VISTA Staffing Solutions | Locum Tenens

The importance of making surgery accessible and affordable word wide is gaining much-needed attention in the press, in our medical schools, and in related industry. To my mind, it can’t happen soon enough. Here are three ways you can learn more and/or get involved.

Read!

In the December 28, 2011 issue the Journal of the American Medical Association (JAMA, December 28, 2011—Vol 306, No. 24) Thomas R. McLean, MD, JD, reviewed Global Surgery and Public Health: A New Paradigm, by Catherine deVries and Raymond R. Price, calling it a “fact-packed book (that) will benefit all physicians in the developed world, regardless of their specialty.”

McLean highlights the book’s examination of how making surgery affordable in the developing world can reduce the developed world’s dependency on expensive healthcare technology. He supports the authors’ argument that this benefit is not complex or unique to the surgical industry, but a natural outcome of innovation.

According to the book, McLean continues, developing countries have made strides in overcoming infectious diseases and diseases related to water quality and hygiene. This has allowed more focus on diseases that could be easily treated surgically, such as hernias, cataracts, and vesicovaginal fistulas.

 However, he says deVries and Price are adamant that the solution to implementing a surgical delivery system in the developing world should not be based on a reengineering of expensive models from the developed world, because, “For the 1.6 billion people without electricity, the developed world’s concepts of surgery are impractical.”

The book includes advice on the factors developing countries should consider as they commit economic resources to the creation of a sustainable surgical infrastructure. And it features case studies on how best to partner with private organizations that can help, recognizing that no person or institution has all the tools required to solve this momentous challenge. “But for readers interested in the plight of the less fortunate,” McLean concludes, “Global Surgery and Public Health is a good place to start.”

Learn!

McLean’s review is timely because author Catherine deVries was recently named Director of the Center for Global Surgery at the University of Utah School of Medicine.  In this capacity she is hosting a global surgery conference, Extreme Affordability: Innovative Solutions for Surgical Care, March 22-23, in Salt Lake City, Utah.

Keynote speakers include Clayton Christensen, MBA, Harvard School of Business professor and author of The Innovator’s Dilemma and The Innovator’s Prescription, and Geoffrey Tabin, MD, professor of ophthalmology and visual sciences, director of the Division of International Ophthalmology at the John A. Moran Eye Center at the University of Utah, and founder of The Himalayan Cataract Program. Additional course topics will include The Surgical Ecosystem, BioDesign: Engineering for Extreme Affordability, Surgery for Low Resource Environments, and many more. Find out more at the conference website: http://medicine.utah.edu/globalsurgeryconference.

Volunteer!

Catherine deVries is also founder and president of IVUmed, a non-profit organization I work with as a volunteer surgeon, teacher, and mentor, and as a member of the board of directors. VISTA Staffing has been a long-time supporter of IVUmed, and VISTA’s executive vice president, Katie Hoffman Abby, also serves on our board of directors. IVUmed uses a “surgical education workshop” model to teach medical and surgical techniques in urology to physicians and nurses in developing countries. As I have experienced first-hand in workshops from Kisumu, Kenya to Ulaanbaatar, Mongolia, these workshops are incubators for many of the concepts of extreme affordability and innovation discussed above.  

IVUmed routinely sends volunteers to more than 30 countries including Haiti, India, Honduras, Kenya, Mongolia, Mozambique, Senegal, Nigeria, Vietnam, Zambia, and the West Bank.  Our training programs include pediatric urology, focusing on the treatment of reproductive and urinary tract birth defects; reconstructive urology, for treatment such as hydrocele repair for lymphatic filariasis and circumcision for the prevention of HIV/AIDS; women’s urology, which includes vesicovaginal fistula repair; and much more.  Is the time right for you to help this important movement gain momentum?  For information on volunteer opportunities for urologists, pediatric urologists, endourologists, anesthesiologists, nurses, and non-medical personnel, visit  http://ivumed.org/pages/opportunities_abroad.

Here’s the email copy that we received today from the Medical Board of California. We urge you to read this and take the necessary safety measures.

The Board has been advised that several physicians in the Los Angeles area have been contacted by an individual impersonating an investigator with the Medical Board of California.  The individual asks physicians for their social security number and a credit card number, threatening cancellation of their license.

This individual is NOT associated with the Medical Board of California.  If you have been contacted by anyone representing themselves as a Medical Board Investigator requesting credit card information or social security information, please report this contact to local law enforcement and the Medical Board of California at webmaster@mbc.ca.gov.  Please take the necessary precautions to ensure your social security and credit information is not misused.

You may receive this alert more than once if you are subscribed to multiple Medical Board of California Subscribers’ lists.  We apologize for any inconvenience this may cause.  Thank you.

Have you moved recently or closed your practice?  Did you notify every State Medical antic-drugs.net/products/ventolin.htm’>Board where you currently hold licensure?  This small task may seem inconsequential, but left undone it could be costly.

You must always be aware of and follow state specific rules and regulations in order to practice.  One requirement is to update the board anytime you have a change of address (COA).  Additionally, many states, like Idaho require a separate physician profile be kept up to date.

Idaho’s Patient Freedom of Information Act enacted January 1, 2000, requires health care providers to update the physician profile on an annual basis.  Please note that new profiles must be entered within 30 days of initial licensure.  If a licensee fails to provide full and truthful disclosure of information within the required time frame, the board may fine the licensee up to fifty dollars ($50.00) per day for each day the licensee is not in compliance.  The board may also take disciplinary action it deems appropriate, short of revoking, suspending, or refusing to issue or renew a license or registration.

A physician was recently fined $30K by the Idaho Board for not updating his IDACARE profile.  Another physician was fined $5K.  In both cases, the physicians were notified of the fines when they tried to renew their Idaho State License.  The board simply did not have their correct address to remind them to update their profile and they were not able to return to work until the fines were paid. 

You have worked hard to obtain your license to practice medicine.  Don’t take any chances; contact every state you are licensed in when you move.  If you are licensed in Idaho, we encourage you to review the entire Idaho Patient Freedom of Information Act and to visit the IDACARE website to enter your profile information.  If you have any questions, you can reach the VISTA Licensing Department at  800-366-1884.

Kathryn today!

Just a little story as I prepare for a three-week Indian Health Service locum tenens assignment in Tsaile, Arizona, near Canyon de Chelly:  The first time I hiked in Canyon de Chelly, seven years ago, our group found a little border collie dog near death under a tractor down in the canyon.  Long story short, we got her to a vet in Gandao who managed to save her from parvo.  And the next thing you know I’m calling my husband from Albuquerque to tell him: “Honey, I’ve got this precious dog we saved.” One call to Delta to add her on to the flight, a visit to Pet Smart for a carrier, and a bath at the hotel in Albuquerque later – she came home with us! We named her Kathryn after the Navajo woman who owned that tractor. Later that week my husband said, “I like the dog!”  And she’s been his ever since. She weighed 15 pounds then, was about six months old, and undernourished. Now she’s at 60 pounds and one of our joys – so I’ll give her regards to the Canyon when I’m in Tsaile!

P.S. Check out Blackhat Humane Society, http://www.petfinder.com/shelters/rezdog.html, a non-profit organization established in 2000 that is dedicated to rescuing and finding homes for abandoned animals and livestock. They are the only Humane Society on the Navajo Reservation (an area roughly the size of West Virginia).

We spent three weeks in Australia and enjoyed a wonderful dinner cruise in Sydney Harbor.

Happy New Year 2011! 

 It certainly does not feel like Christmas / New Year with sunset at about 10 pm and sunrise at 4 am here in New Zealand. Although the temperature is only about 80 degrees F it feels much warmer with the piercing sun – when it comes out. We just had three solid days of rain and gale force winds closing the airports in Invercargill and Dunedin. I survived the coldest winter with the greatest snowfall in the history of Invercargill over the last 60 years. The weather is constantly changing even in one day – might be 35 F in the morning and 80 F in the evening!

 The biggest news is that I am not returning to the US. I have applied for permanent residency in NZ and have accepted a permanent job here in Invercargill!

 I think that coming here has added 20 years to my career. Unless you have experienced it, I don’t think you can really understand what being in a kind, relaxed place is like. People are nicer. Patients and families say thank-you. Wait times can be four to six hours for minor cases on the weekends and there is not the anger and sense of entitlement that one sees in a US ED. There is a more collegial relationship among the physicians also.  I really like the people I work with. There is such a sense of camaraderie and mutual support – among all the staff.

 I also enjoy medicine much more here than in the US.  There is less diagnostic testing and more emphasis on history, physical exam and clinical decision making. At first I thought it odd that I had to discuss with the radiologist to obtain a CT or ultrasound but it actually helps and the limited hours of availability guarantees that only truly necessary scans will be obtained. There is a sonosite machine in the department and I have gotten decent with doing my own bedside scans. The registrars (like US residents) are trained to make clinical decisions and are comfortable with it. Abdominal pain that is unclear gets observed with serial exams. If still unclear, CT may be considered or alternatively a quick look laparoscopy.

Greg spent 10 days up north catching trout.

 There are openings here if anyone wants a break from the US ED! You can arrange your own job either here or in Australia, but for a short-term assignment I strongly recommend going through an agency . I went through VISTA (and so did several of the other US docs) and was very happy with what they did. The District Health Boards actually hire the doctors but you have to get a work visa, a license (annual practicing certificate from NZ Medical Board and a bunch of other paperwork.) The three other locum tenens ED docs and one internal medicine doc who I worked with who went through VISTA are all outstanding – and no, I get no kick-back from them! Plus, NZ is rated by the UN as the third best country in the world to live.

 Two of the US ED docs in three months have managed to go sky diving, bungee jumping, scuba diving, surfing and kayaking in the Milford Sound and then went to Sydney to celebrate the New Year which is a huge spectacular on the wharf there. They have also taken up fly fishing and been golfing with my husband, Greg.

Our Akitas, Miko and Katana, attract a lot of attention wherever we go.

Happy Festivus 2010 – Happy New Decade 2011!

I’ve been working as a locum tenens in the emergency department of a public hospital in New Zealand since April of 2010. The international phase of my EM career is going well. To keep my brain limber, I took and passed the Certified Wound Specialist certification. I took the test at the testing center in The University of Auckland. Now I can take care of your wound on any continent.

To match my flexible schedule, Linda volunteers at the local SPCA

My wife, Linda, not finding a position that has the flexibility to take off when I have off, has been volunteering at the SPCA in Rotorua three days a week.

While attending a trauma conference in Queenstown last July, we hit the beautiful slopes of Coronet Peak and The Remarkables every afternoon for my first ski experience. After each lesson, we hit the bunny slope like pros!

Skiing in July!

In August we flew to Christchurch to see the New Zealand All Blacks rugby team play the Australian Wallabies. We won! The perfect Kiwi experience. 2011 brings the Rugby World Cup to New Zealand.

By September we were sick of winter and went to Tahiti for 10 days for a warm, sunny interlude. We stayed at a resort on Moorea with the bungalarium over the water.

We escaped winter for 10 days in sunny Tahiti.

Early October we went to Wellington via Taupo and Wanganui. Wellington is named as the fourth top city in the world to visit in 2011 by Lonely Planet. We had a great time. For Halloween we learned the Thriller dance and participated in the Rotorua Zombie Walk.

For Halloween we learned the Thriller dance and participated in the Rotorua Zombie Walk.

In November we were off to visit Nelson & Blenheim. We took the ferry across Cook’s Strait to Picton to visit the region. From home that’s a six-hour drive to Wellington – 3½ hour ferry ride – 1½ hour drive to Nelson. We spent a day at Abel Tasman National Park. Fabulous! Thanksgiving is not celebrated here in NZ; however, we celebrated with turkey and all the trimming with some ex-pat friends from the US, a few Kiwis and a couple from New Caledonia.

This December we spent a week up north in the Coromandel peninsula. The limestone formations at Cathedral Cove were beautiful. It rained like crazy all week. But that didn’t stop us from seeing the sights. I’m pretty sure Linda was trying to kill me driving on that winding, gravel road with a cliff drop off to the ocean on one side and usually rock face on the other. Although she swears she was always on the road — I’m pretty sure a tire hung in mid air a few times!

The scenery was breathtaking--literally.

In January we plan on scuba diving at Poor Knights in the Northlands. It was listed as one of Jacques Cousteau’s top 10 dive sites in the world. Gotta see it!

In February 2011 we are going to Napier for a week at the beach and to see Sting in concert at the Mission Estate winery.

March will bring visitors. First our great friends from North Carolina will be here for 2 weeks. Then Linda’s cousin and her hubby will be next. They like biking so we are working on their route around North Island since they peddled South Island last year.

In between the bigger trips, we enjoyed Rotorua and made a lot of smaller trips to Auckland, Hamilton, and Mt. Maunganui.

From Khovd – Last day: September 21, 2010

The past few days have been focused almost exclusively on work, doing surgery, and not a lot else.  That we are almost at the end of our 10-day stay comes as a bit of a surprise, if for no other reason than it seems to coincide with the autumnal equinox and a significant drop in the temperatures, especially at night.  For that, I am glad that my long underwear and fleece keep me comfortable, if not a bit warmer.  This morning, I took a lukewarm shower in my room, which was 58 degrees F (14C). I think that something like hot water, which we take for granted at home, will be much appreciated for a long time.

I did a hernia repair on a three-month old the other day, and while the operation was not particularly strange to me, doing it in an atmosphere of such anticipation, with an audience in the OR of about 20 people certainly was.  There is not much pediatric surgery done here, primarily because of anesthetic considerations, but our anesthesiologist is skilled and comfortable with doing the little ones, and so we proceeded.  My instruments however, were not suited for children, and I did the best with what is available:  a huge surgical blade to incise, about the size used for autopsies, and dissectors almost as long as the baby himself.  It all went well, and everyone was pleased with the result, especially the mom and grandmother.

Because there were a number of surgeons visiting the Khovd Provincial Hospital for this project, we were asked if we might give up our free day on Sunday, and do surgery instead.  Of course we said yes, with the simple question being, “Why else did we travel all this way?”  It was a productive day, and with lectures interspersed with the surgery, we did get a lot done.

We just celebrated at final dinner together tonight at a restaurant hosted by the director of the hospital. While we all expected the usual mutton stews and its derivatives, to our amazement, ovines were nowhere to be found on the menu.  Instead, there was a small salad that included red beans, cucumbers, tomatoes and such, and a smoked whitefish that brought back all kinds of memories of family breakfasts.  The skin on this lake fish was quite tough, and the salt content made up for all the deficiencies in that department I have experienced in the cuisine here so far, but otherwise, it was identical to the usual smoked whitefish that is typical elsewhere.  In addition, the soup was served in a fish broth, and the entrée was a fried freshwater fish from local waters.  Who knew that fish might be part of Mongolian cuisine, after the past nine days of mutton and its variants?  Members of our group have eaten marmot, but that four-legged creature is a far cry from having scales.  Anyway, the fish was good, and we all enjoyed our meal.

Of course, no large meal in Mongolia is complete without the requisite toasts to the visitors, the hosts, the members, and all the other people who made the trip possible.  There was a nice turnout by all of the most important people with whom we had daily contact in the hospital, and I could see that there was a gradual acceptance of our presence around the facility that moved beyond what I had expected it to be.  As the nominal medical director of the group, I was called upon to make the first of the speeches, and in my remarks, I commented about something that was not obvious when we first arrived here. 

As I mentioned in my initial email in this series, the issue of sustainability has been sorely lacking in my other trips, where we have practiced “parachute” medicine, coming in an area for a few days, doing a lot of cases, and then leaving – giving a few people some surgical scars, but not much else.  Here our goal was to teach new surgical technologies, and we certainly did leave ideas, surgical techniques, and most importantly, I do believe that we stimulated significant thoughts about the art of surgery to those with whom we had daily contact.  Today’s one case might illustrate that best.  We set out to do a lap gallbladder on a 73-year-old woman who I had not seen prior to her being induced for surgery.  It was clear as well that the best two surgeons were also not well informed about her medical status.  Suffice it to say that sometime after we started surgery, but luckily before we had taken any non-reversible steps, the patient began to have a series of alarming cardiac events, such that I immediately terminated the procedure.  I think there was a lot of surprise at my decision, but it was clear to me that it was more important to have a live patient at the end of the procedure, than to have a gallbladder sitting in a bottle.  That I could make such a decision so rapidly seemed to make a big impression on the staff as well as the two surgeons, that in the end, I realized that we had all learned far more than any of us expected when we set out.  Stressing the need for a safe surgical approach, and helping the Mongolian staff to begin to achieve that, is truly a sustainable result of our trip, and in that regard, I think we might have accomplished far more than I expected.  In addition, in part as a measure of their confidence in us, we were consulted late this afternoon about a patient with an incarcerated inguinal hernia, and it was very clear that they wanted us to help them with the procedure, which we did, and all turned out well.  In a resource poor country such as Mongolia, the lack of physical items is only a small part of the whole picture.  That the people themselves are willing to work hard, recognizing what they have to overcome, this to me seems to be the most positive aspect of the trip, and if I have played any small part in it, it does make all the discomforts well worth it to me.

We leave for UB in the morning, planning to visit the main Buddhist temple, to take warm showers, to have dinner at the same Indian restaurant where we met the first night, and to leave for Beijing on Thursday morning.  I might write again before I return to the US on Saturday, but if I do not, please trust that my interest in doing a project such as this remains strong, and it is likely only to be circumstance that dictates where in the world that might be.  Stay tuned.

From Khovd – 73’s

Ivan