WARNING: This post has detailed descriptions of medical procedures, dirty surgical tools covered in bloody bits, and a baby being born. If you are at all squeamish, maybe skip this one and read something else. I would!

The company I work at has an initiative to fund the travel portion of global health missions. The goal is to alleviate some of the cost burden of getting to high-need areas across the globe and allow medical groups to dedicate more budget to bringing along additional resources and doctors. In 2020, my employer added a new element to this initiative — company employees could volunteer to pair up with a global health group and actually go on the mission, providing organizational and on-the-ground support.

I was psyched. I already resonated with the company’s mission to help physicians in the U.S. with their day-to-day work, but this was an opportunity to take that a step further and provide direct support. And I felt I could truly help from the get-go as I already had a ton of experience organizing trips for large groups with a lot of equipment (when putting together several rowing tours to China over the past few years).

I immediately raised my hand and got paired with a group of physicians traveling to Chennai, India to assist in cleft palate repair. The trip was scheduled for April 2020, and I immediately began coordinating with the hotel and helping all the doctors book their flights. Unfortunately, the trip was cancelled in early March as the coronavirus bug that had been going around decided to become a bigger bug (if you ask my wife, big bugs are scarier than little ones). But at the end of 2021, I was told we were spinning up the initiative again, and there was a trip that December. Feeling just as passionate and excited about joining one of these trips, I jumped at the chance.

This time, it wouldn’t be for cleft palate repair in India. Instead, I was joining a team of OB/GYNs traveling to a hospital in Santiago, Dominican Republic. The local Dominican doctors were very knowledgeable and effective, but were struggling by a scarcity of resources, an overly large patient population, and hospital organizational issues. The visiting team had already been down to this hospital several times over the years, and so was pretty established in its role. But for this specific visit, the doctors had two goals: (1) continue training the team of local physicians on how to perform laparoscopic surgeries (minimally invasive procedures) using tools the local team didn’t normally have on-hand; and (2) review the hospital’s postpartum hemorrhage practices for areas of improvement.

The trip would consist of four full days in the hospital, performing surgeries and training the local physicians on new equipment and surgical techniques. The visiting doctors performed or guided the local team through vaginal hysterectomies, laparoscopic hysterectomies, prolapse surgeries, and emergent ectopic pregnancy interventions. They also held sims (lectures with visual-based teaching) on best practices for postpartum hemorrhage.

For a person who had never been exposed to the intricacies of obstetrics and gynecology, who had never stepped foot in an operating room, and who had only rarely ever seen a more-than-normal amount of blood, I grew more and more nervous as the trip got closer. The cleft palate trip was mostly going to be logistics, patient interviews, and photographs of patients before and after each repair. But this team had already been established in the area, they knew the hotels they wanted to stay at, they already had a driver and most meals sorted, and had their routine set.

Instead, they wanted me to scan through hand-written charts to identify deliveries that resulted in postpartum hemorrhage, coordinate lunches when they were too busy to, and take photos documenting the entire trip – including all the procedures being performed. The first two I was confident were in my wheelhouse. With a two-month crash course in Duolingo, I knew enough Spanish to order lunches and identify “hemorragia” in a chart. But it was the sitting in an OR, photographing things like c-sections, total hysterectomies, and vaginal prolapses, that worried me. I had only read about those things in books! And even then, not really. Who knew that things could fall out?? Not me! And now I’d have to photograph it, which probably meant looking at it? When I mentioned it to friends and family, they teasingly asked if I would faint.

My partner Lauren is an OB/GYN, so ahead of the trip I recognized terms like “laparoscope,” “prolapse,” and “hysterectomy” (from the dinner table talk I was privileged to hear when we would meet up with her coworkers), but I never really appreciated what each entailed in the OR. Having never even been in an operating room, I asked if there was anything I could do to prepare myself and make sure I wouldn’t pass out onto (or into) a patient. Lauren graciously offered to let me shadow her at work, but I felt guilty going into her hospital as the coronavirus Delta variant was rearing its head. So instead I winced through a video or two online, which really didn’t help much at all.

Also, no one had mentioned the smells! People’s insides smell different than their outsides, and that’s not a fun fact to learn in the moment. And when the doctors need to cauterize, it smells like meat cooking. Face masks don’t really block any of those smells out. I distinctly remember one of my first times hanging out with Lauren during her time in med school, and she was discussing with a classmate how she had finally been allowed to work the cauterizing tools in the OR. They both guiltily admitted that they thought it actually smelled good, and I was left thinking “Do I really like this woman? Was BBQ a bad idea for dinner?” Luckily, I wasn’t as squeamish during the trip as I had feared; there were only one or two scenes that forced me to look away and take a breath before getting back to snapping pics. The fact that doctors do this stuff everyday is wild. It was such an alien experience for me, and so commonplace for them.

Anyway, I flew down with the team, and it was very much a “hit-the-ground-running” experience. Minutes after first arriving at the hospital, I was told to quickly grab my camera and run into an operating room. In front of me was a pair of doctors, tugging and stretching a hole in a woman’s abdomen to make enough room to pull a baby out. I was aghast. Not only was it the first time I had seen a birth, it was also the first time I had even been in an operating room, and the first time I had seen someone’s insides. Apparatuses filled the room with beeps and gasps, people rushed all around to check on the patient, blood covered an alarming amount of the ground. And me in the corner: not a doctor, no real training to justify my presence. I managed to take my jaw off the floor long enough to take photos of the doctors, the baby, everything. I even made a gif of the baby coming out! (I’m not including it here. There are limits to what I would put my readers through!)

My uncertainty in my own value was quickly erased by the team after the c-section. They liked the pictures, wanted more of the other surgeries, and said I should feel free to come and go from the OR as I pleased. But first, could I go grab lunch for the doctors? And when I got back, could I start reviewing charts to help them gather the right hemorrhage research? And then run to the hardware store to buy and assemble some shelves so they could better organize their supplies?

The first day was a whirlwind, but by the end of it, I felt more confident and sure of my role. Each day, I grew less overwhelmed and more comfortable documenting surgeries, reviewing charts, and building a supply inventory. While the days were draining, I felt great because my work was truly additive.

But it wasn’t all lunch-runs, charts, and glamor shots. While the hospital does have access to a sanitation machine for cleaning surgical equipment, each cycle takes 12 hours and there aren’t enough spare tools to accommodate that schedule, even overnight. There are no OR techs (who, in the U.S., typically manage equipment), so the equipment and room cleaning is left to the doctors who just spent hours in a procedure. Because cleaning wasn’t actual surgery, it was an area I could help!

Let me set the scene for you. The cleaning process begins with getting gloves, a bottle of alcohol, and some gauze. Sometimes they don’t have your glove size, so the gloves will keep ripping off when you put them on, but eventually you squeeze in a pair without immediately tearing through. Then it’s time to go to town on each tool, scrubbing with the alcohol-soaked gauze to get the bulk of the blood and little bits of flesh off. Maybe the gloves tear again so you double up and hope both layers don’t rip and you don’t accidentally touch blood again. Safety first! You keep scrubbing and it’s taking a while — wow, there’s a lot of chunkies (medical jargon) and congealed goops (medical jargon) and body bits (medical jargon) on here! Once the bulk of the bits are gone, you let the instrument soak in some cleaning solution for a bit before it is rinsed the dried. Then you move on to the next one. Look at you, you’re an expert!

Anyway, I didn’t faint.

While this process may seem distressing (yes), it was actually one of the moments of the trip that I am most proud of. I can point to it and say, “They needed extra hands. I was able to come in and help.” My work scrubbing gave the doctors time to clean up faster and have a longer breather before diving into the next case. That might not sound like much, but actually experiencing how packed their days are, how early they arrive, how late they leave, and how many patients they see while they are there, every little bit counts. Even scrubbing bloody little bits.

When people ask me how the trip was, I usually say, “Exhausting, but worth it.” You often hear that doctors don’t have enough time in the day and that it isn’t easy to give patients the care they need. With this team, I lived a small portion of their experience and found that it’s all true: there is such a dearth of time that any bit saved truly helps.

And at the same time, I gained a lot more insight into how lacking health care is in certain regions, and how hard it is for doctors to do their work when there isn’t enough equipment, or support, or training. In places like the Dominican Republic, you don’t have support staff to clean the rooms and equipment, or to hand a tool to a doctor during a procedure, or to even organize the cabinets. That all falls on the doctors themselves, which means they have to spend extra time between each patient and during each surgery, and see fewer patients in a day. It falls to global health teams to negotiate donations from medical device companies, bring them to these high-need hospitals, and train the local doctors on how to use them. Even outside of the operating room, they spend time giving lectures on best practices, organizing and inventorying available resources, and building shelving space so the sutures aren’t stuffed into the same bin as the forceps, laparoscope, loose gloves, and lunches.

At the start of the trip, I was worried. I’m not a doctor, what if there isn’t anywhere I can pitch in? What if the doctors think I am just a hindrance? But that wasn’t how it went. I didn’t perform surgery (maybe next time!) (jk) (unless…?) (jk), but my work made it easier for doctors to do theirs.

I don’t have a ton of pictures to share of the inside of the hospital — even though the DR doesn’t have data privacy laws, I wouldn’t feel right about it. And because we spent most of our time either in the hospital or sleeping, I don’t have much from outside either. But I have a few to share below.