N Balachandran Lecture 2002

Volunteerism in Orthopaedic

Dr Fareed Kagda

Introduction & Background

Modern orthopaedic practice is increasingly demanding and can often be frustrating. Ever-advancing technological progress, though exciting, keeps us further removed from our patients. Litigation, excessive paperwork and documentation keeps stress levels high. Faced with hospital administrators who focus on the bottom line and the ‘customer’ being always right, we orthopaedists often re-examine the motives that made us take up the challenge of becoming a doctor and surgeon in the first place. This disillusionment with practice can creep in initially unnoticed, especially given a surgeon’s busy schedule and long hours.

Volunteerism is one way to combat this stress and disillusionment. Volunteering one’s professional services to help the less fortunate or those with no access to modern orthopaedic care can help remind us of and refresh the ideals that started us on the medical path. The genuine gratitude of such patients has been likened to manna for the soul, something to be cherished. The challenges and the rewards of volunteer work will stimulate our minds, broaden our horizons and change our perspective, not only on orthopaedic practice, but also on life in general. It will force us to re-establish our principles and priorities. Volunteering our professional services will make us enjoy our practice and give us a profound satisfaction in life. The designation of 2001 as International Year of Volunteers raised the awareness of volunteering as well as the plight of peoples less fortunate around the world.

What is Volunteerism?

Webster’s English Dictionary defines volunteering as "to act or do of one’s free will without consideration of value or legal obligation". Volunteerism is the art or practice of doing volunteer work in community service. Volunteer work can be done locally, regionally, or internationally. It can be given in a personal capacity—for example, organising an outing for children from the local orphanage or helping the elderly who stay alone at home by befriending them—or can be performed in one’s professional capacity, through offering orthopaedic care to the underprivileged or for those who have no access to orthopaedic services. It is this latter specialized care that is within our privileged hands to offer, and it is this specialized care that many lack, either because they are unable to afford it, or have no access to it—and often both.

Early exposure to volunteering is believed to promote a lifelong commitment to volunteerism (1). In different stages of our career as orthopaedists, we can offer different levels of orthopaedic volunteer care, with differing levels of involvement. For orthopaedic trainees or residents, this may be difficult as their time is often not their own and paid leave is difficult to obtain. However, one way around this is to include volunteer activities as an elective, or as an integral part of training—with adequate supervision, of course. For those of us building up our practice, time is scarce. However, volunteering services for a fixed time once a month or supervising volunteer activities of residents is easily achievable. Towards the end of one’s working life and after retirement, full-time volunteer work is an admirable way to occupy one’s time.

Volunteers can play numerous roles. A volunteer can be a patient-care provider, a mentor to those who want to volunteer, or an advisor on volunteer activities and organisation, teaching basic orthopaedic care to general medical personnel who look after patients in their region. This can be for 4-6 weeks a year, regularly once a month, for an extended period, for a few months at a time or full-time for a year.

The situations in which orthopaedists can volunteer their professional services are just as varied. They can volunteer locally at welfare organisations as a medical advisor or run free orthopaedic clinics for the members of these organisations. This work can be done overseas, at remote locations where sometime even basic orthopaedic care is lacking, such as in community hospitals with only the most basic facilities. They can provide expert surgical care and advice in major hospitals in countries with rudimentary health care. They can participate in disaster relief missions on an ad hoc basis. Semi-permanent or permanent missions to remote rural areas that do not have access to medical facilities are another area where volunteers are needed.

Why Volunteer?

"I solemnly pledge to dedicate my life to the service of humanity." Sound familiar? It should; it is the first line of the Singapore Medical Council’s Physician’s Pledge "promised freely and upon my honour" by all physicians in Singapore. This is similar to the World Medical Association’s Oath, "At the time of being admitted as a member of the medical profession, I solemnly pledge myself to consecrate my life to the service of humanity." This is the prime reason to volunteer.

There are many other reasons for volunteering: learning new skills, returning to society some of the benefits society gives to us and sharing with those who have less, to name a few. Volunteering helps us meet people, learn new cultures and breaks down barriers of misunderstanding, mistrust and fear. It shows that we care. It makes the world a better place. It allows the achievement of a certain satisfaction in life.

Benefits of Volunteerism

Volunteerism has many benefits, for the individual, the community, and the country. Studies show that volunteer work enhances the six aspects of personal well-being: happiness, life satisfaction, self-esteem, sense of control over life, physical health and reduction of depression. The converse is also true, that people who have a greater sense of well-being invest more hours in volunteer service (2). For those who are retired or are about to retire, studies show that older volunteers experience greater increases in life satisfaction over time as a result of their volunteer work than younger adult volunteers, especially at high rates of volunteering. Also, older adults experienced greater positive changes in their perceived health than did younger adult volunteers (3).

For the individual orthopaedist, the main benefit is a sense of personal satisfaction. Volunteering fosters a caring surgeon and inculcates values of selflessness, concern and empathy towards fellow human beings. It broadens horizons and awareness of the world and its problems. It fosters critical and adaptive creative thinking. It lessens the dependence of young surgeons on high-tech tools. In this way, it will reinforce the basic clinical skills of history taking and physical examination. It will bring the volunteers closer to their patients.

For the orthopaedic community, fostering volunteerism improves the standing of the community of surgeons both locally and regionally. As a result, closer relationships with neighbouring and regional orthopaedic communities will be forged. Having volunteers work side by side with members of regional orthopaedic associations will enhance our already relatively good relationships. The orthopaedic community would truly become international and holistic in scope, known not only for providing expert care and being at the leading edge of orthopaedic research in Singapore, but will also gain international renown for its caring and compassionate attitude to the underprivileged.

In turn, this will improve Singapore’s standing in the region. Bilateral relationships will improve. Singapore is a rich developed country surrounded by underdeveloped and developing countries. This has sometimes been a source of difficulty in relations with neighbouring countries. Goodwill fostered in the surrounding communities through volunteerism will go a long way toward improving and sustaining good and healthy international relations for Singapore.

Local Organisations Involved in Volunteer Work

Numerous local organisations need the help of volunteer professionals. The role or capacity required is usually specialist orthopaedic consultations for their members and orthopaedic input in an advisory capacity. Examples are the Society for the Physically Handicapped, the Spastic Children’s Society, the Movement for the Intellectually Disabled (MINDS) and the Diabetes Society of Singapore, among many others.

In addition, there are several organisations involved in international volunteer work. The Singapore International Foundation is involved in international disaster relief and humanitarian missions. They have two main services: Singapore Volunteers Overseas, where in-field and specialist volunteers spend months or years living with a community to help them and the Humanitarian Relief Programme, which recently sent teams of doctors to Afghanistan to help the local populace. The Singapore Armed Forces also sends missions to regional areas such as East Timor for humanitarian medical aid. Local hospital departments have also sent teams of doctors to major hospitals in the region that lack the expertise needed to treat patients and to teach new techniques in specialist care. Teams of orthopaedic surgeons from SGH have been to Yangon and Hanoi.

International Organisations Involved in Volunteer Work

There are many international organisations involved in volunteer work. Many are associated with the United Nations. Some are independent, such as the Federation of Red Cross Societies and Red Crescent Societies.

Medicins Sans Frontieres is an independent humanitarian aid agency committed to two objectives: providing medical aid wherever needed, regardless of race, religion, politics or sex, and raising awareness of the plight of the people they help. They require surgeons to volunteer for a minimum of six months.

Orthopaedic Overseas is a US organisation under the umbrella of Health Volunteers Overseas that is committed to improving the level of health care in several countries. They do this not by sending in a team of specialists for a short visit to perform as many surgeries as possible within that time frame, but by sending in teams to teach the local surgical staff basic orthopaedic care. These teams treat patients together with the local staff. This helps ensure that basic orthopaedic care is practiced within the local context of existing medical services.

The Role of The Orthopaedist in Volunteer Work

Orthopaedic surgeons can contribute in many ways, both locally and overseas. In the United States, for example, decreasing reimbursement has slowed the impetus for volunteer work. Also, practitioners providing free health services in the United States take the risk of professional liability exposure, so many physicians pursue volunteerism overseas (4). However, in recent years, there has been a resurgence of interest in volunteer work from orthopaedic surgeons in the United States.

Eighty percent of the world’s orthopaedic surgeons live in developed countries, but 80% of the world’s population live in underdeveloped or developing countries and lack basic health care (5). The orthopaedic resident training programme at the University of California at San Francisco’s International Orthopaedic Elective programme, set up in 1992, addresses this disparity. Under this completely voluntary programme, residents can spend one month in a remote hospital in Africa, fully supervised. Forty percent of their residents have volunteered, and half of these continue volunteering after completion of their residency (6).

Orthopaedics Overseas has only one objective: to impart orthopaedic training to local health-care providers by sending volunteer surgeons to Africa, Asia and Latin America. This is encapsulated in its motto, "Give a man a fish, feed him for a day; teach a man to fish, and feed him for a lifetime" (7). The programme has been so successful that some locations no longer need volunteers, as the local surgeons have been sufficiently trained to be able to take over.

Locally, many orthopaedic surgeons are actively involved in volunteer work. Various senior surgeons are volunteers and advisors with local welfare organisations such as the Society for the Physically Handicapped, the Spastic Children’s Association, Balestier Special School, etc. Several of our surgeons have gone on disaster relief missions to East Timor, Afghanistan, and Gujarat in India. Some are actively involved in volunteer work in India and Bangladesh. Some Orthopaedic Departments sends teams of surgeons for short visits to regional hospitals.

A Plan of Action

What can be done to foster the spirit of volunteerism within the orthopaedic community in Singapore? I believe that the Singapore Orthopaedic Association is perfectly positioned to take a leadership role on this issue, partnering with other local groups who would be able to provide funding and the organisation skills required. The target work should be local initially, then expanded to the region and internationally as more experience is gained. Senior orthopaedic surgeons, especially those who are retired or semi-retired, should be actively involved in advisory and organisational capacities. More importantly, these senior surgeons should act as mentors, encouraging orthopaedists who are interested in volunteer work. This should be followed up on by inculcating this spirit in orthopaedic trainees, through creating the opportunities for them to perform volunteer work.

Organising a programme for local orthopaedic trainees to perform volunteer work, either locally or internationally, will require the support of various institutions and organisations. The Orthopaedic Specialist Training Committee and the Ministry of Health must throw in their support. Hospitals can support this initiative by allowing paid leave—or at least no-pay leave—for orthopaedic trainees who sign up for volunteer work. Funding may be sourced from local societies with an interest in funding charitable work, such as the Rotary Club. Organisations such as the Singapore Armed Forces and the Singapore International Foundation already have the resources to organise such programmes. However, in order to lower anxiety and feelings of inadequacy associated with such volunteer missions, where resources are limited and the technological modalities of diagnosis and treatment are absent (8), these programmes must be carried out under the supervision of experienced surgeons, Senior surgeons already involved in volunteer work can expand that to volunteer their time as mentors. Mentoring is the modern-day equivalent of apprenticeship taken to new levels of interpersonal commitment and interaction (9). Mentors act as role models. They would be involved in introducing residents and trainees to the activities they are involved in and allow them to actively participate, or to at least observe their roles in community service and the benefits that they derive from it. This will stimulate an interest in volunteerism and also increase the awareness of the plight of the underprivileged locally.

Finally, those departments or groups of surgeons who travel abroad for volunteer surgery at the invitation of regional hospitals and medical communities should always encourage participation from their trainees in a similar fashion, or suggest that they bring along a team of trainees and residents.

There are many barriers to this participation. There will never be enough time. Often young surgeons are raising families and building up a practice which would suffer from their absence and loss of income. The pressure of work in hospitals with limited leave and a shortage of manpower will always be present. With the cooperation and support of the above-mentioned institutions and organisations and with the leadership role that the Singapore Orthopaedic Society can take, these barriers can be minimised.

The most important gift that a volunteer can give is to give those whom he or she works with is a sense of optimism about the future (10).


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