promote education and they teach members of the orthopedic community the surgical procedures involved for the correction and the postoperative treatment needed for each patient. Dr. Lee says they “strongly emphasize” the Ponseti method for treating clubfoot deformity and that quick intervention in these cases is essential. Challenges On Mission Trips Go Beyond The Medical Even apart from the medical side, the work can be difficult. “Visiting third-world countries is quite a challenge,” admits Dr. Lee. “But actually going there for missions is much more than challenging.” Dr. Lee cites customs, religion and socioeconomic and behavioral changes as some of the factors that require high levels of knowledge and sensitivity on the part of specialists visiting foreign countries. “Financial support is always a concern,” notes Dr. Lee. “Furthermore, having the proper team of physicians and supporting staff is crucial.” Dr. Lee says there are many other things to consider, from receiving authorization from local authorities and transporting hundreds of boxes of supplies to the site to educating local surgeons and even gaining the respect and friendship of local residents. “It is very important to realize that we are there as ambassadors representing not only our country, as Americans in a foreign land, but we are also representing podiatric foot and ankle surgeons,” adds Dr. Lee. The impact of mission work on Dr. Lee’s life cannot be overstated. “This is about making a difference,” he says. “If we can make a difference in this world as individuals and as podiatric surgeons, then I think we have achieved part of our goals as physicians and human beings sharing this world.” Heeding The Call To Serve Patrick DeHeer, DPM, credits his first mission trip to Honduras three years ago with awakening a “call to serve those in need with the gifts God has given me.” Dr. DeHeer, who practices in central Indiana and is team podiatrist for the Indiana Pacers and Indiana Fever, went to Honduras with a large mission group from a church in Little Rock, Ark. He says his initial experience was “fantastic” and has led to three subsequent mission trips. According to Dr. DeHeer, the Little Rock team has been going to Honduras for several years now. The group is comprised of about 90 missionaries, some medically trained and some not. In fact, the experience in Honduras left such a positive impact on Dr. DeHeer that he wanted to help out in another country as well. After doing some research on the Internet, he spearheaded a trip to Haiti in September 2003. “This took some time and work to arrange, but it came together well,” he says. “It can be difficult to set something up on your own, but you have to stay with it and continue to offer yourself and your skills.” For Dr. DeHeer, the biggest challenge he has faced in both Honduras and Haiti has been providing adequate follow-up care for postoperative patients. There are certainly other issues to deal with as well. He says he tries to bring equipment and supplies with him so he tries to “borrow and plead for donations well in advance of a trip.” The facilities can also present potential problems, especially when it comes to surgical procedures and, of course, there are communication issues. Dr. DeHeer notes it was difficult to communicate with patients and hospital staff as he does not speak Spanish or Creole. Despite what Dr. DeHeer describes as “the physical demands of operating in locations such as Honduras and Haiti,” such experiences have had a profound influence on his life. “Being able to serve those who are less fortunate is truly a blessing from God,” offers Dr. DeHeer. “Frankly, if there was a way to do it and still provide for my family, I would do it full-time.” Going Beyond The Call Of Duty One 12-year-old patient with clubfoot deformities stands out in Dr. DeHeer’s mind to this day. “I could tell he was a special young man from the time I first met him,” says Dr. DeHeer, who operated on the boy’s left foot while in Haiti. A month later, after checking up on the patient, Dr. DeHeer learned that a severe infection and wound complication had resulted in the decision to amputate the boy’s leg. “I was stunned,” he says. “I came to the realization that I had to do whatever I could to get him to Indiana and try to save his foot.” Hard work and determination, including calls to ambassadors, senators, congressmen and local Haitian officials, enabled Dr. DeHeer to secure a visa and passport for the boy in 10 days rather than the six months it usually takes. Once in Indiana, numerous medical personnel worked on the boy for months, ultimately saving his foot. The treatment culminated in a nine-hour operation in which Dr. DeHeer corrected the right foot and plastic surgeons performed a skin and muscle free flap on the boy’s left foot. “It was truly humbling to see so many give of themselves for this little Haitian boy they did not know in the least,” recalls Dr. DeHeer. “It still brings tears to my eyes.” Recent reports suggest the boy is doing well. It is a case Dr. DeHeer will surely never forget. “The mission trips have had a huge impact on me,” he says. “They have changed my life so much for the better. You realize what is important. Serving those in most need with little or no hope far outweighs the money, acclaim and status. Very soon, you come to the understanding that you are receiving much more than you are giving and it becomes addictive. You yearn to serve.” Overcoming Obstacles And Making The Most Out Of Mission Trips Luke Cicchinelli, DPM, has been on 10 missions to date and remembers every single patient he has treated. He will be traveling to El Salvador this fall. Dr. Cicchinelli, who is on the faculty of the Podiatry Institute in Atlanta and also practices with the Eastern Carolina Foot and Ankle Specialists in Greenville, N.C., first became interested in mission trips after practicing for a year and a half in Madrid, Spain. Upon his return in 1996, Dr. Cicchinelli was contacted by Todd Gunzy, DPM, who invited him to join a mission team that Dr. Gunzy was organizing. (See “‘Small Steps’ Makes A Big Impact” below.) Dr. Cicchinelli began to prepare for his first trip to Guatemala by learning Spanish, which he says helped with “both cultural sensitivity as well as surgical teaching.” He also quickly got involved in fundraising and coordination efforts for the trip, which was a collaboration between the Guatemalan Pediatric Foundation and the organization Healing the Children, Northeast. He kept busy on that first visit, which lasted 10 days. “We evaluated about 125 kids and provided surgical treatment for 40,” recalls Dr. Cicchinelli. “We fostered interchange with the local doctors for the sharing of techniques, as well as conducted follow-up evaluations of the kids.” Dr. Cicchinelli says getting used to the rougher conditions, including no running water or air conditioning in the operating rooms, wasn’t all that difficult. “You get used to it,” he says. “The focus is on the kids and trying to help them get a better step in life.” He says most of the children being treated were born with congenital foot and ankle deformities that required surgical correction. What has Dr. Cicchinelli found most rewarding about his mission work? “It was the interaction with the host country people and doctors, appreciating their customs, the families of the children,” he says. “You gain a sense of appreciation for our comforts here at home.” For Dr. Cicchinelli, much of it comes down to destiny. “Many of these folks were simply born into circumstances they had no control over,” notes Dr. Cicchinelli. “There are so many ways to help.” In fact, Dr. Cicchinelli says being a missionary “frames my daily work in a context of value and service beyond the hustle for the next dollar. It completes my sense of being a human being.” “Todos somos hermanos,” he adds. “We are all brothers in the world, just born and existing in, at times, very different circumstances.” The ‘Gift’ Of Treating Deformities Among The Less Fortunate Joe Southerland, DPM, who is based in Arlington, Texas, began his involvement with mission trips as a resident at the Northlake Regional Medical Center in Tucker, Ga. His first trip was a weekend trip with the Baja Project and it reaffirmed his interest in mission work. After the Baja Project experience, Dr. Southerland went on to join Dr. Cicchinelli and Dr. Gunzy in Guatemala in 1999. He is currently involved with the Texas Podiatric Medical Foundation, which started a monthly clinic in Reynosa, Mexico. The project has been ongoing for three years. Dr. Southerland, a faculty member of the Podiatry Institute, has vivid recollections of his first trip to Guatemala, which he describes as “a phenomenal experience.” There were certainly issues to deal with, he remembers. “We did have to do everything with cold sterilization. The autoclave at the hospital we were at was small and could only run at night due to the power it pulled.” However, the nurses set up a system through which the instruments were rotated. “This actually worked quite well,” notes Dr. Southerland. As the other doctors have described, it was the families and patients that had the greatest impact on Dr. Southerland. “The thing that struck me the most was the profound appreciation these people had for what we were doing for them,” recalls Dr. Southerland. “To these less fortunate people, fixing their deformity was a precious gift. One nurse told me it was the lottery of life and that we could have just as easily been born here. That phrase has stuck with me ever since.” The story of one Nicaraguan girl with an immensely large foot is also something he will never forget. “She was 5 at the time,” says Dr. Southerland. “As it turned out, she had a large lipoma deep to her plantar fascia. I would love to see her today to see how her foot healed. She was such a cute little girl and I felt so bad for her.” Currently, Dr. Southerland travels to Reynosa three to four times a year. “Those of us from out of town fly in on Friday night and spend Saturday seeing patients and doing surgery,” he says. “We then fly out on Sunday morning.” He says they often lack materials but have learned to adapt. “Sometimes you just have to make do with what you have,” notes Dr. Southerland. He says the positive effect of the mission trips has been twofold. “You can’t go there and see and do the things you do, and not come back feeling better about yourself,” he explains. “And hopefully, you helped make someone’s life a bit better.” Realizing There Are ‘No Barriers To Care’ John McCord, DPM, has incorporated the philosophy of mission work right in his own backyard of Centralia, Wash., so to speak. “The economy in my community has always been a challenge,” says Dr. McCord, a Diplomate of the American Board of Podiatric Surgery. “I don’t have to travel far for the opportunity to provide services to the poor. I have that opportunity daily in my clinic.” Dr. McCord, along with Michael Dujela, DPM, have a policy of “no barriers to care” at their office. Nobody is turned away because they cannot afford treatment. Travel has always been a passion for Dr. McCord. When he was approached in 1978 to volunteer some time in a clinic run by the Dominican Sisters in Cuernavaca, Mexico, he agreed to go. Although he didn’t speak a word of Spanish, the work he did with orphans at the clinic was well organized and one of the sisters translated for him. Last fall, Dr. McCord traveled to Rivas, Nicaragua with a local orthopedic group that conducts such trips each year. The trip was extremely well organized, according to Dr. McCord, who stayed for one week seeing patients and conducting surgical procedures. “The clinical problems we faced were not sore toenails and flat feet,” recalls Dr. McCord. “There were birth defects, trauma and complications from prior surgical procedures and wounds. People traveled for days to get to the clinic and they were always grateful even if we didn’t have a solution to their problems.” There was one patient in particular Dr. McCord says he will always remember. “She was a 4-year-old girl with multiple birth defects,” notes Dr. McCord. “Her mother wanted me to operate on the child’s clubbed feet so she could walk. The child was paralyzed from the waist down. There was no muscle control at all in the lower extremities. Through a translator, I was about to give the young mother the worst news she could imagine.” Before Dr. McCord left Centralia, a Catholic chaplain had given him a bag containing 350 sets of brightly colored rosary beads to give to the Nicaraguan patients. “I gave a set of pink rosary beads to the little girl. She and her mother beamed as the mother showed the beads to the little girl.” Despite having to tell the mother that her daughter would never walk again even if the clubbed feet were corrected, Dr. McCord says “they continued smiling at the pink beads. The mother explained to her daughter what the rosary was used for. She thanked me in Spanish and left.” Dr. McCord says working with doctors in other countries has helped him to appreciate the medical system we enjoy here. “I have learned to respect the medical providers from Mexico and Nicaragua for their ability to care for their patients with little resources or reward,” emphasizes Dr. McCord. “I learned a lot from them about the real calling of medicine.” Ms. Garthwait is a freelance writer who lives in Downingtown, Pa.