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Hope and Healing: An Interview with Mark and Peggy Shrime

One of the most popular trends in modern travel is voluntourism. One part travel, one part volunteering, voluntourism offers travellers a way to delve deeper into a place while supporting the local community in some small (or large) way.

Mark and Peggy’s trip is a perfect example of voluntourism. A pair of physicians from New York City, they are on a one-year trip around the world, combining their love for travel with their desire to offer their medical skills as volunteers. After 6 months of roaming the globe, they will spend another 6 months in Sierra Leone, where they will volunteer with Mercy Ships, a charity providing free specialised health care to the Sierra Leoneans.

TravelBlogs caught up with Mark and Peggy last week to learn more about their trip, Mercy Ships and healthcare in the developing world.

What inspired you to make this trip?

Mercy Ships… first world medical services to the third world, not third world services to the third world.

Mark: We had been talking about doing this trip for a long time–since we met, actually, six years ago. We have both travelled a fair bit in the past, and so doing something like this was pretty natural. And, this year was a logical break-point in our respective training schedules (I’ve just finished my fellowship, and Peggy has just finished her residency).

I did the trans-Mongolian railroad back in 1998, as a way to get home from a year living in Singapore, but I forever regretted not actually stopping in Mongolia. That, and a desire on my part to see Central Asia and Iceland, and a desire on Peggy’s to see India and visit her family in Taiwan, formed the kernel that grew into the first half of this year. We started out with a pretty ambitious itinerary and gradually cut out countries that we couldn’t fit in, until we got to something reasonable. A lot did have to be cut, since we’re planning on doing most of this trip overland (although we’ve had to throw in some flights, especially near the end).

That’s the first half of the year. We have also been interested, throughout our medical training, in doing some international health, and this was also a logical time to explore that option on the ground. Hence the second half of the year.

Tell me a bit more about Mercy Ships and what you will be doing in Sierra Leone.

Mark: A lot of volunteer medicine in the international sphere is relatively general. Unfortunately, both Peggy and I are a bit too hyperspecialized, making us much less employable in many of these volunteer organizations, including MSF (Medecins Sans Frontieres), which was our first choice.

So, we looked at a large number of them before finally settling on Mercy Ships. The organization is fascinating (in my opinion). Its model is to buy old passenger ships and to retrofit them into fully-functioning hospitals. It then parks in the port of a city, usually in West Africa, for about six months and performs surgeries, free of charge, for the people of that country. They’re currently in Liberia, and are (hopefully) going to be in Sierra Leone when we join them in February.

The ship we’ll be on is a new acquisition, actually–Liberia is its first port of call as a medical ship–so it’s got as up-to-date a set-up as it can. Fully functioning pharmacies, CT scanners, operating rooms, ICUs, and the like.

And that’s why we settled on Mercy Ships. I’m a head and neck cancer surgeon, and the organization does a fair amount of head and neck surgery. And they have an ICU (though we’re a bit unclear how much intensive care medicine they actually do), which is Peggy’s area of interest.

Even though the civil war came to an end in 2002, many people would still be pretty concerned about travelling in Sierra Leone. Did you have many inhibitions before you decided to go there?

Peggy: Yes. In preparation we had read a number of books, including Ishmael Beah’s “A Long Way Gone: Memoirs of a Boy Soldier,” which is a particularly chilling account of his transformation from a regular hip-hop-loving teenage boy to a killing machine. An American passport really is not much protection over there. The recent elections were also unsettling because whenever there is a changeover of power there always seems to be more violence. Yet, Mercy Ships has an excellent reputation in Sierra Leone and we feel that this is a perfect opportunity for one specialized surgeon and one internal medicine doctor to help. You know that saying, “Do one thing a day that scares you”? Well, we will be for our time in Sierra Leone and I think it will overall be a good experience.

Mark: Although we’ve both travelled to less-than-stable places before, we’ve never decided to live an extended period of time in a place like this. Interestingly, we had initially been booked to go to Liberia; we found out we’d be going to Sierra Leone instead right about the same time we saw Blood Diamond and read Beah’s book, neither of which made us all that comfortable.

But, we felt like if we were truly going to get started in international medicine, we wanted to go whole-hog (we’re just that way). So, West Africa was the place to do it.

That said, you’re right that things aren’t stable there. So much so that now, with a new administration freshly elected, we’re actually up in the air as to whether we’ll be there, Ghana, or Liberia.

You’re both physicians in New York City, but obviously health care in a country like Sierra Leone is going to be a big change from the USA. Have you ever worked in health care in the Third World before?

Peggy: Yes. In 2002 I spent a year in rural Guatemala. Things were very rudimentary there, and, even though I had only finished my 3rd year of medical school, I still had more book knowledge than the local health promoters there. They more than made up for it in clinical experience, and we were pretty effective in combination. I saw everything from allergic reactions to a jellyfish sting, to gunshot wounds to the head, and delivered a good many babies. No epidurals there, only a rope hanging from the ceiling that women would hold on to while delivering in a squatting position.

Patients came to us either borne on the backs of family members or by boat, and every couple of nights we would wake up to the calls of “Emergencia!” We would then fire up the generator so we could turn on the lights, although a good many children were delivered via my trusty Petzl Zipka headlight.

Mercy Ships will be a step up from that in that it will offer first world medical services to the third world, not third world services to the third world. The ability to perform complex head and neck surgery and close vesiculovaginal fistulas is very very meaningful, because these problems are not addressed by most NGOs since they require specialized care. Yet these problems lead the patients to be shunned or ostracized by their community, and some to die from really benign conditions. I think that though the patients will still need to deal with poverty and unemployment (which unfortunately often translates into “patient noncompliance” and an apathy for life), at least we can offer them some first class medical service and some hope for a better future.

Mark: Not like this, as Peggy said. I’ve worked in Jordan and Mexico before, but that’s, comparatively, easy.

The one thing that’s good (and bad, actually) about Mercy Ship’s model is that we won’t be reliant upon the infrastructure of the country we’re going to, as Peggy has mentioned. The ship brings its own infrastructure along with it. This is important in the intensive types of medicine and surgery that we do. You don’t want to be in the middle of a fifteen-hour operation and have the electricity and water die on you, nor do you want to be keeping someone alive on a ventilator and find yourself without power.

There’s a public-health negative about this, though–what we’re doing, to a large degree, does not engender sustainability. Yes, there are local physicians we’ll be training to do the things we do, but the lack of infrastructure means that this training can only go so far. And to some degree, we become a deus ex machina, sweeping in for six months, helping people, and then leaving.

Mercy Ships attempts to combat this by returning to the same countries over and over again, and by partnering with local physicians for follow-up. That helps, to some degree. But, as one of my friends, who teaches public health in NYC, told me, it’s not as if Sierra Leone is five or ten years away from developing the infrastructure necessary to do complex head and neck surgery or intensive medicine; it’s decades away. In those decades, there are thousands of people who could be helped, and that’s what we’re hoping to do.

What is your advice for people who are interested in volunteering overseas? What are some of the particular challenges you’ve faced?

Mark: Wow. That’s not an easy question, especially since we’re still on this side of the six-month stint. The biggest immediate challenge we’ve faced is fund-raising. My guess is that’s probably anyone’s biggest initial challenge. We’re unpaid volunteers on this ship, so we have to raise enough money to support our crew fees, flights, medical insurance, and all that. When we first got started, it seemed a daunting sum that we’d have to raise. What we’ve been humbled by, though, is the sheer outpouring that we’ve seen.

Most humbling is that, when we started, this was just our little dream, our little mission. But we’ve seen people come out of the woodwork and say, “Hey! I’m sitting here in NYC (or Toronto or Dallas or Taiwan or…) and will probably never do something like what you’re doing. Let me help you get there.” I tell you…every time we get our support update, we’re humbled by this.

But, bigger than that, honestly, has been the challenge to keep this desire foremost in our minds throughout our training. It’s easy to get sucked away from that–physicians in the US can, despite Medicare, still make a very comfortable living. The temptation to move in that direction, and away from the not-so-comfortable living that we think we want to do long-term…that’s the hardest challenge. And, on this side of the volunteerism, that’s the only advice I’d give someone interested in doing international medicine: stay focused on this particular dream, despite tuggings in opposite directions.

Peggy: My advice would be, Don’t give up! Inevitably you will run into people you trust telling you it would be disastrous for your career to take time off from the race to be on top (especially if you are in medicine), or that you will be more useful at a later point in your career. Yet, these same people who told us these things had the most wistful expressions on their faces when we decided we would do this anyway. Persevere to find the right place and the funding, and things will come together.

Of course, you’re doing quite a bit of travelling before you get to Sierra Leone. What have been some of the highlights so far?

Mark: Another hard question. We haven’t been to countries we’ve hated yet…every country has been pretty impressive. I think our absolute, hands-down favorite country so far has been Mongolia. Everything about that country, from its people to its landscape to its horses, language, food, music, and way of life, is haunting and beckoning. There really isn’t anything like riding a horse through the steppes of Mongolia. Or seeing how proud someone is to tell you about their country.

A close second, though, has to be Iceland. What an amazing (and amazingly expensive) country!

Peggy: We rented a 4 wheel drive and drove around the perimeter of Iceland on the Ring Road. That was tremendous, as the country is not only beautiful, but varied. One day you are in the middle of the red and brown hues of boiling mud pits in Krafla, and another day you are listening to glaciers clink against each other in the purple and blue lake at Jokulsarlon.

Mark: You can drive the whole thing in four days–provided you’ve got a 4WD rented–but you shouldn’t. It’s not one of those show-off countries (you know the kind… “Well, I’VE been to Kyrgyzstan, so top that…”), but it’s some of the most intense travelling we’ve done, in terms of testing our driving skills, our weather tolerance, and in terms of impressing us with topography you really can’t see anywhere else.

Peggy: And then, in one of those quintessential travel moments, just yesterday we paid off a policeman to climb the minaret of the Registan in Samarkand to watch the sun set.

Where are you off to next?

Mark: Depends on what you mean by that. We’re currently in Uzbekistan, after which we take a train to Lhasa, and then overland to Darjeeling (yes…crossing the Himalayas in November. This will be fun).

But more long-term: since a trip like this engenders similar ones, we’ve discussed quite a lot of options. We’ve talked about going Lisbon to Capetown overland (around the Mediterranean, through the Middle East, and down the east coast of Africa). We’ve talked about motorbiking the circumference of South America (with a jaunt over to Easter Island, of course). And–my personal favorite, though Peggy’s not as keen on this one–we’ve talked about retracing Genghis Khan’s steps (from Ulaan Baatar to Vienna) on horseback.

Keep track of Mark & Peggy’s trip on their blog, Hope and Healing.

Posted by Eric Daams on October 29th, 2007 in Interviews.
Tags: Guatemala, medical volunteering, Mercy Ships, Sierra Leone, volunteer work, voluntourism