Medicine in Action (MIA) is a non-profit 501©3 global medical organization founded in the spring of 2006 by two like minded energetic doctors, Drs. Deborah Chong and Karolynn Echols. The two doctors knew each other from their residency training at Jackson Memorial Hospital, in Miami, Florida. They sensed each other’s desire for providing quality healthcare in impoverished countries around the world. It was this common interest that would eventually become the motivation behind the founding of Medicine in Action.
The inaugural mission took place December 2005 in Kingston, Jamaica led by Drs. Chong and Echols. Dr. Chong also traveled to Tanzania in December 2007 to set up a relationship with International Health Partners( IHP) By January 2012, we have made 23 medical missions to Jamaica, Tanzania and also Haiti. We have seen about 5000 patients, performed approximately 150 surgeries and screened thousands of women for cervix cancer. In Jamaica, we have expanded our time and effort and have built a pediatric team. We have partnered with the Franciscan Ministries through which inner city outreach clinics are organized; St. Joseph’s hospital, and Victoria Jubilee Hospital where we perform our surgeries, Port Maria Hospital and outlying rural clinics where we perform most of our cervix cancer screening program. We have also begun educational programs for residents at the University of West Indies. We would like to set up a similar program in Tanzania to help educate local doctors there as well.
You can email firstname.lastname@example.org
MIA’s board is comprised primarily of dedicated physicians from various academic institutions around the United States. However, non health care providers may also join us on our missions.
MIA accepts all volunteers regardless of whether or not they are in the medicalprofession. With the right attitude and willingness to help, we welcome your presence.
Yes, please contact us at email@example.com for potential volunteer positions.
Possibly- please contact us at firstname.lastname@example.org
Yes- please contact us at email@example.com for potential internship positions
MIA is mostly funded by private donations. We also have been awarded grants.
Please contact us at firstname.lastname@example.org for donations.
MIA is a 501c3 organization and donations are tax deductible.
Donations can be made in Jamaican dollars and US dollars only at this time.
We accept monetary donations, mileage donations and UNEXPIRED medical supplies.
Donations are used for costs associated with direct patient care or the student scholarship fund depending on YOUR designation. A small percentage of your donation is also used for administrative costs of running the organization. Your donations are NOT used for plane tickets, or room and board. Our volunteers are required to pay for their own way.
We work in places that are under-funded, under-resourced and destitute. As valuable as volunteering is, money is also necessary to support our efforts. An initial donation secures your commitment to the cause and helps fund missions.
Students are not asked to make a donation. Residents are only asked for $100
Join our mailing list to keep informed of future possible events by sending an email to email@example.com
Between 5 and 15 volunteers participate in each mission.
Missions are usually run by one or two of MIA’s board members.
Please see our schedule for upcoming missions.
We require a CV and two letters of recommendation to join our mission. A temporary licensing application may also be required to practice as a nurse or doctor. Lastly, we ask for a donation to the organization if this is your first mission with us.
MIA is a grass-roots organization run mostly by volunteers. Each medical mission costs between $5000- $10,000, the donations go towards covering these expenses.
We usually ask that you apply approximately 4 months before the mission you wish to participate in.
Maybe, we evaluate these circumstances on a case-by-case basis. Contactinfo@medicineinaction.org for more information.
There is no age requirement, but we do ask that volunteers do not bring their children unless they can also be unsupervised helping members of the team as well. If you are pregnant you may also consider not joining. MIA volunteers often work under extreme working conditions and it is important to consider your own physical health before joining us.
Costs run approximately $1000 to go to Jamaica (not including your donation) and $3000 for Tanzania.
In Tanzania, yes, it is on-site. In Jamaica, we find accommodations for the volunteers either in the hostel at Immaculate Conception Convent or at people’s residences.
Each mission ranges in length between 1-2 weeks.
You must stay for the entire mission.
We go on a mission four times a year.
Currently MIA does not conduct any research. Our focus is geared towards treatment and education.
You must make a one-time donation of $400 for non-medical professionals and $600 for doctors. We also have a list of suggested readings that we are happy to share with you. Please contact firstname.lastname@example.org for this information.
There is no set rule. You may accompany the group leaving from California. Others choose to meet in Miami on the way to Jamaica and in London or Amsterdam on the way to Tanzania.
Four to Six months before the mission: Update your CV and ask for two letters of reference to be sent directly from the letter writers’ email email@example.com requesting to participate in the mission. Your CV should also be sent in email format.
Four months before the mission: You will receive a packet from Medicine In Action about the mission to Jamaica. Fill it out in its entirety and send it and all of the supporting documents with notarized papers to our secretary Ann Leiber (whose address will be listed in the packet). These papers are mandatory for the Ministry of Health in Jamaica for all volunteers. Doctors and nurses must obtain a temporary license as well, the forms for which will be included in the packet (and are also to be returned to Ann Leiber). You may either include the requested donation for first time volunteers or donate online at our website. If donating online, please let us know.
One to three months before the mission: Start gathering supplies for the mission. A list of necessary supplies will be circulated via email. Those items should be considered first priority. If you have extra space after this, any other UNEXPIRED supplies may be included. At this time, you should also purchase your airline tickets for the mission to Kingston, Jamaica. You will be arriving at Kingston Norman Manley Airport in Jamaica. Try to schedule your arrival time during the day. Please do not schedule an arrival time after 6 pm (when it is dark).
Days to one month before the mission: Pack one suitcase with medical supplies and another suitcase with your personal items. You may be required to declare items, in which case you will likely be asked to open your suitcases. Keep an itemized list of your supplies and email a copy to Medicine In Action. (This way, if you need to leave supplies with the ministry of health, we can return the following day to pick them up.)
Mission materials: (make an itemized list of what supplies you are bringing just in case we need to leave your supplies with customs and return to pick them up the following day with the ministry of health.)
1. Supplies: equipment, requested medication, suture, instruments.
2. Patient educational and lecture materials
* Money– bring US$ with you and we will change it for you upon arrival. We suggest bringing about $200 for spending money (see below for answers about cost for lodging and food)
1. Insect repellent
2. Bathing suit
3. Beach towel
4. Three pairs of scrubs
6. Aqua socks
7. A long sleeved shirt (in case we go up into the mountains)
8. Ear plugs (in case your roommate snores)
9. An alarm clock
10. Your own surgical hat
11. Optional– sleep sac
12. Optional– tennis racquet
Scrubs and sneakers or OR shoes may be worn to the hospital. You may either wear scrubs or light pants and short sleeve shirt to the clinic (since it can be hot). You do not need to bring a white coat. For the night time you may simply wear shorts and a t-shirt. If we go into the mountains, or out to dinner, we recommend wearing a light sundress with a sweater or jeans, light pants and a light shirt.
A VISA is not required for US travelers to Jamaica.
Yes, volunteers are responsible for their travel and housing. Airline tickets to Kingston, Jamaica usually run approximately $500 round trip. We normally make arrangements to get you to and from the airport but occasionally (depending on the arrival and departure time) volunteers may need to pay for a taxi which runs about $30 one way. Housing usually costs around $30 per day and is inclusive of breakfast and dinner. Lunch is provided at the hospital. On most days, we pack our lunches for clinic and do the grocery shopping beforehand.
The housing is at a hostel in the Convent of the Immaculate Conception run by the Franciscan Ministries. Lodgings consist of a basic room with two twin beds and a bathroom. You will probably have a roommate unless you request not to (although it is a lot of fun).
There are surgeries and clinics with a typical day running from 7am to 8pm.
For the hospital:
6:00 – 6:15am – Wake up time for the surgical team.
6:15 – 6:30am – Breakfast.
6:45 – 7:00am – We leave for the hospital (otherwise a normal 20 minute ride can turn into an hour due to horrendous traffic).
Upon arrival – The first day – We sort supplies and see patients in the preop clinic in the hospital for surgery for the week.
– After the first day – We typically round upon arrival at the hospital and gather our supplies for surgeries for the day to be immediately accessible.
8:00am – 5:00pm – Surgeries.
5:00pm – We see our post op patients, gather information for the next day’s surgeries, lock up our supplies and leave the hospital for home (which can take up to an hour ride because of traffic).
For the clinics:
7:30 – 8:00am – Wake up time for the clinic team(s).
8:15 – 8:45am – Breakfast.
9:00 – 9:30am – Depart for the clinics.
10:00am – 5:00pm – Clinics.
5:00pm – We pack our supplies and head home.
It is important to be culturally sensitive. Things sometimes do not run on time and one must be willing to accept the delay without any issues.
Each clinic in Kingston is organized by a community leader. The community leader collects $100 Jamaican for each patient and uses this money to maintain each clinic. Usually we arrive to clinic around 9:30am and the patients are waiting to see us. A patient signs up for an appointment with the community leader who keeps track of the order in which the patients are to be seen. Many questions you have can be addressed to the community leaders (for example- where to find the garbage, toilet, etc…).
Some of our clinics are “make-shift clinics” whereas others are permanent. Typically, the clinics do not have supplies, so we must bring our own each day and restock at the end of each clinic.
Pap smears- These can be wrapped in paper, folded into the requisition and sealed with a rubber band or tape. Do not forget to write the name and date of birth on both the pap smear slide and the outside of the wrapped paper so it is easily identified.
The pap smears should be labeled in three places with name and DOB.
Patients who are given medications for chronic problems from our supply (ie metformin, HCTZ) should also be given a prescription in case they run out before we or another group returns. Please give at least 3 months supply of medications (excluding pain meds).
Patient education is one of the most important ways we can effect change! All patients should receive instruction and information on SBE, STD’s, contraception options (if appropriate), healthy diet and dietary needs specific to DM, HTN, and weight loss (if appropriate).
Consider spending the first 30 minutes of clinic giving short educational session, while some of the group are still setting up. Make sessions interactive whenever possible.
Ideas include: Patients who need mammograms should be referred to Jamaican Cancer Society. Patients who need to be referred to ER for acute problems should have a referral written on a prescription form. This should also be done for patients who are being referred to Specialty Clinics.
HTN- first line therapy should be HCTZ. If a patient is on HCTZ and needs more control, then give a beta blocker or Calcium Channel blocker. Diabetics should be on an ace inhibitor. HCTZ can be given out in abundance, since they are inexpensive. All others are second line, but be sure to give the ace inhibitors to diabetics.
Diabetes- This is very common in Jamaica and most of our patients have very little education on proper eating habits. Check fingersticks liberally, however, this can become very expensive. Sometimes patients will come to clinic just to get their glucose level checked. Before doing so, assess the need for this. Once in a while you will have a patient who comes in for a glucose check who is not diabetic but had it checked a few months ago. Educate this patient that she/he does not need another glucose check rather than wasting a glucose strip.
There is no specific medication required for you to take before or during the mission. If you are on any medications at home you should of course bring these and take them as regularly scheduled. Any medical issues i.e. pregnancy or illnesses such as HTN or DM need to be disclosed to the mission leader before the trip just in case.
There is usually one day for sight seeing but we do work hard.
Yes, we require first time volunteers to donate $500 if they are doctors and $300 if they are nurses, surgical or medical assistants or any non-medical personnel.
No, neither students nor residents are required to make the donation.
? Yes. You apply for your visa when you land at the airport. You will be required to get a work visa ($100) and a tourist visa($100 for US citizens). These can be purchased at the airport with cash. Credit cards are not accepted. MIA will reimburse you for your visa after the mission
Though this is not necessarily a comprehensive list, be sure to bring the following:
MIA recommends carrying HIV needlestick prophylaxis with you. It can usually be obtained through your health insurance for your co-payment fee. In some cases, members of the mission team can share (there should be at least 2 individuals with a month-long regimen on each mission).
The usual recommendations where HIV prevalence is high are Truvada and Kaletra.
Alternative regimens include: Truvada, Atazanavir and Ritonavir
or Kaletra and Combivir (though Combivir can have more side effects than Truvada).
Please note that most of these medications are good for about 2 years but need to be kept within a fairly narrow temperature range to maintain their potency. Be sure to store them between trips according to their specific instructions.
Clothes that cover your shoulders and your knees are the norm. You can wear scrubs in clinic and in the operating theater.
A translator will be available to help you communicate with the patients. These translators are usually either lay people in the community or nurses.
International Health Partners (IHP) is a Non-Governmental Organization in Tanzania that has been working to construct and develop a small regional hospital in Nyakato, near Mwanza (the second largest city in Tanzania). IHP is run by Paula and Denny Lofstrom and Mary Ellen Kitundu. Originally from Minnesota, their volunteer work has moved them to Tanzania, where they currently reside.
Thanks to a gift from the Lutheran Diocese of Mwanza, IHP is based out of a small office building that functions mainly as a clinic, but also acts as the core of this project. The building has one small operating room that runs on a generator and a functional lab capable of processing blood, urine, stool and some surgical specimens for basic patient care. A new patient ward has been built adjacent to the clinic and the other buildings under construction consist of an operating suite with 3 ORs, a maternal/child health center that will provide pre-natal care and some labor and delivery services. Presently, this clinic has one medical officer who sees about 40-50 patients a day.
Be aware that there are subtle differences in the way people speak with one another and communicate non-verbally. Though it is challenging to recognize what is a cultural convention, it is important to note that non-verbal communication queues differ from than those our own culture. In general, Tanzanians tend to be modest and shy. We must adapt to these differences. Women do not wear clothes that show their shoulders or their knees. Often times they also will not want to be seen by a male physician and may have trouble expressing themselves to a male provider.
Go slow and spend a lot of time with each patient. Remember that quality over quantity is the key. Ask questions more than once in different ways. Oftentimes, the patient (and possibly the translator) will not understand the first time around.
Tanzania is a resource-poor country. Many things that we take for granted here in the United States in our clinics and ORs are not readily available in Tanzania. Oftentimes, these can be unexpected things. For example, certain medications, gasoline for the generator to run the anesthesia machine or extra OR lights may not be readily available. It is also possible that we run out of certain reagents to run basic lab tests, making these tests unavailable for a few days.
It is also important to keep in mind that the clinic’s infrastructure is not used to supporting so many healthcare providers. We can easily “overload” or overwhelm a system that is already strained due to lack of resources. For example, our team usually provides free HIV testing for all the patients we see. Normally the lab functions with two techs. Ordering an extra 50 HIV tests on top of the usual days work can be very stressful for techs who are not used such volume. MIA tries to alleviate this burden by hiring temporary nurses and translators.
Expect the unexpected. We are used to working in the United States where things run very smoothly. This is not the case in the developing world. Something unexpected occurring is usually the norm and often affects the “flow” of seeing patients. Systems based practices can be a bit difficult as well. I have noticed that when we try to create a “system” or “method” for seeing patients, not everyone will be “on board” with the system and so everyone still ends up doing things their own way. It’s best to just go slowly to make sure you don’t miss anything, keep track of your own patients.
Patients check in at the front. They pay the equivalent of approximately $2 US to be seen. When our team is present, we pay for all their lab work but the patients must pay the $2. This helps keep the clinic operating. After being seen, if a patient needs medication, there are two ways of getting it. Firstly, if our team has the medications then we give it directly to the patient. Secondly, if this is not the case, prescriptions can be filled at the pharmacy on site.
Yes, on the prescription, please write “charge to MIA” so the staff will know not to charge the patient.
To order labs, please fill out a lab slip. Again, be sure to indicate on the slip that this patient is being seen by our group, MIA, so they are not charged.
At the present time, we are the only US based team that uses the operating room. We have trained Maria Seleman, a local Tanzanian in training to become a scrub tech, to take care of the OR and sterilize equipment. There are no other OR staff, thus we must ensure that we thoroughly prepare the OR and the patient ourselves before surgery. Mary Ellen, President of IHP and head of the clinic, is also with us during surgery overseeing and helping us with whatever needs to be done in the clinic.
We try to schedule surgeries in a way in which we can alternate trays, e.g. one major and then one minor, so that we don’t have to wait for the sterilization process to be complete. (After surgery, Maria will wash the instruments and sterilize them for the next surgery.)
The OR is run by electricity and by a generator.
In the OR it can be 110 or 220V. Be careful when plugging equipment in to the wall sockets. If you plug something into the wall that requires 110V into a 220 socket- you will burn it out and we will not be able to use this equipment and perhaps we will not be able to do surgery.
A sono-site ultrasound is available. There is only an abdominal probe. The probe cannot be easily replaced in Tanzania, so it is important to be extra careful when using the machine. We do not charge for ultrasound services though the medical officer does. Time permitting, consider sharing your knowledge of pelvic ultrasound techniques with the medical officers. Remember, part of our mission is to provide sustainable improvement to the clinic’s services so they are able to continue smooth operations in our absence.
At the current time we have one TAH tray and one BTL tray.
THINK BEFORE THOWING SOMETHING IN THE GARBAGE: Many things that we think are disposable in fact, are not. For example, the blue paper sheets that are used to wrap instruments for sterilization are re-used. Blue or green towels are reused. Lap tapes are washed, bleached and reused. Some plastic items can be reused as well. When in doubt, you can ask Mary Ellen or any physician who has already worked there, e.g. any MIA board member should know.
– You are responsible for more of the prep work than you are probably used to (see What is the team responsible for?)
– More instruments are re-used. For example, many plastic items such as speculums can be washed, sterilized (by cold sterilization techniques) and re-used. Please check with any of the staff members, Mary Ellen or an experienced volunteer team member. (see What can be reused?)
The only tests available are RPR and HIV. Therefore if either of those returns a positive result, then empirically treat for gonorrhea and Chlamydia (with cipro and doxy; or treat with ceftriaxone and doxy if PID).
Infertility and pelvic pain is common. Many adnexal masses may be hydrosalpinx. It may be worth a try to treat with antibiotics before taking someone for surgery. If the pain is still present, we can do surgery on the next medical mission.
(1) It is the correct patient and correct procedure- we have implemented our own time out.
(2) Our own counts- we keep track on a counts sheet.
(3) Ensuring that the patient’s labs are in order before surgery, the H&P is done, and the patient understands the procedure. (We have created a pre-op checklist to confirm that all important elements are completed and reviewed, e.g., pregnancy tests, heparin, antiobiotic prophylaxis.)
(4) The staff is responsible for ensuring that there is enough gas in the generator, but it is also our responsibility as surgeons to ensure before we start the day that the generator is full.
We take some of this for granted in the United States as we have a support staff of nurses and other OR personnel to help us. At Nyakato, we must do most of this for ourselves. It’s important to go slowly and not rush or we may miss something important.
Our guest quarters are either in small guest houses or in a hostel, depending on where each person is assigned. (For cost, see What does room and board cost?)
Breakfast is at 7:30am at the house of Paula and Denny (they run IHP). We arrange our lunch and dinner meals with Lucy, a local chef. (For cost, seeWhat does room and board cost?)
Room and breakfast is approximately $10/night. Lunch and dinner is approximately $5 each.
There is one dial- up guest computer that is at Paula and Denny’s house. Internet in Tanzania is not a flat rate like in the United States- it is pay as you go. Therefore guests are expected to contribute to the “pot” to keep the internet running. At your discretion it should be approximately $5-$10 or 5,000-10,000 Tanzanian Shillings(Tsh).
There is indoor plumbing, but you must follow certain guidelines regarding the toilet. If it’s yellow, let it mellow, if it’s brown, flush it down. Do not put toilet paper in the toilet. It goes in the trash bin. There is also a place to put this trash on the grounds of wherever you are staying and it is burned every so often. Organic trash is also in a separate bin.
In Tanzania, we are usually supplied with a local cell phone. You can have your family call on this if you want. Receiving calls is free on a cell phone, but to make calls, we buy phone cards to add money to the cell phone.
Please check with your cell-phone provider regarding your plan and rates internationally.
There are a few bars and restaurants around town. If we want to go out, we are required as a group to pay for the gas as well as pay the drivers (either Sele, Magola or both). Petrol is very expensive in Tanzania, but if we each pay our share as a group, it usually works out to a few dollars each. Sele and Magola work for IHP and typically have the nighttime off. Therefore, we must always ask them first to see if they are willing to drive us. Paula does not like us to take taxis from people we don’t know.
Yes, you can purchase a wide variety of souvenir items of high quality in Paula’s store at the health center. The proceeds from her store help support both the health center and the local craftspeople. In the past, many volunteers have used the suitcase originally containing medical supplies and filled it with souvenirs to bring home. Hand-made baskets, jewelry, African print material and sculptures are very popular. The prices at the store are very reasonable and I have not found anywhere cheaper in Tanzania.
For some people that have not previously traveled to a developing country, it can be eye opening and at times disturbing or overwhelming. It will almost always be challenging. Things will seldom go as planned. You can COUNT on the unexpected, often with things that just seem routine to you. We place a premium on timeliness and schedules in the US. This is not always the case in other places, and it down not always hold the same high value to people you will work with in other cultures. We are the ones who must be flexible, as guests. When approached in this manner, your mission experience can be extremely rewarding and something you will get “hooked” on quite easily .Be aware that this can also be stressful to the health care provider, even when it is a positive experience. Try to notice your own signs of stress early on, and take care of it. Try not to wait until you are frustrated, or physical or emotionally exhausted. If this is your first mission, seek out someone who has more experience. Remember, we are a TEAM. We are there to provide help to others, but also to support one another.
It can often feel overwhelming as a health care provider when confronted with what you can or cannot provide in these situations. All things CANNOT be fixed. “Quality” can be relative and cannot always be comparable to previous standards of “quality” at home. Replacing “quality” with “quantity” may be tempting at times to bolster feelings of accomplishment. However, you must remember that overstretching your capabilities and pushing yourself to physical and/or emotional exhaustion can have unintended consequences. Try to slow down, take a breath and enjoy your mission. By taking care of yourself, you will be better equipped to take care of others – and that is where true accomplishment lies.