Right person, right place, right time.

By Dr Keith Russell. Medical Coordinator at HealthLink360.

For the past 30 years it has been our privilege at HealthLink360 to help a very large number of health care professionals prepare for their overseas work. It is encouraging to see so many UK-based nurses, doctors and allied health professionals volunteer for short-term placements all round the world. A high proportion of these NHS staff may eventually even offer their skills for long-term international placements.

Sometimes those who serve on  short-term placements go because of demanding emergency or crisis situations - such as the Sierra Leone Ebola crisis of 2014. Others go for regular but brief periods overseas – and over time build long-term relationships and help develop the skill-sets of those practitioners and teams they work with. Some volunteers find this style of working so rewarding, that they decide to work overseas long-term and commit sizeable periods of their professional lives to health development work.

Pre-departure assessment.

But whether the placement is short or long-term, our experience is that the volunteer can benefit not only from a comprehensive pre-departure health assessment, but also may benefit from several assessments over the longer term. The experience of many agencies similar to ourselves is that going overseas may be challenging for the individual – but returning home is often more so.

Many factors can affect a person’s readiness for an overseas deployment. They may have long-term illness (physical or mental health) which will be difficult to manage in an overseas situation. Pre-departure health screening may reveal a new medical diagnosis. Preventive measures such as immunisation need to be managed. Psychologically, even very experienced health professionals can find themselves in circumstances overseas that are so unfamiliar to them (such as extreme climates, or working in forced isolation) that they find their normal resilience breaks down, and to their surprise they cannot cope.

Sometimes, individuals may be working through stressful personal circumstances that they are leaving behind. If these are left unresolved, then the individual may find themselves emotionally unprepared to cope with the extra stresses of working in an unfamiliar overseas environment. Most overseas healthcare placements go very well. Occasionally things go wrong. And for the individuals involved - who are almost always very highly motivated - these difficult experiences are unnerving and destabilising.

Host organisations.

Of equal importance for the host organisation, these issues can cause major problems which can threaten the long-term success of health-related projects. Most successful partnerships between UK-based health professionals and overseas partners are down to the quality of the human relationships that people make – rather than any purely technical excellence that is given. Our experience at HealthLink360 has taught us that successful overseas health-care projects  are usually down to relational factors – rather than technical. When things go well the volunteer is always very deeply encouraged by their contribution. I’ve listed here some of the comments I’ve heard from nurses, therapists, physios and medics that we have been asked to assess at our HealthLink360 clinic when they return:

*        “I’ve never felt more effective as a health professional”

*        “deeply satisfying”

*        “great to be able to make such a difference”

*        “I hadn’t realised that primary health care could be SO effective”

*        “Why don’t we use more near-patient testing in the NHS?”

*        “This is what I trained for”

*        “I was at my most effective when I was passing on my skills”

Before, during, after, what.

Here are four very simple measures that can improve the chances of success in global exchanges of volunteer workers. When they’re followed they can help achieve what everyone hopes for from this type of exchange: that the volunteer is the “right person, in the right place, at the right time.”

Before – a comprehensive medical and psychological assessment of the individual who wants to go is invaluable. This gives the volunteer confidence that they are fit to serve: and the receiving agency is reassured that the volunteer is fit for purpose.

During – even the most resilient of  people may find an overseas placement difficult. Enthusiasm can quickly go when there are just too many challenges to overcome. This is especially difficult for people who are placed alone or in isolated places or where there is civil unrest. Emotional and practical support -by Skype, email exchanges or online mentoring – can profoundly reassure the volunteer. And the host agency appreciates that this support is offered - it reassures them that the burden of making the exchange a success is not all theirs.

After – when they return, most health-care volunteers have had remarkable or even life-changing experiences. But some may need professional counselling to help process the changes in themselves. These can  be either of a personal nature  or a new perspective on their professional life.  They may want to change the way they professionally practice, because their outlook on their professional lives may have radically altered. They may have discovered new personal qualities – or weaknesses – that only an overseas experience has revealed to them. If the volunteer is not to be left frustrated with unfinished personal questions they are struggling with, then we owe it to them to help them find their answers.

Lastly there is one measure to be taken which is often overlooked. We need to ask the overseas partner:

What did you make of this?” Helpful questions to be asked might be; “What ticked the boxes for you?” “What needs to be changed next time?”; “Was this the right set of skills this volunteer was offering?”; “What do you now know you need?”; “Was this the right person at the right time?”

It is a tribute to the personal qualities of so many UK health volunteers that most overseas exchanges go very well indeed. We are aware of some volunteers who have been working in successful overseas partnerships for decades. But we are also aware of many examples where partnerships haven’t been as successful as everyone hoped. With careful preparation and support - before, during and after the exchange - we suggest that the chances of success are increased. And the goal that everyone wants -  “the right person, in the right place at the right time” – can be achieved.