Medical Missions Abroad: Vivian Ringo, MS, BSN, RN, CNOR

We've written about medical missions before -- we even put together a guide to going on your first medical mission -- but this time we want to hear from another expert! Vivian Ringo, MS, BSN, RN, CNOR has decades of experience abroad and has worked with numerous organizations in furthering the medical mission of developing countries around the world. We’ll let her take it from here!
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From Nursing School to Medical Mission Trips

In December of 1998, I had the honor and privilege of earning the degree of Bachelor of Science in Nursing (BSN) from Texas Woman’s University. Five months after graduating from nursing school, I found myself volunteering in Antigua, Guatemala on my first surgical mission trip. Being able to volunteer as a nurse was never a question for me, as I was extremely proud to be the first person in my family to not only graduate from high school, but, to earn a college degree. I could not wait to give back in an international surgical capacity and was thrilled to have been invited and included on this mission outside the United States. 

That trip changed my life and subsequently led to the desire to volunteer in many more countries throughout the next two decades. The emotions I experienced as a nursing volunteer often led to many more questions than answers throughout the years. The work is extremely rewarding on many levels. It was, and is, however, extremely difficult to witness the extreme levels of poverty and lack of healthcare that is prevalent in so many parts of the world.

The weeks following a mission trip are often difficult to mentally navigate upon returning to the comforts of home and life in the States. It was after living and working in Africa for a period of almost a year that I really began to dissect the complexities of why this marginalization is so prevalent and if the work I was doing was really making a difference. Furthermore, I wanted to have a better understanding of the root causes of social and health inequalities, human rights violations and overall geopolitical issues.

Most importantly, I sought out answers to how these occurrences could be prevented on a larger and more permanent scale. 

I took the decision to complete a Masters of Science in Global Affairs at NYU to answer these questions and to bridge the knowledge gap between my clinical practice and the realities of why these dire global problems exist. I firmly believe that nurses are vessels of change and opportunity. Nurses are dynamic in their dedication, their knowledge, and their expertise. The role of the nurse in the management of global affairs is vital to the future. Nurses have a contribution to make in the international arena and local community.  

This year, I joined other medical volunteers as part of a nine-member, all-female surgical team from Surgical Volunteers International (SVI) to Mansoura, Egypt. This is remarkable to me that our team was able to have such a successful presence and outcome in a country that is often associated with misconceptions of the value of the female mind and its capabilities.  

The main goal of the mission was to provide as many surgeries as possible to the surrounding community, free of charge. Global health initiatives often overlook surgical interventions and focus on communicable disease processes in a silo. Surgical disease inclusion and management is frequently referred to as the “neglected stepchild of global health.”
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Part of the Problem: Surgical Intervention is Neglected

One primary reason surgery is not placed at the top of the global health hierarchy is because interventions are geared to large scale numbers vs. a single patient. Surgery is a complex process that involves not only human resources but actual systemic processes. Facilities, sterilization, anesthesia providers, nurses, and supplies are a few of the factors that must be taken into consideration when planning for surgical missions. SVI is dedicated to changing lives on an individual basis.  

The week-long mission was successful in performing surgery on 34 patients. On day one, over 80 children were triaged and evaluated for the possibility of being chosen for one of the coveted surgical slots. 22 children received cleft lip/palate repairs, and the other 12 underwent complex laparoscopic general surgical procedures.  

To be born with a cleft lip or cleft palate in many parts of the world is an almost guarantee for a lifetime of social stigma and poverty. Generally, the defect needs to be repaired within the first year of life, preferably within three months of birth. If the repair is not performed in a timely manner the child will suffer from speech impediments, ear infections, poor dentition, hearing problems, malnutrition, and breathing problems. The facial disfigurement associated with this defect is devastating.

If this defect is not surgically corrected, the likelihood of being married, educated, accepted socially or contributing economically is extremely low. Children that are subjected to poor-resource settings are often overlooked, as surgery is too expensive and there are not enough providers to remedy the problem.

To date, the backlog of known cases worldwide is estimated to be over 600,000 in 113 countries that have data available for review. Awareness is growing within the international community of the correlation between the cost effectiveness and economic gain of surgically correcting this defect.

If the child can receive surgery, its entire future is positively altered.

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Part of the Cure: Health Education and Advanced Medical Training

The secondary goal of the mission was met by providing education and training to local surgeons, residents, medical students, and nursing students. SVI strongly believes that enhancing local surgeons’ knowledge base contributes to the long-term medical success of local healthcare professionals and healthcare systems. It is of the utmost importance to recognize how the lack of surgical care impacts lower- and middle-income countries.

The World Bank, The WHO, The Lancet Commission for Global Surgery, and The G4 Alliance for Surgical, Obstetric, Trauma, and Anesthesia Care are working together with countless NGOs to bring global surgical needs to the forefront of policy making and international medical funding. However, there is still an enormous knowledge and public awareness gap regarding this issue.

Poverty reduction, gender equality, economic growth, infrastructure, reduced inequalities, and sustainable cities are all issues that are positively influenced if surgical services are given a higher priority and a chance to improve. Increased surgical planning and intervention is imperative in order to save lives and improve the health, well-being, and security of global public citizens.    

Surgical missions can be challenging in terms of language barriers. However, working alongside the local staff, who spoke only Arabic, and being a part of this special team was extraordinary. There is a magical and wonderfully intense feeling of working under the challenges of the pressures associated with a mission. The thought processes are always focused on what can be accomplished vs. what can’t be done. The nursing staff and local physicians worked tirelessly through the week to accommodate our needs.

I am grateful to have been a part of an all-female surgical team in a region that is often misunderstood culturally by the west. I am truly humbled by the kindness and enthusiasm of Egyptian hospitality. Until next time, as-salamu alaykum.‍
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--Vivian Ringo, MS, BSN, RN, CNOR
Interim Perioperative Clinical Educator John Muir Health Walnut Creek and Director of Clinical Operations for SVI. Please email me with any interest in global public health or future mission involvement: Vivian.ringo@surgicalvolunteers.org