Medical relief work overseas
Dr Sean Keogh is an A&E consultant called on by Merlin to help when there are natural disasters, and specialises in leading the initial assessments.
Q: What kind of medical relief does Merlin provide and in which parts of the world?
A: Merlin is the only specialist UK charity which responds worldwide with healthcare and medical relief for vulnerable people. It tackles four main challenges:
1.Natural disasters (like the 2003 Bam earthquake in Iran, the 2004 Asian tsunami, or the cyclone in Myanmar in 2008);
2.Conflicts, such as a civil war (for instance in Iraq, Sudan, the Congo and the occupied Palestinian territories);
3.Disease (including TB, malaria, HIV/Aids and common childhood diseases);
4.Health system collapse (for example, in the former Soviet Union, Liberia and Afghanistan).
Merlin is currently helping more than 15 million people in 20 different countries.
Q:What has been your involvement with Merlin?
A: I'm an A&E consultant and have been working for Merlin since shortly after it was set up in 1993 [read about Merlin's history]. My involvement is in trauma management, which is probably a bit different from that of most doctors who work for Merlin. I lead assessment teams in the early stages of a natural disaster. That means I'm usually one of the first people on the ground, for instance in the Kashmir earthquake. It is my job to assess the damage and advise what the healthcare needs are and what people are going to need to get themselves back on the right track.
To give a UK analogy, if I were driving along and came across a train crash as an A&E consultant, my first responsibility would be to report that there had been accident, explain what the injuries were and advise on the scale of the need. Only when that had been done, so that medical relief could be arranged, might I then provide treatment myself.
Q:As an individual doctor, what might you find yourself doing?
A: This will be different depending on which of the four main challenges you're dealing with. For example, if you're helping with a disease programme, you would probably be setting up and running a health programme, like an immunisation campaign. If you're working in an area of conflict, you might be ensuring sanitation, shelter and water (although organisations like OXFAM tend to specialise in this sort of help) or more probably surgical input. Much of the important long-term good comes from simple and common problems you have to fix. It could be setting up a new immunisation programme for measles, for instance.
Q:How does medical relief compare with working in the NHS?
A: There's not really much comparison. When you go off on a mission, that is a major commitment and very much the focus of your life. There's no going home at 5pm. You get very absorbed, especially in an emergency, where you might get three to four hours' sleep a night over, say, three to four weeks, and you're working, working, working, because people are dying in large numbers.
The countries you're working in may have their own challenges (like North Korea, Myanmar or Afghanistan), with security and military checkpoint issues. It's not like getting on a commuter train to the hospital.
You're likely to have a very varied day. You might find yourself doing anything from fixing a broken leg to going out in the field to check mosquito nets. That's one of the good things about medical relief - you're never quite sure what's coming down the line.
Even if you're quite junior in the UK, you're likely to be quite senior in the country, running teams of local staff (although you may be helping organise the work of experienced local doctors).
You'll also get all sorts of problems landing on your desk that you'll never get in the NHS.
Q: What specialties tend to be in greatest demand?
A: The four specialties in greatest demand are public health, reproductive and child health, tropical diseases and other communicable diseases (HIV/Aids, for example).
Surgical skills may also be needed at times, for instance in a field hospital.
Q:Is there any specific experience or qualification an organisation like Merlin will be looking for?
A: Qualified doctors with some post-qualification experience and a masters degree in public health or a diploma in tropical medicine, preferably with overseas experience and/or primary care or public health experience. These organisations are not usually the best for very junior doctors.
Q: How long or short a commitment is likely to be involved?
A: Usually about six months for doctors, although it can be 12-24 months for senior management.
Q:What are the best stages of your medical career to consider this?
A: Merlin isn't the easiest of organisations to get into. Ideally, you should have two to three years' post-qualification experience and, if possible, overseas work experience.
Q: Is there much scope for medical couples to work together?
A: The nature of the assignments means this isn't usually feasible, although opportunities can arise occasionally.
Q: Can there be problems finding work on return to the UK?
A: When I first started working abroad in the late '80s, there were definitely issues - it was not commonly done and was often frowned on. However, things have changed a lot since then. As a UK consultant, I would look for people with experience abroad - they tend to be more rounded and more competent and better able to cope with the stresses and strains of modern clinical medicine.
These days, it is much easier and there are often times which can be taken within training schemes.
Q:What sort of salary can you expect?
A: This isn't something you do for the money - £12,000-£17,000 would be the norm, maybe a bit more for a consultant with management experience.
Q:Overall, what would you say are the pros and cons of working in medical relief?
A: On the downside, you'll be away from your home and your family for a prolonged period and you won't earn much.
However, there are lots of pluses. There's a greater opportunity for you as an individual to make a difference than in any other field of medicine. You'll be making a vast difference to people's lives. It is nothing like what you will have done in the UK.
There'll also be places and people you'd probably never have seen otherwise, in countries that don't appear in any tourist itinerary. You'll get to have a very varied career and not just cover medicine.
As a junior doctor, you'll mature much more quickly in the way you work with people.
Find out more
Merlin has a website at www.merlin.org.uk and for a more in-depth idea of the work, you can attend one of the charity's training courses
Other overseas medical volunteering options
Use the Tropical Health and Education Trust to find opportunities to create or support links with healthcare partners in the developing world (use the 'search links' tab to the top-right of the homepage). THET itself also has volunteering opportunities; for example, you can work, from the comfort of your own home if you wish, as a research volunteer to do small projects, "which may vary from research in health policy to diaspora groups". (At THET's 'work for us' page, you will then need to click on their 'volunteer at THET' link on the left-hand side to access information about the research role.)
The other main overseas aid organisations seeking doctors are the British Red Cross, Medicins Sans Frontieres, and RedR.