This story first appeared in IMAGE Magazine. 

It’s been two years since three TCU students interested in health careers decided to look outside of the classroom to learn about medicine.

“We were all getting bogged down and defeated by the course load and the physical and mental demands of being pre-med,” senior Alex Sanders said. “We needed something that was going to remind us why we wanted to be doctors.”

Sanders, along with senior Garrett Sohn and now-graduate Zach Kosmatka, launched a TCU chapter of Global Medical Training (GMT), an international humanitarian organization that provides free medical and dental services to medically deprived communities in Mexico and Central American countries. To date, TCU’s chapter has sent 80 students on five different medical mission trips, traveling to Nicaragua, Panama and the Dominican Republic. They have helped about 3,000 people so far Sanders said.

TCU-GMT is part of a growing trend among some undergraduate students who express their desire for a medical career by traveling abroad and assisting doctors who are bringing care to areas with limited access.

GMT founder Dr. Wil Johnson said he has seen an increase in students going on trips since 2004 and currently has about 1,000 students go on trips per year and a chapter at more than 40 universities in the U.S. and Canada. Maghan Knight, a global health volunteer program manager, and Amy Jordheim from Intentional Medical Relief both said they have also seen an increase in the number of students who go on their trips. This may be in part to more students using medical mission trips to boost their medical school resumes.

Applicants often use medical mission trips to show their fulfillment of two expectations – “Breadth and Depth of Premedical Educational Experience” and “Motivation” – of the University of Texas Health Science Center at Houston, said Dr. Wallace A. Gleason, Jr., associate dean for admissions.

“My general impression is that applicants are participating in these activities more frequently, but I have no data to confirm that impression,” Gleason said.

Dr. Paul T. White, assistant dean for admissions at Johns Hopkins University School of Medicine, said while students who go on medical mission trips aren’t given preference, the trips are a way of showing “knowledge of clinical medicine, patient exposure and service.”

However, these trips are limited for TCU students because of the university’s study abroad policy regarding dangerous areas. Students are generally not allowed to travel to locations on the State Department Warning or Alert lists, but the growing interest in medical mission trips and the opening of the new TCU medical school have brought the issue into debate.

TCU Chapter of GMT

While on these medical mission trips, students serve as a kind of medical scribe for the doctors, Sanders said. Students talk to patients through a translator and try to figure out what the patients’ symptoms are and for how long they have been going on. The students then make an educated guess at what is wrong and present it to the doctor, Sanders said. The doctor will tell the students if they are correct, maybe run some diagnostic tests and provide prescriptions to the patients.

Sanders said providing vitamins and supplements is another big part of the trip.

Sohn, who has gone on trips to both Nicaragua and Panama, said the trips are useful for helping students figure out if they really want to be doctors.

“I think GMT does a really good job giving that opportunity to students to really get some hands-on care and see what it’s all about to provide medical care,” Sohn said.

Both Sanders and Sohn have said the benefits of medical mission trips extend even further than just helping others.

Sanders said the part he talks the most about in interviews is how much he has learned from his nursing friends in the GMT program.

“When we get to collaborate, I’ve learned so much, not just how to treat the patients but how to educate them so they don’t end back up in a hospital or in our clinic,” Sanders said.

For Sohn, he said the biggest part was learning about the different cultures in the places he visited and learning from and about the people he helped.

“You see things that you would never see in the United States,” Sohn said. “You really talk to them about their lives, their country and what the patient experiences growing up.”

TCU-GMT is planning to send 35 more students to Nicaragua and Panama this semester, Sanders said. He said the group has grown from 10 students meeting in a tiny room in Winton-Scott Hall, to receiving emails daily from students interested in joining the program.

Sohn said he has also noticed the rising increase in students, and it’s more than he expected when he started the program.

“It’s been growing every single semester, which has been incredible,” Sohn said.

The group is currently planning officer elections in the spring and looking for pre-health and nursing student representatives. Sohn said he is also looking into planning medical mission trips to both Peru and India in the upcoming year. Students who are interested in joining the GMT program can email Jill Fritchen, coordinator for the Pre-Health Professions Institute, at [email protected].

The academic benefits of medical mission trips

Dr. Matt Chumchal, the president of TCU’s Pre-Health Advisory Board, said there are many things professional schools are looking for in pre-health students. He said a few of those things they are looking for is students who took the right classes, got the right grades and have clinical experience.

TCU’s pre-health program provides students opportunities for these by offering one-on-one pre-health advising–which is mandatory for first-year students and sophomores, and recommended for upperclassmen–and a clinical program with about 20 clinics and hospitals that students can visit to observe physicians, Chumchal said.

Chumchal said there is one more crucial thing professional schools are looking for: that students are getting into the profession for the right reasons.

“The right reasons, according to these professional schools, is that they have a desire to serve other people,” Chumchal said. “So students have to show that.”

Medical mission trips are becoming popular among TCU pre-health students as a way to show that desire.

Jordheim, who works at the International Medical Relief organization, said medical mission trips help provide already accomplished students a greater sense of focus for their specific future career field.

“I believe that participating in medical camps provides hands-on experience with dedicated professionals and they return with a sense of purpose,” Jordheim said. “The experience gives students the ability to discuss specific reasons for entering their chosen field with admissions committees.”

Junior Mikaela Miller, a biology major on the pre-health track, has gone on two medical mission trips. They were both based out of Ensenada, Mexico, but the group traveled to different cities depending on the needs of residents.

“I do think it’s very valuable for pre-meds to have that experience,” Miller said. “It’s something that is rounding out my application and will round out others.”

Both American and local doctors made up the group on the medical mission trip. On her first trip, Miller coordinated the children’s ministry, and on her second, she was a patient assistant and helped show patients where to go. She said she also spent a lot of free time shadowing the surgical and gynecological suites.

“That’s what made me decide I want to do medicine,” Miller said. “That’s been my driving force to move on.”

One memory in particular sticks out for Miller. A little boy needed a cyst removed from his head, and the only thing doctors could bring over the border into Mexico for pain was Advil and numbing shots, Miller said. The boy was scared, so someone had the idea to distract him with Angry Birds on an iPad.

“It was pretty neat that he was completely distracted and even laughing while a bunch of surgeons are cutting into his head,” Miller said. “He was so fascinated by it!”

Miller said she hopes to one day be able to do medical mission work full time. She recommends medical mission trips for students who may be unsure of what they want to do in the future.

“The value of a medical mission trip for a student who is trying to decide what they want to do is—you can’t even put it into words—it’s just so life changing,” Miller said. “It’s good for you as a person and for you to be more mature in your decision for medicine.”

Concerns about medical mission trips  

Despite the benefits of medical mission trips, there are some downsides that students have to deal with. Miller said the biggest problem she sees is what she calls “the savior mentality.”

“You can’t just think, ‘I am a rich American so I can help you,’” Miller said. “A lot of times, you can be causing more harm than good.”

A prime example of this is what happened in Haiti after the earthquake when so many doctors rushed there to provide free help, Miller said.

“None of those people who went there to help had bad intentions, but to provide all this free stuff and then leave, this country has nothing left,” Miller said. “Haiti’s healthcare system was just crushed.”

Miller said there are ways to make sure a clinic is really helping, such as charging for services and hiring locals to staff the clinic in order to make it more self-sufficient.

“You really have to build up the country, and you really have to take their needs and their desires into consideration,” Miller said. “If you’re able to discern a program that is doing real good, I would definitely recommend it.”

Sohn said he has noticed a different problem with medical mission trips. He said he was concerned about students who don’t always realize they are still learning and not fully qualified to provide all the care at a clinic.

“When we go over there, we’re not playing doctor for a week, we’re working under doctors, and doctors are overseeing everything we do,” Sohn said. “Sometimes, the line gets a little blurry for students who come back and say, ‘Oh, I played doctor for a week.’ That doesn’t sound so good.”

Sohn said he often reminds other students going on the medical mission trips to remember that they are there to help the doctors, not be the doctors.

This problem of pre-health students getting out of their depth is one that has some medical school admissions officers concerned. Paul T. White, Assistant Dean for Admissions for John Hopkins University School of Medicine, said most of the students with clinical experience enrolled at the school got that experience while in the United States instead of abroad because clinics outside the United States may not be as regulated.

“The AAMC [Association of American Medical Colleges] discourages students going abroad for medical exposure if the program does not tightly oversee the actions of the student,” White said.

According to an AMMC document that offers guidelines for students providing patient care abroad, “While many students have had beneficial experiences through involvement in patient care activities abroad, and services have been provided to people in need, the potential for harm and abuse in these situations cannot be ignored.”

It lists such negative consequences as a student who is unqualified accidentally harming a patient, getting into legal trouble with local authorities or a student being involved with a fraudulent company that is more focused on making money than helping people. According to the document, it could even jeopardize a student’s medical school or residency applications if the student took on tasks that are beyond their training because it “could make you look unethical, unknowledgeable about the health professions, irresponsible to admission committees.”

Danger Zone

For some, the hesitation about going on a medical mission trip isn’t a moral concern but rather a safety one.

TCU alumnus Dr. Ric Bonnell has been trying to take TCU pre-health students to his clinic in Haiti. Bonnell has worked at the clinic since he helped found it in 2012, making at least four trips every year since. However, Chumchal said Bonnell has yet to be able to bring any pre-health students over.

“Dr. Bonnel wants to take students but can’t as part of an official TCU trip,” Chumchal said.

TCU’s study abroad policies are the reason for  this restriction. According to the TCU study abroad website, “TCU will not permit travel to countries where travel warnings have been issued,” and for countries with travel alerts, “TCU faculty/staff/student groups are not permitted to travel in the designated area without prior written approval by the dean or appropriate vice chancellor.”

These travel warnings and alerts are issued by the U.S. State Department. A travel warning, according to the department website, is issued when they “want you to consider very carefully whether you should go to a country at all.” Examples of events that would cause warnings include unstable governments, civil wars, ongoing intense crime or violence or frequent terrorist attacks.

A travel alert, according to the department website, is issued when there are “short-term events we think you should know about when planning travel to a country.” Examples of events that would cause an alert include an election season that is bound to have many strikes, demonstrations, disturbances, a health alert like an outbreak of H1N1 or evidence of an elevated risk of terrorist attacks.

Haiti has had a travel warning in place since Aug. 5 and a travel alert since Aug. 7. The alert is in place until April 7 because of an upcoming election in the area, according to the State Department website. The travel warning cautions Americans about “the poor state of Haiti’s emergency response network” and says the “medical facilities in Haiti, including road ambulance services, are particularly weak.”

However, according to the warning, “hundreds of thousands of U.S. citizens safely visit Haiti each year” and “reports of kidnappings have fallen off sharply” with only one kidnapping reported in 2015. In addition, according to the same 2014 study from the Catholic Health Association, Haiti is the most popular place for people to visit on medical mission trips.

It’s changes in Haiti like these that have some students frustrated by TCU’s rule preventing them from going with Bonnell to Haiti. Miller said while she understands that TCU is responsible for the safety of students, she still thinks it would be valuable for students to go.

“It would be great if there was another way around it,” Miller said. “I think that would be awesome for TCU to go to Haiti.”

Sohn, who hasn’t run into any issues with GMT because the national leadership chooses the locations and gets them approved, agrees with Miller about the benefits of Haiti.

“Haiti would be cool,” Sohn said. “That would be an awesome place to go.”

Bonnell is not the only alumnus to have this problem.

“We definitely have alumni who are working in places on the State Department warning list, and they just can’t go as part of an official program,” Chumchal said.

According to Jane Kucko, the director of the TCU Center for International Studies, Bonnell’s insistence may bring a change to the rule preventing travel to anywhere on the warning list.

“He raised the concern to when and if TCU will ever re-evaluate that policy now that we have this new medical school,” Kucko said. “I suspect we will be having that kind of conversation.”

Kucko said this issue will likely be part of a larger conversation about safety and the global reality in which we now live.

“This is the way the world is going to be for a while,” Kucko said. “So I think exploring the world and understanding it is even more important.”