Providing health care in developing countries offers many opportunities to problem solve. Those on medical missions have to adapt to new situations and work with limited resources. Despite these challenges, Sabena Kachwalla treasures her ability to travel and offer medical service to those in need and training to local healthcare providers. The knowledge and experience she gains from these missions is irreplaceable and Sabena loves to share what she’s learned with others.
How many medical missions have you been on?
I’ve done over fifteen. There are usually two kinds of missions; teaching missions and service missions. Service missions are when we administer medical attention to patients in the countries we’re visiting. The goal of a service mission is to provide medical service to the patients. Teaching missions involve us instructing local healthcare providers in a classroom setting.
An example of a teaching mission is our more recent trip to Kenya. That involved classroom teaching and helping the anesthesia students practice. They have a limited number of anesthesiologists there. The curriculum is a little different. We were there for a week and taught just about everything from advanced cardiac life support to trauma to pediatric care.
An example of a service mission would be our recent trip to the Philippines. We saw the OR in Kenya but we were actually performing surgery in the ORs in the Philippines. We were doing anesthesia for minor and major surgeries, and even things like cleft palate surgery on children.
What challenges did you face in the Philippines?
First is the communication barrier. English is a second language that’s taught in school and most people in cities do speak it. However, once you get into more rural areas very few people speak English, so we had to make sure we had good translators.
Another challenge is that, for many of our patients, it was their first time seeing a health care provider. Some of our patients had previously undiagnosed medical conditions that affect the use of anesthetic. We also had to adapt to having limited equipment and medication. For example, local hospital facilities couldn’t provide the needed airway equipment and it was too expensive to bring our own. It wasn’t like we could just borrow something from a nearby hospital. This was definitely a challenge if a patient had problems with their airway because our resources were so limited.
When our patients were recovering from anesthesia we had to make absolutely certain that they were okay before we transferred them to a ward in the hospital where their family members were basically their nurses. Sometimes fifty patients would be squeezed into one big room and five or six members of a family would be crammed around one bed.
How are these missions learning experiences for students?
In the Philippines, we were able to talk to the nurses there and help to educate them on some things, but Kenya was really the place where we had a classroom. Students were able to see that, even though these lecturers came from other countries, anesthetics are very similar. It was kind of refreshing that they were able to see that they could practice anesthesia virtually anywhere in the world and be up to speed.
It’s expensive for health care providers such as these to subscribe to medical journals, so we usually bring materials from home for them. Books, articles, and journals that they can use as resources and references. I learned some things too. You have to learn how to pay incredibly close attention to your patients when you don’t have the monitors and other equipment you do here at home. I also brushed up on my ability to take a pulse and blood pressure manually. In some cases I had to figure out how to “MacGyver” something together for suction.
What is your biggest take away from these missions?
Travelling to places and seeing the limited resources and access to medicine has given me more of an appreciation for the healthcare system in the United States. Even in poor areas, a lot of people have access to some kind of healthcare. In these developing countries they don’t have that. We’ve had middle-aged patients that have never seen a doctor before because of the cost. When they can make it to a clinic, they may have to wait months to see a physician or may never get to see one at all. It really shows how fortunate the U.S. is to have such easy access to doctors.
Many of our patients think that going into surgery means they’re going to die. They’re still afraid to have extensive medical treatment because they have friends and family who, by the time they finally see a surgeon, die in the operating room. People should feel relatively safe when they do need to go to the hospital for an operation. They shouldn’t have to be fearful of that happening to them.
The people are friendly and incredibly appreciative of us being there. I feel like people in America feel entitled to health care, whereas these people cherish it. That lack of entitlement and the lack of resources results in patients that are very grateful and strongly appreciate our service.
The work we’re doing is often life changing for patients. For example, many children with cleft palates were ostracized for having this condition they couldn’t control. At times it even affected how well they could chew, swallow, and speak. After the surgery there’s such a huge transformation. Obviously, there’s a physical change, but these children can also start living and communicating far better. I feel so privileged to be a part of that.
Do you think going on these missions has improved your teaching ability?
Absolutely. You need to learn how to adapt to new situations and the technology available to you. We had to tailor our lectures towards our students, their situation, and what would be beneficial for them. Everything you teach has to be relevant to their clinical practice. At times, we face difficulty trying to target what they need. We have to take what we’ve been told by local doctors and our experience in the field to gauge what students really need.
Do you have more missions planned for the future?
I do! I’ve been going to the Philippines every February for the past seven years and I plan on continuing that. I’ll also continue to go to Kenya once a year.
Why do you choose to go on these missions when it can be so challenging?
I enjoy volunteering my time to help others. It’s a way that I can use my medical training and experience to give back to the world. I think that’s the reason why we’re all here; to help other people and I think that if you can’t do that, it’s harder to connect with people. It’s incredibly rewarding to be able to provide access to medical care to people who don’t normally have that. Obviously, it would be ideal for everyone to have the same medical accessibility we enjoy, but given the current situation, I’m glad that I can help.
How did you come to find the MSA program at Case Western Reserve University?
I knew I wanted to go into medicine, but I didn’t have a specific career in mind. I didn't excel at the MCAT so I was curious about my options. That’s when I began searching online and found the Certified Anesthesiologist Assistant program.
How long have you been a clinical instructor?
I’ve been teaching clinically for ten years. When the DC campus of Case Western Reserve opened the CAA program in 2012, I started to teach there.
Does this opportunity to go on missions set Case Western Reserve University apart?
Oh, absolutely. You carry these experiences with you forever. Most students already have an inclination towards volunteer, service-based work. Medical missions are eye-opening and skill developing experiences. My hope for students that come on these missions is that they’ll want to make them part of their career.