A Call to Service: My Personal Experience of Three Decades of Sonography Volunteerism

Abstract

Although published articles have highlighted global health volunteering, sonographers who provide volunteer work have become an increasing area of interest, within the profession. The fast-paced evolution of technology, internet connectivity in remote regions, portability, and the growing expansion of new applications within the field of sonography have made sonography an invaluable diagnostic tool, at home and abroad. With this type of global access, providers look for opportunities to learn and be mentored by volunteer sonographers. This symposium provides a personal experience and many examples of over three decades of global sonography volunteer service experiences and history. It also highlights the personal motives behind this call to service and recent post-COVID-19 volunteer trends.

“We make a living by what we get, but we make a life by what we give.” These inspirational words by Winston Churchill have resonated with many people, who have chosen to pursue a life of service and can be expressed through global volunteering. Volunteerism has been described as a form of helping, in which people actively seek out opportunities to assist others in need, making considerable and continuing commitments to aid others. These efforts are often sustained commitments over extended periods of time and often at considerable personal cost. In 1956, People to People International, an organization established by President Eisenhower, was launched to enhance international understanding and friendship through educational, cultural, and humanitarian activities. This involved the exchange of ideas and experiences directly among peoples of different countries and diverse cultures, as well as sponsoring a cross-cultural professional exchange. In 1995, Joan P. Baker, MSR, RDMS, RDCS, FSDMS, an icon and pioneer in the development and evolution of sonography, lead a delegation of 19 professionals to China, as part of People to People International. Those participating with Joan were sonography professionals that included radiologists, obstetricians, researchers, and sonographers. This delegation traveled to four Chinese cities, which were Beijing, Xian, Guilin, and Hong Kong. At that time, China was not the bustling economic giant that it has become today. Hospital-based ultrasound equipment systems in Beijing were the size of small refrigerators with limited applications, resolution, and diagnostic capabilities, compared with modern equipment of today. Imaging reports were hand-written on a piece of paper the size of a small post-it note, and hand carried by the patient to their provider. In Xian, the delegation visited a traditional Chinese medicine hospital where modern technology was scarce and seldom played a role in the treatment of symptoms and disease. Guilin, a city in southern China known for its dramatic landscape of limestone karst hills, presented an opportunity for the delegates to visit a small clinic in the countryside where radiographs were developed by hand dipping the films into harsh chemicals, in an antiquated darkroom. This was my first experience abroad serving as a sonography delegate to an unfamiliar country like China. It was immensely transformative and the genesis of what would ignite my three decades of international volunteering in the fields of sonography, public health, and English as a second language (ESL), which continues to this day.

Sonography Global Volunteerism

Diagnostic medical sonography plays a crucial diagnostic role in health care, including in remote and developing countries, where access to advanced medical imaging may be limited. The evolution in technology and the growing body of evidence, has positioned sonography as a recognized and valuable diagnostic tool in resource-limited settings. The recommended use of sonography has come from ministries of health in low- and middle-income countries (LMIC), several nongovernmental organizations, and the World Health Organization (WHO). ¹ To help meet this need for training, an estimated 1.6 million people volunteer abroad annually and the international demand for volunteering to promote global health and nutrition, is increasing annually. ² Cardiac, abdominal, obstetric, vascular, trauma, musculoskeletal, and breast sonographic applications are now commonly used in global health care settings.

Although access to ultrasound equipment systems has become more accessible in this modern era, the education and varying skill levels among those global providers in resource-limited settings, remains a challenge. The demand for highly qualified and experienced sonographers willing to donate their resources, skills, and time to support training projects abroad has subsequently increased in recent years.

Travel to remote regions of the world where abject poverty, political unrest, and gang violence are common can be dangerous and even life threatening. Haiti, a great example of high risk volunteerism, is the poorest country in Latin America and the Caribbean (LAC) region and among the poorest countries in the world. ³ It is a place where people live in extreme poverty and outright squalor. At the time of this writing, the United States’ State department has issued a “do not travel” advisory to Haiti, due to kidnapping, crime, civil unrest, and poor health care infrastructure. ⁴ Last year, several news outlets reported the kidnapping of an American nurse and her young daughter in Haiti, and in 2021, 17 missionary volunteers were kidnapped and held for over a month in Port-au-Prince. My personal volunteer work in Haiti, on three separate occasions, in the areas of adult and pediatric cardiac sonography, were both initially shocking and incredibly rewarding. Those who might consider a call to serve in a developing country, where people live in such dire conditions, should be prepared for the physical danger and the psychological impact of such an endeavor. As a volunteer, I did complete a gynecology sonography project in the war-torn mountainous jungle regions of Guatemala, after a 30-year revolution, but it was not as dangerous as the three Haitian projects, over the past decade. Travel to Haiti has been the most hazardous service that I have completed, compared with the more than 50 countries I have visited.

Financial Considerations

The recent and growing trend of “voluntourism” and rising interest in health care volunteer work, post-COVID-19, has created increased opportunities for individuals interested in global service. ⁵ Along with accepting physical risk, it is important to consider the personal financial challenges that may come with service abroad. International projects may or may not provide financial support for travel expenses, food, and accommodations that can vary significantly depending on the country, project type, and geographic location. My personal experience with varied accommodations throughout the years, include the home of a missionary in Managua, Nicaragua. The missionary hosted a large group of 50 health care volunteers who were there to provide open heart surgery services in that country. Up to 16 people shared one bedroom in a humble home without indoor plumbing. This experience took place in 1999 and Nicaragua was experiencing a tremendous 60% unemployment rate. This resulted in making Nicaraguans desperately poor, with very limited resources and accommodations. This is in stark contrast, to the ocean side accommodations in a luxurious hotel in a Caribbean Island, with turquoise waters and glorious beaches that were provided to volunteers. These amenities were provided to participants by a well-funded, ongoing, pediatric cardiology project that had been operating in Grenada, West Indies.

These recent trends in “voluntourism” ⁵ and health care “volunteerism” postpandemic have created increased opportunities for individuals interested in combining the traditional aspects of tourism with volunteer work. There are important distinctions that need to be considered between volunteering and taking on the personal financial costs of such an endeavor. Volunteer tourists who participate in a service project cannot use travel expenses as a charitable tax deduction. Most short-term volunteer projects abroad are 7 to 10 days in length, requiring 1 week away from work, at most. Individuals considering donating their time would likely use accrued vacation time or request an unpaid leave of absence for professional development purposes. Although some qualified travel expenses for volunteer work abroad can be used as a charitable tax deduction, it is not possible to recoup lost wages/salary for time away for volunteer work. ⁶

Volunteer Motives and Expectations

Mahatma Gandhi observed “that the best way to find yourself is to lose yourself in the service of others.” ⁷ This path of self-discovery can be a difficult and arduous journey as placing the needs of others above one’s own is an important personal step. Health care careers are already uniquely driven by service, and although “giving back” is another reason that many consider volunteering, motivations can vary widely, be highly personal, and not always altruistically driven. An article published in the Utah Farm Bureau Federation cites the following as the top reasons that motivate a person to volunteer:

• Making a Difference: Some people are motivated to make a difference in the world. They will put full effort into things they care about and view as important.

• Social Opportunities: Others are motivated by the social aspect of being with fellow volunteers. They enjoy meeting new people and making new connections.

• Personal or Professional Development: Many are motivated by learning something new. They may see the volunteer opportunity as a way to become better personally and/or professionally. ⁸

Additional personal advantages to be gained from volunteer work include opportunities to gain new skills, knowledge, and experience. Developing existing skills, added knowledge, enhancing a personal resume, improving employment prospects, and gaining accreditation are all possible motivating factors in our highly competitive job market. ⁹

For me personally, volunteer work continues to be a calling, a vocation, a rite of passage, an adventure, an opportunity, an education. ¹⁰ Combining my two life passions of sonography and global exploration has given me an infinitely rewarding and fulfilling life of service. It has culminated in a life in the Andes mountains of Ecuador, a beautiful country that has been my residence for the past 6 years.

Volunteer Expectations

Many volunteers find such adventurous experiences abroad to be very rewarding and incredibly transformative. Quite often they lead to a greater interest in global health care initiatives and even careers in the public health sector. Others may come away with a vague sense of dissatisfaction in that they were not able to do more or make a big difference in the lives of the people they served. Managing volunteer expectations and advance preparation can present great challenges to volunteer organizations, who are recruiting individuals for travel to developing countries. An investment in learning about the history, culture, political structure, and current challenges of the country, as well as a few words and phrases in the native language, can make any trip abroad a better personal experience.

A month-long project in Chennai, India was a great example of how a little knowledge and preparation about the country and community, prior to travel, helped to make the experience more positive. In certain locations and communities in India, women are expected to dress conservatively and not expose much skin. Therefore, such items as tank tops, shorts, and revealing dresses that are commonly worn by women in the United States might be very inappropriate in some countries throughout Asia and the Middle East. Packing appropriate clothing with layers that made the tropical heat tolerable was key to staying comfortable and remaining respectful of local customs and traditions. Another example of cultural gaps that exist, even in global health care settings, was a public sign at the Chennai hospital radiology department entrance that read: “It is against the law to reveal the gender to expecting parents during an obstetrical ultrasound examination.” In a society that highly values the male gender, the enforcement of this law was designed to prevent the abortion of female fetuses, which could result in a great disparity between males and females born in that country.

Trends and Insights

Although several nonprofit organizations and nongovernmental organizations (NGOs) reported a decline in volunteerism as a result of the pandemic, there is evidence that volunteer projects are recovering and have a renewed sense of purpose. This altruistic motivation may be compelling volunteers to pursue their passions and make a meaningful global impact. A resurgence in the rapidly evolving and changing landscape of volunteerism is being driven by changing societal dynamics, technological advancements, and shifting priorities to include virtual volunteering, data driven volunteering and environmental volunteering. ¹¹ The future of volunteer work looks very promising and brighter than ever with the potential to create positive impacts and much needed global transformation. As people navigate this modern technological revolution with change occurring at hyper-speed levels, it is important not to forget the constant and timeless wisdom articulated by the anthropologist Margaret Mead, “Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.”