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When discussing efforts, experiences and ambitions related to global emergency medicine (EM), I am often met with a variety of responses from colleagues, ranging from genuine interest and curiosity, to tolerance or disdain, and occasionally supportive like-mindedness. Part of the challenge has been to grapple with the stigma that can be associated with healthcare workers that volunteer or work in developing settings (part-timers, travel junkies, commitment issues), and articulating the relevance of the value they bring back to their home institutions. While there has been a recognition of the skills brought back to the NHS by those working overseas as outlined in the 2007 Crisp report on global health partnerships, these messages remain difficult to filter in times of increasing burden and strain on our Emergency Departments (ED). However, it may be precisely for these reasons that a global outlook needs to be embraced as we develop solutions to meet our needs. While we reflect on the systems, teams and collaboration required, the starting point is that of the individual.
Learning about yourself
When I first started out on my journey in international health at the end of the 1990s, global emergency medicine didn’t exist, except perhaps as a concept. However, a critical early lesson was one of understanding oneself and motivation. Travelling to an austere or unfamiliar environment, and working outside your comfort zone forces a challenging critique of one’s intention, rationale for risk taking, and justification of why you are there. I recall an elderly doctor I worked with in Russia’s North Caucasus refugee camps of Ingushetia who carried two sections of rubber Bunsen burner tubing in his medical bag in case he had to intubate a patient. He demonstrated how he would advance his fingers into a patient’s mouth into order to access the oropharynx of the unconscious patient, as well …
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