How can I combine GP work with humanitarian aid?

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Many GPs are drawn to do humanitarian aid work. It's a natural extension of the vocational aspect of being a GP.  Some GPs have chosen the locum career path particularly with humanitarian aid work in mind: it gives the doctor the broad skill mix often needed in resource-poor environments as well as the flexible working pattern to allow you to keep a foot in the UK while being free to travel abroad.  But while many GPs are tempted to do this kind of work, "how do I get started?", is a common question.

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Things to consider

Working overseas comes in all sorts of shapes and sizes.  "Missions" (periods of time) in what is colloquially termed "the field" come in differing periods of time varying from one week to several years.  Longer periods of time allow the doctor to learn more about the culture and infrastructure in which you work and potentially enable you to make a more meaningful contribution.  However shorter missions that are well set up and supported may be equally valuable.

Other factors include whether you have the appetite to work in zones devastated by insecurity or war, whether you are looking for clinical or academic work or even managerial work and whether or not working for a faith-based organisation is for you.

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Tighter restrictions on performer's lists, appraisal and revalidation mean that spending years in the field make it likely that GPs will need to apply for a returner's scheme if and when settling back in the UK.  Debate goes on about what constitutes a minimum number of sessions to practice. The RCGP has produced a 'mythbuster' document on their position over appraisal and revalidation.  A minimum of one NHS GP session per year plus an annual appraisal should be sufficient to remain on the performer's list.  Those out of clinical NHS practice for 2 years will be required to apply to the Induction and Returner Scheme.  Many Responsible Officers feel that doing one session per year for more than one consecutive year, is insufficient; therefore it is wise to check with your local appraisal team if considering longer periods abroad.

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Finances also need planning.  Most first-time missions will be as volunteers, meaning you may be entirely self-funding or else paid a minimum volunteer stipend.  Bursts of locuming when back in the UK are an ideal way to cover expenses.

Both academic schools of tropical medicine in London and Liverpool offer 3 month diplomas in tropical medicine.  These can be highly informative, fun learning and a very good way to network with other like-minded doctors as well as find opportunities. For those committing to longer missions, one of the diplomas is very worthwhile.  Christian Medical Fellowship also run an annual two week course.

Ask yourself if you are in sufficiently robust physical and mental health to deal with the long hours and often harsh conditions of this type of work.  Some postings will allow you to take your family while others are advertised as "unaccompanied", (particularly anything in a war zone).

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Opportunities

These are numerous but may not be obvious (think beyond BMJ careers) and require a bit of probing and persistence.  Here is a (non-exhaustive) list.

VSO (Volunter Service Overseas)

VSO recruits volunteers for long term placements (1-2 years) in stable but resource-poor regions.  Usually GPs combine clinical work with some form of training or development.  Accommodation is usually equivalent to that of a local doctor with a local salary provided.  This can be a great opportunity to get to know the community, unlike less secure postings where workers are required to live and work together in guarded compounds, leaving only by vehicle.

The RCGP now partner with VSO for some placements.  Further details are on the RCGP International page - which also details other opportunities.

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Medicins Sans Frontieres (MSF)

Highly respected amongst other humanitarian aid agencies for their effectiveness in crises and good security, MSF require a minimum of 9 months commitment for a first posting, as well as a diploma in tropical medicine and at least 3 months experience of working or travelling in a developing country.  Following a first mission, doctors can then commit to shorter postings.  Most of their work is in areas of insecurity, either due to war or natural disaster.

Dr Rose Ansorge tells more about her experience with MSF in Chad here.

Primary Care International

The social enterprise arm of the Red Whale (formerly GP Update) courses, this delivers training and project support in mental health and non-communicable diseases in developing countries.  Placements are usually for short periods of travel but with an ongoing commitment including some volunteer work while back in the UK.

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International Committee of the Red Cross (ICRC)

Another agency focussing on regions of armed conflict and natural disasters, they advertise on their website for primary health care doctors in the field as well as those doing visits to "detention centres" (prisons).

Other ideas

Plenty of GPs have secured international work via smaller organisations.  These are not usually advertised - word of mouth is best.  Dr Farida Bhatti volunteered in the Mediterranean refugee crisis in Lesbos while Dr Hajra Siraj trains health workers on the Thai-Burma border.   Many GPs have volunteered with Doctors of the World, either in the European refugee crisis or further afield.  They are not currently recruiting on their website but it's worth keeping an eye on them.

And finally

Remember to speak to your indemnity provider before you go.  Some will cover you for free whereas others can be more picky these days.

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Other useful links

GP opportunities in international health Facebook group

RCGP toolkit for GPs working abroad

Alma Mata network for those interested in global health

A GP volunteer in the Syrian refugee crisis

Claire 10(1)

Dr Claire Davies

GP and editor of the Network Locum (now Lantum) blog

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