FTC Volunteer Resources

Face the Challenge Volunteer Guide

The Face the Challenge Mission for Short-term Volunteers exists to provide free facial surgeries and medical care for people living in the least developed low-income countries of the world. These countries have the lowest life expectancy, the highest infant mortality and population growth rate, the lowest GNP, the lowest access to healthcare, and the lowest number of healthcare workers.

FTC currently exists mainly to build surgical teams of healthcare volunteers willing to travel abroad for one- to two-week missions. This mission is a noble one, but all volunteers must have realistic expectations about such trips. During these trips communities in developing countries gain from the skills and knowledge of our health specialists. The volunteers, in turn, benefit from their experiences abroad in impoverished settings. Be mindful, however, there are pitfalls in such an approach. FTC teams often go on transoceanic trips, crossing several time zones. Adjustment to new time zones and very different cultures can be hard even for the most fit and prepared team members. A large percentage of the trip time is necessary to acclimate to the new settings. Thus, repeat volunteers can help new FTC volunteers in these transitions.

Short-term volunteers must be aware of the fact that some foreign hosts perceive them as only a hindrance, taking more and giving less. Therefore, even though Western volunteers generally may be more skilled and highly motivated, they must be sensitive to their potential negative impact on the host medical staffs. FTC desires that all volunteers try to keep their demands on the hosts to a minimum. In order to have the most positive outcomes possible, it is, therefore, incumbent upon the volunteers to be well-prepared for their trips, understanding well FTC's scope and purpose as they become an extension of our overall organization.

The Ideal Face the Challenge Volunteer

FTC is looking for team members who are:

• well-prepared with realistic expectations (not naive)
• flexible and resourceful; have a sense of humor
• team players and collegial (willing to teach and share)
• confident, yet humble
• organized and punctual, both in meeting deadlines before and during the trips
• service-minded
• mentally, emotionally, and relationally stable; not trying to "find themselves"
• able to respect boundaries
• culturally sensitive (e.g. historically, traditions, social and political climate, health care)
• gracious in receiving gifts from the hosts and patients
• bi- or multi-lingual, if possible
• experienced in international travel or working with foreign cultures
• good listeners (it takes 2-3 times the normal effort in a foreign country) and observant
• in good to excellent health and safety conscious
• Internet savvy, who can explore pertinent trip-related topics on their own
• and be able to process FTC-sent correspondences

Further, the types of health care specialists FTC seeks include:

• Surgical Specialists (Pediatric and Adult) in:
  - Oral and Maxillofacial Surgery
  - Craniofacial Surgery
  - General Plastic Surgery
  - Otolaryngologic Surgery
  - Head and Neck Reconstructive Surgery
  - Oculoplastic Surgery
  - Neurological Surgery
  - General Surgery
• Anesthesiologists (Pediatric and Adult)
  - Nurse Anesthetists
• General Dentists
• Pediatricians
• Dermatologists
• Registered Nurses (e.g. Preoperative, Recovery, Critical Care, Pediatric, Neonatal)
• Physician Assistants
• Surgical Technologists
• Pharmacists
• Nutritionists (e.g. preoperative nutrition, malnutrition, protein deficient anemia)
• International lactation/feeding specialists
• Speech Pathologists
• Anaplastologists/Ocularists
• Genetic Researchers

Other healthcare specialists are also considered on a case-by-case basis.

All of the above volunteers must be in good standing with their licensing boards and be board-certified in their specialties, if offered. Basic and Advanced Life Support, Pediatric Advanced, Advanced Trauma Life Support, Pain Management, etc. certifications are also highly valued.

Many of the FTC team members have at least five years, but more often greater than 10 years, of experience in their specialties. If a volunteer is a surgical resident, he/she must be traveling with a board-certified surgeon from the same specialty team.

FTC will also consider possible team members who are:

• Play Therapists
• Childhood Development Specialists
• Translators
• Culture Specialists
• Religious Leaders
• High School and College Students
• Community and Business Leaders
• Writers and Photographers FACE the Challenge's Standard of Health
• Care provision

Whenever it is practicable, FTC strives to maintain the same standards of care as are established in the United States. We, therefore, do not authorize tea members performing procedures they are not trained to do in the US. We also will not employ any procedures, nor administer any medications, nor apply devices that are not approved by the Food and Drug Administration (FDA). We also take the position that if the host health care staffs have not sufficiently demonstrated a working knowledge of a new procedure or in administering any type of medication brought by the FTC teams, we will not give the tools or medications, for example, to do so. Although our goals are to teach and provide medical/surgical care, insofar as we are able, we will not compromise these standards in any way that would endanger or harm the patients we encounter.

Comments About Culture Shock

To varying degrees, FTC team members who travel abroad experience culture shock. This condition is comprised of more pronounced reactions to the psychological disorientation most people experience when they move into a culture strikingly different from their own. Signs of culture shock are:

• Homesickness
• Withdrawal
• Irritability
• Stereotyping of and hostility toward the hosts
• Loss of ability to work effectively and physical ailments

Culture shock is a cyclical phenomenon, with the volunteer experiencing at least two "low" periods during the course of his/her time abroad. This condition is also staged as follows:

1. initial euphoria;
2. irritation and hostility;
3. gradual adjustment and a level of comfort with the culture; and
4. adaptation.

We ask that prospective FTC team members consider their own culture first in order to combat the subsequent culture shock. Foreigners has described Westerners/Americans as outgoing and friendly, and sometimes these traits are perceived as rude and informal. Americans are also viewed as hardworking, lavish, wasteful, know-it-alls, hurried, and disrespectful. FTC volunteers must be aware of cultural differences where they travel, in order to work well in close contact with others where expectations and values are not the same.

Another approach to confronting culture shock is to learn as much about the destination country as possible. Some of the countries where FTC teams go have citizens who are isolated and oppressed. Most FTC team members react significantly to such settings. It is especially important to be well-informed about, for example, being under the authority of communist officials. Volunteers must be cautious about how they conduct and express themselves where such governments rule over their citizens much differently.

The bottom line is to remain realistic, with perhaps lower expectations. Be flexible and allow for tolerance. Laugh and keep an adventuresome spirit.

As is always true, FTC team members will encounter glitches and challenges, regardless of how well they are prepared. These members do make a difference in the lives of those in need, but perhaps on a measurably smaller scale in painfully slower ways.

Reference: Robert L. Kohls, Survival Kit for Overseas Living, pp. 65-66. Some Tips for Volunteering Overseas

The concept of volunteering is one familiar to Americans. But in some countries, there is no word for "volunteer" in their native tongues. Be mindful, therefore, that some people may receive you with suspicion; perhaps there is an ulterior motive to what you are doing in their homeland.

At the same time, you may not understand the local host health professionals' ordering of events and priorities. Remember it is their prerogative if they opt to arrive late to the clinic or leave early to do other activities. Many of these health care providers must maintain private practices or hold other jobs, in addition to the roles they have at the clinics you visit. They may be every bit as concerned as you are in assisting those in need, but they may also have to do extra tasks to provide for themselves and their dependents.

Be prepared for health care settings that perhaps are not as clean as what you normally encounter. They will most likely be overcrowded as patients and loved ones spread out in whatever space is available. Other common conditions include a lack of reliable plumbing, water sources, and cleaning supplies. As circumstances allow, your example of good techniques for hygiene and minimizing contamination may become valued. You will have to choose methods, however, that preserve the hosts' and patients' sense of self-respect and avoid situations that cause undue embarrassment.

When you are faced with patients who are especially in dire need and have complex surgical and/or medical needs, please remember the "big picture". Consider such questions as:

Will recovery or care demands be too great for the local health care providers? Are the proper medications, equipment, supplies, technologies, etc. present and in the necessary amounts for whatever the cases demand? What about the special requests for treatment not part of FTC's mission or beyond the scope of the FTC team members? Do FTC teams do cosmetic surgery for the hosts' family members or communist party officials?

Each of these questions must be addressed as FTC volunteers try to strike a balance between functioning within the parameters of the mission and patient safety/promoting goodwill overall.

It is everyone's desire to improve the lives of the people with whom FTC teams come in contact. But FTC volunteers must be very careful not to raise hopes unfairly or state or imply promises that FTC cannot keep. Reassure the hosts of an ongoing commitment to helping through future FTC teams if that, in fact, is what FTC as an organization intends to do. The best rule of thumb, if in doubt, is to have the FTC team leader be the spokesperson and the team translator reliably convey such information.

It also is a precarious position to tell hosts the values of the items teams bring for use among or donation to the host providers. In some cultures, the native physicians expect that humanitarian organizations bring even more supplies than on previous trips. The hosts expend much personally to host FTC teams. Thus, some do not hesitate to ask for supplies and are offended if we do not meet their expectations. Some FTC teams have even had supplies not intended for donation impounded. Then some very delicate diplomacy ensues to get them back. This misunderstanding may not be well-received at all and dynamics may change.

Finally, approach your trip with a high level of curiosity and sensitivity. Use all your senses to appreciate this unique experience. Try to see yourself through the eyes of your hosts and the patients. Mutual respect will be the best path to learning, helping, and teaching.

Issues to Consider

Passports/Visas: Every FTC team member must have a valid passport about 4 months prior to departure. Please check to make sure if your current passport has expired or is about to expire.

It is often necessary then to obtain group visas, usually 2-3 months prior to departure. This process requires that all team passports be submitted at the same time from one original location. Once approved and barring delays, the passports and visas will be safely returned to the team members at a reasonable time prior to the scheduled departure.

Trip Expense/Fund-Raising: FTC requires that all its team members raise their own support, an expense that is 100% tax-deductible, usually due in full 4-6 weeks prior to departure. FTC works with value-sensitive travel specialists who coordinate the travel and accommodations and FTC usually benefits from discounts and group rates.

Taking Spouses and Other Family Members: FTC does include some spouses, especially if medically-trained, and mature family members on some surgical trips. This decision must be approved by FTC and there are several factors to consider, such as the location, accommodations, flexibility, and skills of the spouse or family member. We are very sensitive to how each additional team member may become a greater responsibility or burden to the hosts. But, the presence of such a person may also be a wonderful asset to all concerned. Please contact FTC for guidance regarding such a possibility.

Local Politics/Government: FTC takes a clear position about its beliefs and values, but FTC as an organization and it team members should remain neutral regarding their opinions about the local politics/government. All people concerned, both the hosts and FTC team members, may be embarrassed, or worse still, endangered by comments made by FTC team members (publicly, by phone, FAX, e-mail, etc.). Such comments must be reserved for post-trip evaluations or conversations with others upon return to the US.

Equipment/Supplies: FTC makes every effort to inform its team members of the amounts and types of equipment, supplies, and medications that will be used prior to their travel abroad. FTC may also seek FTC team members' advice regarding supplies orders for upcoming trips. Sometimes FTC desires to offer state-of-the-art technologies, but FTC teams may be limited by conditions that exist abroad. FTC tries to create the best available scenarios of supplies and equipment best suited for the host clinics' present conditions.

Maintenance, electrical systems, and access to spare parts, for example, may dictate that FTC teams use older, sturdier, less complex equipment.

Licensing Requirements: Some sites where FTC teams go may require documentation about the team members' educational and professional backgrounds, especially if visas are required. Understandably, host institutions need the assurance that FTC volunteers meet appropriate licensing and credential standards. FTC will notify team members of such specific needs.

Medical Evacuation/Travel/Trip Cancellation Insurance: FTC now requires this insurance for all team members, an expense which is included in the total trip expense. FTC currently uses International SOS Assistance, 1-800-523-8662, www.intsos.com, and will order the policies for each of the team members prior to the surgical team's departure.

Liability Insurance: Liability insurance has not been an issue yet, however, FTC will notify team members if such a need arises.

For additional information related to team membership, please see FTC's additional forms to be completed and signed by FTC-approved team members.

Returning Home

Returning home can be the most stressful experience for FTC team members, especially if such a trip is their first one. Culture shock upon return may even be greater than what the team members experienced abroad. While abroad, team members logically would expect their experiences to be different. But if they return home, a place of familiarity and sameness, and they may find that they themselves have changed, others may not be as receptive to their desires to talk about their surgical experiences abroad. The people they knew before they left, their loved ones and colleagues, will have continued in their lives without such significant personal changes. Effective "processing" after such a trip depends upon the team members' own preparations for this period and how much those they love and trust express their concern. All of a sudden the Western lifestyle may be distasteful to the team members.

Perhaps anything symbolizing wastefulness will have lost its appeal. These team members will have seen poverty at its worst and will have emotionally connected with these people whose lives hold little hope.

It is very natural for the FTC team members to want to talk about these experiences and emotions. Team members may discover that their friends will not be as interested in hearing the details of the trip, only the cursory highlights. But what the team members may really need to share has to do with economic depression, poor health conditions, malnutrition, pollution, illiteracy, and social inequity.

All people cope with such conditions at some point as they are exposed to them through various media. But they may opt to employ such defense mechanisms as denial, for example. Thus, such a numbing reaction may limit friends' and colleagues' abilities to empathize with the FTC team members who return.

Sometimes conflicts between these groups arise as differing values are confronted. Some team members may then choose not to talk about their experiences, or at least limit their responses to just a few superficial thoughts. FTC team members may next feel lonely and depressed since they may not be able adequately to share about their foreign experiences.

On the other hand, those team members who succeed in coping with their re-entry usually do so when they can integrate their experience into their home lives. FTC, therefore, recommends that team members communicate with other FTC team members or others who have had or will soon have similar experiences. Keeping a journal of thoughts have helped some members as well. Some other team members gain from the re-entry strategy of presenting to groups interested in learning about their travel experiences. This way they can channel their excitement for surgical and medical missions abroad to those who share common interests.

FTC encourages team members to contact the team leader, its Executive or Assistant Executive Directors, or Board members upon their trips' return to express anything they desire regarding their experiences. FTC appreciates such information, especially since it alerts the organization of any concerns and can help FTC make any necessary changes. If team members recognize that they are having more serious problems in the re-entry process, FTC encourages them to seek the help of mental health professionals or those trained in dealing with stressful life experiences.

General Reference: Cobey, MD, MPH, James C., Author, and Nancy A. Kelly, MHS, Editor, A Guide to Volunteering Overseas, Health Volunteers Overseas, 3rd. ed., pp. 3, 11-18.

What Can FTC Team Members Expect to Gain?

Generally, FTC team members return to say they "got more" than they gave. They observed people in need who, still self-respecting, generously offered themselves and their humble gifts to the team members. They saw intelligent, host health professionals creatively using whatever resources available to them.

They watched treatments and procedures employed, not necessarily standard to the Western mind, but somehow still they were effective. They offered their own surgical and medical skills and showed acts of compassion that they did not even know were within their capacities. They found courage in the midst of fear. They witnessed high levels of pain and suffering, yet did not always hear expected and "rightful" complaining. They listened and understood, yet without understanding the words. They taught others by doing.

First-hand, they saw different cultures, customs, and attitudes, all of which impacted the health care of patients. They became advocates for better health care and international development. But they also learned to pray harder than ever for the oppressed and forlorn.