Awakened Anesthetist

[PROCESS] Exploring Medical Missions as a CAA with Sabena Kachwalla, CAA

• Season 3 • Episode 40

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Navigating the intricate world of medical mission work can be a daunting task, especially if you’ve never sat down with a CAA who has gone on one. That all changes with this episode. Sabena Kachwalla, CAA has been on nearly 20 clinical and educational medical missions and shares with us her practical insights, including the need for supervision, licensure, and the costs associated with missions. Our conversation takes a deeper turn as we delve into her personal experiences administering anesthesia in third-world countries. Her vivid stories will inspire and empower all CAAs and AA students who want to take their own medical mission trip. And even bigger, Sabena's PROCESS episode allows all CAAs to see to believe what's possible when you follow the path uniquely meant for you.

More questions for Sabena? Email Sabena skachwalla@nova.edu

Medical Mission Agencies with CAA history:
https://mmomusa.org/
https://www.medicalmissionsfoundation.org/

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Speaker 1:

So initially I think it was hard to break into doing medical mission work as a CAA.

Speaker 2:

Welcome to the Awakened Anesthetist Podcast, the first podcast to highlight the CAA experience. I'm your host, mary Jean, and I've been a certified anesthesiologist assistant for close to two decades. Throughout my journey and struggles, I've searched for guidance that includes my unique perspective as a CAA. At one of my lowest points, I decided to turn my passion for storytelling and my belief that the CAA profession is uniquely able to create a life by design into a podcast. If you are a practicing CAA, current AA student or someone who hopes to be one, I encourage you to stick around and experience the power of being in a community filled with voices who sound like yours, sharing experiences you never believed possible. I know you will find yourself here at the Awakened Anesthetist Podcast. Welcome in, hello to all my fellow CAAs, aa students and anyone hoping to become one. This is your host, mary Jean, and welcome to our process series. I am so excited to share this story with you all today, this process episode. It's really the crux of why I created this podcast, which is to expand everyone who's listening, who's in the CAA profession or adjacent to the CAA profession, to expand our understanding of what's possible for us as CAAs, and Sabina's story is such a wonderful example of the power of human connection, the power of seeing someone who's similar to you doing something you never thought possible. And this episode, this interview, expanded myself as I was doing it and then in the editing process, I just kept learning new things and just feeling so inspired to go after the unique path that's meant for me. And I just preemptively want to say a big thank you to Sabina, today's process guest, for chasing her unique path and by doing so she expanded what was possible for all the CAAs who have already come behind her and taken mission trips, and any of us who are listening who never thought a mission trip would be available to a CAA, or there's no one in your immediate vicinity who you know, another CAA who's taken a mission trip that you could have spoken to or learned from. Let this process episode with Sabina expand your understanding of what's possible for you individually and thank you, sabina, for being such a guiding light in this medical mission's work. So, before I say anything more, let's start this episode, like all things medical, with a quick timeout. Sabina Ketchwalla is a CAA currently living and working in the state of Florida. She is a University of Alabama, at Birmingham alum, and a Southern girl at heart who made a big leap to accept a position at the Case Cleveland AA School, leaving her friends and family and the warm weather. Sabina then graduated from the Case Cleveland AA program with her Masters of Science in Anesthesia in 2007 and took her first job as a CAA at Washington Hospital Center in Washington DC. Fun fact, I happened to graduate from Case Cleveland just a year after Sabina, so I certainly knew of her and I had elected to do one of my second year away rotations at Washington Hospital Center. So Sabina and I have met before during that rotation and I wouldn't say that I knew her really well. But because the CAA community is so small, I had heard that Sabina and a few people who I also knew that were in that DC area had been taking mission trips. Initially I had set this process interview to be with a couple of CAAs who I had a more direct connection with, but when I did the introductory discovery call with them, they both pointed back to the fact that Sabina was really the person who had initiated and coordinated their ability to go on these missions. So I knew that this first ever CAA Medical Missions episode needed to be from her perspective. Sabina has been on nearly 20 mission trips since 2007. She's taken both clinical medical mission trips, which are likely the kind you are thinking of right now, but also educational medical mission trips which I had never heard of, and she will explain more about in this episode. After a decade of working and living in Washington DC, sabina reclaimed her Southern roots and took an associate professor role for Nova Fort Lauderdale, teaching pharmacology and sim lab. She also still works clinically at a hospital in Miami. Sabina happens to work 7 12-hour night shifts in a row and then has 2 weeks off. And Sabina also does some additional 1099 work. Sabina is still taking mission trips and always encouraging her Nova students to come with her. She believes all CAAs should take at least one medical mission trip in their lifetime and after Sabina's process episode, we all are one giant leap closer to that being a reality. If you, like me, have never sat down with another CAA who has been on a medical mission trip, then this episode is going to blow your perspective wide open. You will hear me trying to get Sabina to tell me like the crux, the plan, the formula for how to get accepted to go on a medical mission trip as a CAA, which is very type A CAA brain of me, but, like most things for our smaller, lesser known profession, you may be the first CAA the medical mission agency has ever met or spoken with, and you likely will have to do some educating and some pushing to get what you want. But after listening to Sabina you will understand that it is so, so possible and once you open that opportunity for yourself, you have made it easier for all CAAs to come after you. So let's jump into this episode by welcoming Sabina to the Awakened Dnesotist. Hi, mary Jean, how are you? Hey, I'm so good. I'm happy to have you. I'm excited to learn about your journey and this episode is going to be in particular, about your mission trips and the work you do giving anesthesia overseas. But I'm really excited to learn so much more about you. So I was hoping we could start out with a rapid fire round, if you're game for that.

Speaker 1:

Absolutely. Thank you so much for having me. I'm happy to be here Awesome.

Speaker 2:

Okay, well, these are kind of fun for me. So I want to know, I think, what would you be if you weren't a CAA?

Speaker 1:

That's a good question. I would definitely do something in medicine because I've always been drawn to the sciences. Particularly, I have a love for animals. So I always thought about. You know, veterinary school would be a route I would consider Because I'm an animal lover and it combines my love for science and medicine. So if I wasn't a CAA, I probably would be maybe in veterinary school Very cool, interesting.

Speaker 2:

Okay, and are you a coffee gal or a tea gal?

Speaker 1:

Actually neither I don't really drink coffee or tea. Shockingly, people say how can I work these crazy hours and not drink any tea or coffee on a regular basis? More of a water person, I try and hydrate as much as possible.

Speaker 2:

That is very good, samina. Okay, and what did you want to be when you were a kid?

Speaker 1:

Oh, when I was a kid I always was interested in science, medicine, of course, always a doctor, Some sort of science field. I had different influences in my life, but always interested in medicine.

Speaker 2:

You work nights and I like to ask people what time they go to bed, what time they wake up. So that doesn't really apply maybe, but let me ask you how much time do you spend on social media, if any?

Speaker 1:

Very, rarely on social media, probably more so on my vacation. I might, you know, open up social media, or if I'm trying to do research on the next vacation that I want to take, or maybe I just need like a laugh or a giggle. I'll open up social media, but not very frequently.

Speaker 2:

It's an interesting theme. The people who I've had on here, most of them aren't on social media and I guess I would say probably. I've been speaking with an older demographic, like my demographic, and we didn't absolutely grow up with social media. But it is kind of like can you do a lot of different things and interesting things and spend a lot of time on social media? It remains to be seen, I'm not sure.

Speaker 1:

It can be very time consuming Going through all those Instagram posts and it's just time consuming and you can definitely lose track of time.

Speaker 2:

Yeah, yes, I've been trying to do some social media for Awakened Anesthetists and it's like, wow, it is a job. You've got to manage that thing. So I don't know, I'm trying to find the balance myself. But okay, I think that is all of my intrusive questions that I want to ask you. Let's kick it off with a question I love, which is to tell all of us about your cultural background and your upbringing and kind of how that informed who you are today.

Speaker 1:

So I come from a mix of a background. My parents are first and second generation. My father is a first generation, from India he came over when he was a teenager and then my mom is second generation, hungarian. So it's a bit of a combination of two different cultures. So growing up, I was growing up in a household with a Catholic mother and a father who was Muslim, but grew up in a suburb of Atlanta where I went to school with majority white. So definitely a mix background.

Speaker 2:

And how did you first hear about the CAA profession?

Speaker 1:

Funny story. So I didn't know anybody who was a CAA specifically or didn't hear any stories. When I went to school, there were only two schools. There was only Emory and Case Western at the time and I was living in Atlanta. So I went on to Emory's website, you know, looking at different options in medicine, and had came across their PA website and happened to come across their AA program and that was my initial you know kind of exposure or how I found out about the AA program, which you know was really, you know, I want to say in its infancy, because we've been around for 50 years but still a lot of people didn't know about AA's.

Speaker 2:

Mm-hmm, were you in college when you found, when you stumbled onto the, a website, I was yes, okay.

Speaker 1:

Yeah, I was still in college. Um, I had Taking us some time off to decide because I had taken the MCAT, didn't do as well in the MCAT as I wanted, and Then decide you know where I should go, you know what's my next? Rocks it up I want to go to a grad school. Mm-hmm you know whether or not it would be a PA or DO program or go to the Caribbean and do a program there. So I was trying to, you know, figure out what my next route would be. So I had to take some additional classes. So technically I was still in school but had graduated, had a double degree in English and biology, and then, you know, I was trying to take some additional courses like anatomy and physiology, which were some requirements to get into some of the schools.

Speaker 2:

Mm-hmm, and obviously you ended up applying, getting into case Cleveland and then just briefly share what your experience in a school was like.

Speaker 1:

So I had to move to a whole different state. So that was kind of a culture shock. I Was used to living in the South and then having to move to Cleveland was it was cold in Cleveland and just a different location. Or I didn't know anybody, I didn't have any family, didn't have any friends, yeah, so the students who are in the program essentially became my most immediate friends. So we, you know, hung out, we spent a lot of time together. I mean, when you go through a program, as you know, as the CA, you get really close to the people who you know are going through the program as well, because you have the same experiences, you go through the same things, and so I built some, you know, long-lasting friendships from there. I still keep in touch with several of the people who I graduated with. So it was, it was tough. It was tough going to a new city and being in an environment which was Stress. You know what the expectation was as a student was a very high expectation.

Speaker 2:

Mm-hmm. Yeah, and I actually graduated a year after you, after Sabina, and so, interestingly, I know what you did immediately out of case after you graduated, because I ended up picking Washington Hospital Center, correct, that was the name of the hospital.

Speaker 1:

Yes.

Speaker 2:

Yes, as a way rotation, when I was in school and I happened to be paired with Sabina and a few other AA's there, there seemed to be a fair amount of AA's working there at the time, so I kind of know what your first job was like. But maybe can you Explain why you chose to go to Washington DC and what you hoped your experience would be as a new grad AA.

Speaker 1:

Well, I wanted to be in a large city, so that was kind of a consideration when I was choosing where to work. And then, because I'm a friend of a multicultural background, I wanted to be in a city where that was also had, you know, some culture to it, and had did a rotation there to see if I that was something that I really wanted to do. We're a place where I wanted to work and just really enjoyed the culture of DC, the environment of the hospital and the support from the AA's that were there as well. Except made a big difference to have mentors who are available.

Speaker 2:

Yeah, and I am really interested in hearing how that first job kind of launched you into Really a large body of experience doing these mission trips and doing mission educational work. And so can you take us back when you first thought, oh hey, I could do mission work as a CAA. Was it someone at that first job that kind of expanded you, or was this always an interest of yours?

Speaker 1:

So I would say, doing volunteer work has always been an interest of mine growing up. Volunteering, you know that was a part of like our family culture Was to always give back. You know I volunteered to different places, you know, as a teenager and you know, kind of Took that along with me and continued that sort of work into college and, you know, as undergrad did volunteer work and then Obviously we didn't really have a whole lot of time in a school but I had done a mission trip prior as an undergraduate to Guyana had, you know, family friend and you know people who had influenced me at the time. It was they like hey, you know you're interested in medicine. You know why don't you experience going on a mission trip? I so had the opportunity to go to Guyana to do more of a kind of clinical not necessary or mission trip, but they were there to do medical Provide. You know medicine not, you know, it wasn't an operating room, so my role was very limited. I didn't have any sort of certification, I didn't have any sort of medical training. So I basically did have training. You know, taking blood pressures it's pretty easy, which and blood sugars, which you think is very, you know, simple. You don't really think that that would be. You're not really Adding anything or value, you know, but it was an opportunity to interact with the locals there in Guyana as well as to interact with the medical professionals who did Mission work and you know, talk to them and spend time with them what their experiences were and how they themselves got involved in doing mission work. And then ever since then I was like, okay, that kind of put the idea, you know, when you know I definitely want to do medical mission work when I would ever route, I end up taking and had, you know, the opportunities to get involved in mission work through some of the other Physicians at the hospital that I worked at in Washington Hospital Center. There was, you know, physicians from different backgrounds and from different countries who they themselves would go back to their country from where they're from and they would give back. I happened to get in touch with a physician who was a Filipino and he did, him and his family. They had a small medical mission group, medical mission of mercy, and they would go back to the Philippines every year as a way to give back and, you know, a lot of them were Filipinos. But that doesn't necessarily mean that you had to be Filipino in order to participate. It was just a way to give back to their country and from you know where they were from. So I was interested and said you know, sign me up. You know I this is a great opportunity to get involved and to give back and to use my training and To do volunteer work. And so it combines things that you know I was trained at doing Anesthesia and then you know my passion for giving back and for volunteering and then also my passion for travel, because I really enjoy traveling as well. So it was a, you know, opportunity to to get involved.

Speaker 2:

How long had you been practicing as a CAA before you took that first mission trip?

Speaker 1:

It was probably about a year and a half to two years. That was practicing before I actually did a mission trip.

Speaker 2:

And do you feel like you had enough experience under your belt to go do that? Would you recommend that timeline?

Speaker 1:

I don't think anything can like really prepare you for your first medical mission. You know you could talk to people, you have the training, but I think there was also an aspect of the cultural shock. I mean, I've traveled a lot and but then going to an area that you don't necessarily have resources available, it's really hard to prepare yourself for that and to prepare yourself for the cultural shock and for what to expect and to really see people who don't necessarily have access to medicine. But it's. It's hard to prepare from some aspects but you do your best, you know, to get an idea of what to expect when you're doing mission work.

Speaker 2:

And you had. You had joined an existing group that had experienced taking CAAs over, or were you the first CAA to ever go on this mission out of your hospital?

Speaker 1:

I was the first CAA, however, the Group that I went with. They've been doing medical mission work at the time probably for 20 plus years, I would say Mm-hmm, so they were well.

Speaker 2:

They already knew what the routine was for doing mission work over there, but I was the first CAA within that group at the time, okay, and I just think it's really expansive to hear someone kind of break into a space that a CAA has never been before. And I know there's a lot of CAAs out there or student AAs who are interested in eventually doing mission work. And I'm just interested what you've learned about how to break into that space, especially if you're going to be the first CAA out of your area or your hospital to do that. Can you remember that first experience? Can you just describe that a little bit, how that broke down?

Speaker 1:

So initially I think it was hard to break into doing medical mission work as a CAA. I had reached out to several different groups and either the group didn't know who CAAs were or they said, because we can't practice independently, that they don't want to have CAAs. Now that's changed. I mean, that was probably 16 years ago, so it's that sort of it's changed. Over time People are more familiar with CAAs and our scope of practice. But being deterred so many times, it's where do I turn to? So I had reached out to the people who I worked with, which I had already established a relationship. I worked with on a daily basis and they know my work and I talk with them daily, so they know who CAAs were. And that's how I kind of got started in working with particular groups.

Speaker 2:

So when you say you reached out to the groups, you're saying you reached out to medical mission groups outside of the ones you had heard about at your practice. Like this how happened before you connected with the? Was it any anesthesiologist who had established the Filipino or the trip to the Philippines? I was actually a surgeon.

Speaker 1:

He is a plastic surgeon that did plastics like ENT plastics, like cuff lip, cuff palate, and prior to reaching out to them I first initially reached out to, like doctors without borders. They were sort of charities, just really like shooting emails and making phone calls, and I'd spoken with different people who had run the charities from anyone for who they were non-medical, like. They were volunteers to people who are medical or even CRNAs and who were maybe familiar with us and kind of shot me down on my willingness to volunteer. But I think it's definitely changed. So I think there's a definite need for people to volunteer and there are more opportunities as well.

Speaker 2:

Yes, I think you can kind of, I think, get trapped, or maybe I personally feel like a little bit hurt or shunned or like hey, caas aren't welcome here, and I just want everyone to hear that it sounds like it's not that we're not allowed to be there, it's just that no one's ever asked or educated how a CAA can fit into the previously established you know, I don't know hierarchy, or however you go to a mission trip because there's confusion on whether we can practice independently or do we need to be supervised, and I would love if you could even give just like an overview of a few answers to those questions, because I don't really understand if we have to be supervised on a trip, do we practice independently? Do we get a license, like? Can you offer some of your experience and insight into a few of those questions?

Speaker 1:

Absolutely so. We practice the way that we practice over here. So we have at least one anesthesiologist. So maybe the ratio isn't like one to four, maybe it might be like one to six. So the ratio is a little bit different, but we practice safely. So had there been times where I wasn't supervised, there were anesthesiologists available, I would say, but they were like local Filipino anesthesiologists I wouldn't say that they are like specifically supervising myself but they were available if needed. So in terms of licensing, it depends upon the country which you visit. So you would go through the Ministry of Health or equivalent and you would submit your license and obtain temporary licensing to come into practice within that country. So again, it has to go through the process of the country, through the Ministry of Health, and every process is a little bit different. So there's a lot that goes on behind the scenes that maybe necessarily volunteers may not know about, because those groups have already established their sort of relationships with the Ministry of Health and so it makes it a little bit easier for them to submit reoccurring licenses for their providers every year or however often that they do those trips.

Speaker 2:

Okay, and so we're fighting against just the fact that these medical mission agencies have already figured out how to get an anesthesiologist over there, wherever the country is, or get a CRNA, and they've kind of done all of that hard back work and it's kind of convincing them or showing them hey, you could also do this for a CAA, because we're not so different and providing a little bit of that education to the medical mission agency. Right.

Speaker 1:

Exactly. I would say each medical mission charity has their own process as to how they handle the volunteers. So each one is a little bit different, but it would essentially be similar to what you're submitting for kind of a job. So when I had applied as a volunteer, as a CAA, I submitted my license, I submitted my CV references, but then they also I worked with a lot of the surgeons I worked with and the people that went on the mission work. I worked with them daily too, so it made it a little bit easier from that aspect. So they're a bit more familiar with CAAs and our scope of practice. But it depends upon the charity. Each process is their process in terms of how they handle their volunteers is a little bit different.

Speaker 2:

I kind of figured. Unfortunately, that was probably the answer that there is no routine and like, hey, everyone collected this amount of paperwork and take it to these medical missions and then they can't say no, it sounds like we're dealing with like an interpersonal communication thing, like who ends up answering your call. When you call these, you know a cold call, a medical mission, and say, hey, I'm a CAA and I want to do a mission trip. There's you know that level and then there's the you know licensing back level on the United States side for the medical missions, and then there's also the country that you're going to serve. They're going to have licensing paperwork that's needed and you call it the Ministry of Health for these different countries. They're going to have some say in how you become licensed or who can become licensed.

Speaker 1:

I suppose Correct. Yeah, so temporary, what's called like a temporary license to come and practice within the country.

Speaker 2:

Okay, so we just need to be persistent If you want, if you're a student or you're a CAA. Listening, you know, being persistent, basically collecting the information that you would to apply to any other AA job, is what you're going to need. And then I have some more questions for you at the end here to hopefully give some more empowerment to the people who are listening, on kind of the how, like how do I go on a medical mission? I do want to dive in, since we have you. I want to hear your personal story on that first medical mission. If you could give us some of that description on what it felt like to give anesthesia in a third world country and what your setup looked like and how you felt and maybe some of the emotions behind it.

Speaker 1:

So my first medical mission doing anesthesia, it was just anesthesiologists and myself there was the two of us and I didn't know what to expect as far as resources like availability. I was told, hey, get you know it, gets your hospital to donate supplies. You know, bring things that you're comfortable with. You know, bring your own stethoscope, your pulse ox. Always have a backup stethoscope. Have, you know, a backup pulse ox? But you know, backup blood pressure cuff. So I didn't know what to expect as far as, like the anesthesia machines themselves, the hospital. Each hospital is a little bit different. So each hospital facility it's an active, running hospital. But you know, maybe they have an anesthesia machine that's 20 years old, maybe they have a brand new one that GE had donated. So you may or may not be familiar with that particular anesthesia machine. I believe that the anesthesia machines they weren't ancient, you know, but they weren't probably the newer anesthesia machines. So I think I had that sort of anxiety like trying to figure out okay, this is how the anesthesia machine works. You know, they did have availability for halothane, which is very unusual seeing halothane being used, but we did use SIVO and I mean some of the anxiety that I had was kind of relieved by the fact that the anesthesiologist was going to be in the same room. We had our own cases but he was at least going to be in the same room, which is very different than what we do here. Because of sterility you don't have to perform two operations in one room. But that's actually fairly common practice when you're doing medical mission work is you'll have two patients, two different surgeries, going on in the same room itself because of limited space, limited resources. So that was reassuring for myself that he was readily available. And then there was a bit of a language barrier. They did speak English and the Philippines they speak English for the most part. However, sometimes, depending upon where you're at, they may not speak English. You had to get a translator. The patients would already go through a preemission, essentially a preemission testing, where they would get worked up. We would do healthy patients and we wouldn't really do a lot of complex surgeries, so sort of general surgery things. We wouldn't do any sort of orthopedics where you had to do implants that required a lot of follow-up work and that could potentially have infections. But I think I had a few gray hairs my first mission, just because I was concerned for the safety of the patients and what available resources there were. But I had a good time and had the opportunity to give back, which was a very rewarding experience.

Speaker 2:

Yeah, Is there a breathing tube for everyone? I'm so ignorant on what resources there are and I feel like, yes, I'd have a lot of anxiety of can I even Am I skilled enough to like think on my feet and like, okay, we don't have this or that, how can I sort of rig something together and use it? Is it that level of lack of resources? Or you just you only have one breathing tube, don't mess it up. Kind of a deal.

Speaker 1:

We did have endotracheal tubes, but the hospital, depending upon what hospital that you're at they I have been to some hospitals where they would reuse their endotracheal tubes and the alamase that was, you know, in Nigeria, where they did have a little bit more limited resources. But we try and bring everything that we need, or the group that you work with. They themselves will provide you with everything that you need in terms of, you know, drugs. You know they'll either buy them there or they'll get people to donate. You know the drugs that you need. You know, of course, we didn't have a. I didn't have a glidescope on my very first medical mission work. I mean, glidescopes weren't really that accessible at the time. So if we had a difficult airway then you know you're in, you know could have potentially been in trouble, you would have to, you know, solicit the help of the general surgeons if needed to do it like a surgical airway. You know, I think we didn't have as, maybe, limited resources, we did have to have flashlights, you know, just in case the electricity went out. So that was something that you always had to keep in the back of your head if, in the event, electricity went out, because sometimes it fluck, you know flickers on and off, so maybe for like a couple of minutes the electricity would go out and we would have, as well as the surgeons would have you know kind of flashlights available to them if, in the event, that did happen. So it varies upon the hospital, depending upon which what they call district hospitals that you go to. Some are more resourceful and have you know businesses that will donate things, like you know GE. They donate like these amazing new, brand new anesthesia machines, or maybe you do have a little bit more a cake anesthesia machine, but luckily the group that I'm with they have. They actually invested the money and bought, you know, the own anesthesia machines that were like portable anesthesia machines that they would use. There were earlier my days of doing medical mission work. We didn't have Entitle CO2. So you didn't have that sort of confirmation that you were in with that Entitle CO2. So that was, you know, kind of limiting. But we had pulse oaks. We had a pulse oaks, we had a blood pressure cuff, you know EKG. We had all that sort of standard ASA monitoring. Now if we wanted to put an A line in, we, you know, would have to. Maybe the hospital did, or maybe they didn't have that capability. Most likely they didn't have that capability to do some you know advanced monitoring techniques. It just really depended upon the hospital.

Speaker 2:

Wow, it sounds like the patients are kind of matched with the level of resource. Did you say that's been true on your missions? That, like you're the, I guess the agency is picking to operate on patients who match the resources that they know they're going to have available for these patients. Right, exactly.

Speaker 1:

So it would, it wouldn't be like we're doing, you know, these ASA threes and four patients. Typically they're ASA ones and twos. Maybe they have hypertension, diabetes it's you know about the extent of their medical history that they have. So they're relatively healthy patients. We do do some like pediatric cases because we do a lot of cleft lip, cleft palate cases, but they those cases I, you know, would pass on to pediatric anesthesia providers Because I, you know, wouldn't necessarily feel calm. I don't do peeds here on a regular basis. I do some peeds but not I wouldn't say that would be my specialty. So we kind of pass those off to people who would do you know specialties and pediatrics. So there there is a matching between you know resources and a patient population and what we can do, provide for them.

Speaker 2:

Yeah, wow, okay. Just, there's so much that goes into it, there's so much need, yeah you. I just don't want anyone's anxiety or fear or like, hey, this is too hard, I can't jump over these hurdles to to deter them from doing a medical mission if they really want to any CAAs I mean. So how many medical missions have you been on?

Speaker 1:

Clinical medical missions. So I've done different types of medical missions. I would say more clinical, where I'm actually practicing anesthesia. I've probably done around 12 to 15 or so, oh wow. But I've also done kind of you know, educational medical mission work, which is a little bit different than the clinical part, but it's hard because you have to. You're taking your own time off. So this is it's not like you're getting paid, you know, to go and do these medical missions work. It's all on your own time, it's on your own vacation times. I mean, there have been a few years where I do, maybe you know, two in a year, but because of you know our vacation time, usually it's been about one per year.

Speaker 2:

Tell me more about those educational mission trips, because I don't know that many people understand that that's even an option.

Speaker 1:

So I had the opportunity to do medical mission work from educational standpoint, because there was an anesthesiologist who had already gotten involved with they're called clinical officers in Kenya so these are essentially kind of our equivalent to CAAs who practice in Kenya and he had already established a relationship with a training facility, a training school, who would train these clinical officers in anesthesia and he would go over there and do lectures and teach and he would actually bring some of their residents you know, the anesthesia residents from the States and bring them over to Kenya so that they would have opportunity to practice and kind of create an interest in continuing to do this sort of work. So he wanted to know if I was interested and you know, because I, you know at the time I also teach some classes for the clinical officers in Kenya and I said absolutely sign me up. So it's a little bit different, you know. So all the licensing you really don't have to get the sort of medical like, you don't have to submit your license and you don't necessarily have to give the same process as you would through the Ministry of Health for that country. You, essentially there was a relationship already set up with the school and it was, you know a very large school in Nairobi. It was actually kind of like a university. The university hospital is actually the largest hospital in Kenya, which was in Nairobi and it had, you know, nursing students, residents, all sorts of medical providers that were there, and so there was already kind of an academic environment already set up. So it wasn't coming into, I wasn't creating a new educational path or anything like that, so it was already set up and I was just kind of coming in and bringing my sort of American education and you know what I learned here in the States and then delivering the same sort of lectures. I would always already deliver to the CAA students but to the clinical officers. So that was, you know, an opportunity to impact in a different sort of aspect. So you're, you know, doing clinical work, you're helping people individually, providing services, but you're having a larger. I think you're having a larger impact when you're actually helping educate, you know, the providers themselves and so that they take that knowledge and they are able to practice the way that we practice here in the States, where they're, you know, hopefully practicing safer.

Speaker 2:

So you've purposely aligned yourself in communities that it sounds like these opportunities present themselves a little bit more readily, because it does seem like if someone sort of blazed the trail before you, you know, it's kind of easier, especially if they know you personally like Sabina the CAA if they know you and know your skills, they can almost advocate for you to go on these trips. It sounds like is what's kind of made the situation a little bit more seamless.

Speaker 1:

Oh, exactly, absolutely yeah. So the anesthesiologist who got me involved in the education, he kind of helped pave the way for, you know, this opportunity for CAAs who are interested in teaching.

Speaker 2:

Gotcha. Okay, so I'm hearing networking. I'm like you need to kind of surround yourself with people who are interested in the things you're interested in, and I'm kind of thinking of the CAAs who are out in the middle or you know, or in Missouri, where I am, and maybe aren't running into other surgeons or physicians or CAAs who have done this, and so I kind of actually have a little bit of a rapid fire questions lined up because I'm hoping to empower those people, or really all CAAs, aa students, with just a little bit more of the debunking of what's possible. So I have a few questions that hopefully you can. I think they're probably going to be really long answers, but maybe there's like a short sort of brief thing just to give people just a little nugget to move forward. Absolutely, I'll do my best. Okay, awesome, let's maybe keep it with the clinical missions, just because I think that's what people think about. I think this whole educational mission I didn't even know about until I spoke with you, so let's focus on that. For just for these questions. So to go on a clinical medical mission, do you need to go with an anesthesiologist and be supervised as a CAA?

Speaker 1:

Ideally, yes, again, so we practice. It depends upon the charity. You know it's up to the charity, but ideally you. The way that we practice here is the way that you want to practice internationally.

Speaker 2:

Okay, and do we have to get a license, a license to practice anesthesia in the country that we plan to practice?

Speaker 1:

It depends upon the country in which you go. I would say most likely you would have to get some sort of temporary license.

Speaker 2:

Okay, and the medical missions agency will help you know that information. They'll know, because of their past relationship with the Ministry of Health, if a CAA needs to get and what kind of license we need to get. Correct.

Speaker 1:

They actually did a lot of that footwork for me. So I just had to submit my license, my CV, to the charity and they turned around and submitted it to the Ministry of Health, because they had already established these relationships and these connections with the Ministry of Health, and so the Ministry of Health was already familiar with the charity group.

Speaker 2:

Gotcha.

Speaker 1:

So I didn't have to necessarily take the time and individually go out and seek and apply, and so it was kind of nice that they did that work for me, gotcha.

Speaker 2:

Okay, do we have to pay like money out of our pocket to go on a medical mission trip?

Speaker 1:

So it depends upon the group in which you go with. Obviously you're doing a service, so expect to pay something out of pocket. I mean this is you know it's volunteer work. You're volunteering your time and oftentimes you're also paying for some sort of aspect of the mission work. Mission work that I went to Nigeria they were happened to be nice enough to pick up my airline ticket. However, majority of the time you're volunteering your time so you have to kind of coordinate your PTO time and then usually you're paying for a flight over. Accommodations are very depending upon the country which you go to, but the countries that I've been to the accommodations are very. We're either covered by the mission group or you're paying very minimal. Maybe you know two or three hundred dollars to do a week, which I think is a very minimal contribution.

Speaker 2:

Totally Okay. Can AA students take medical mission trips?

Speaker 1:

Absolutely, I've taken students with me. I try and take students with me all the time. It just depends upon the area and obviously we're not taking students to Nigeria because it may not necessarily be a safe area, but absolutely it's. You know, students. I think it's easier for them, in terms of the licensing and the paperwork for them to go on mission trips as opposed to a certified.

Speaker 2:

CA Gotcha, and do we need malpractice insurance?

Speaker 1:

as last one, Personally, I've never sought malpractice insurance for mission work. It is available if you want to individually seek out that. However, I don't want to speak for all mission groups. Usually they themselves have malpractice insurance that they submit to the Ministry of Health.

Speaker 2:

I'm thinking that's probably where some of the regulations on who can go and what it needs to look like in terms of supervision and ratios and stuff is probably coming from those malpractice insurance policies. Yes, okay, interesting, okay, so good. Another it's good to know what kind of roadblocks we're going to be facing. Let me ask you what medical mission agencies you've worked with in the past.

Speaker 1:

So the group I've worked with the most as far as a clinical is they're called Medical Mission of Mercy. They go to the Philippines, they go to different areas of the Philippines. Another group I've gone with to Nigeria once before in the past. They didn't necessarily have a group name but it was a bunch of physicians that got together and that, would you know, they were Nigerian physicians and they would go to different areas of Nigeria. From the aspect of educational it was through Kenya Medical Training College that was in Kenya.

Speaker 2:

Have you heard of any other CAAs taking educational missions? Do you think you were the first one to do that?

Speaker 1:

I don't want to say I was the first one. I don't want to take credit for that Other CAAs who before me who have done medical mission work. But I've tried to enroll A lot of CAAs, encourage them to do mission work with me. I just happen to be in a position, you know, being in an education and having contact with students and kind of planting that sort of bug in the student's ear saying, hey, this is also available to you. I really think that you should take advantage of this opportunity and volunteer your time and do medical mission work.

Speaker 2:

This is so expansive, sabina, I just see so many light bulbs going off in people's heads because I just think to hear the first person's story of how a CAA has done this for themself like allows other CAAs to be like, oh okay, maybe there's no one in my area who's done this, maybe I don't have any anesthesiologists who are saying, hey, I want you to do this with me, but it's possible. We just need to be probably a little persistent. It sounds like, and do some, you know, do some behind the scenes work to kind of give ourselves the opportunity. And I think what's really interesting about the CAA profession is that, similar to Shane Angus who I just interviewed, it was just so obvious that you look to your right and to your left and you are the person who's meant to do this. There likely isn't someone before you that's made the road there. You likely are the one that's paving that road, and I think that is sort of surprising for a lot of people. And I think it's also really amazing opportunity as a CAA that you can really impact our profession by putting the effort in and creating all these opportunities downstream from you, like exactly what you've done with all of the students that you now touch. So I just think it's really expansive and I'm just so happy to have you on the podcast, I'm so happy to be here, yes, and I just have a couple of closing questions that I like to ask, and, as you may know, this podcast is really about the CAA profession's ability to help each of us build a life by design, build a life that's uniquely meant for them, and I'm wondering if you would agree with that statement and, if so, how do you think that's manifested in your life?

Speaker 1:

Absolutely. I think there's opportunities, depending upon what you're interested in, different roles that you could play, so you can kind of design your own career as a CAA and you can kind of take on different roles or put on different hats depending upon what you're interested in. So I always encourage a CAA and the students that I talk to is to do at least one medical mission in their life. Just have that experience and have that impact in giving back. If you're interested in doing mission work, that's definitely available to you. If you're interested in doing education, that's available to you, or even research, or even if there's opportunities to kind of take on a corporate role, become a chief CAA or kind of work your way up in that sort of corporate world, that's available to you. So I think there are definitely opportunities for CAAs depending upon what you're interested in to get involved.

Speaker 2:

What's next for you in your life? What do you see on the horizon? Or you feel like this is the life I've wanted and I'm living it now.

Speaker 1:

I can definitely say this is the life that I've wanted and I'm living it now for sure. What's next? No-transcript. Play different roles within our profession. I've, you know, had different leadership positions, had, you know, educational positions. You know, I've had an opportunity also to start my own business. So that was it's also an opportunity I've learned a lot. I Think that if I continue to have, like a sort of curiosity and what's available to us as CAA's, you know, you can kind of, you know, choose what sort of path that you want to go on, depending upon what interests you and what kind of sparks your curiosity, but it's you know, who knows what another the future will hold.

Speaker 2:

What business did you start? This is news to me.

Speaker 1:

Well, I open up my own business, you know, says, because I do some 1099 work on the side. Oh, I learned a lot by doing that, so that's been Interesting yes, maybe another maybe another podcast.

Speaker 2:

So you opened an LLC so that you could file the 1099 paperwork.

Speaker 1:

I Essentially opened up as corporation and that's okay, yeah, so a little bit different than LLC. So there's like escort and C corp and you know, as far as tax they're concerned, you're either a S or a C corporation. Llc, you know in the sole proprietorship. So those are kind of subcategories. But for tax purposes your S or C corporation and for small businesses it's more advantageous to be S corporation. So I learned, like I said, I don't do anything on my own. Obviously I have mentors and people I've talked to who know more about Business or more about, you know, medical mission work. So it's never I'm never done this solo. I've always had some sort of mentor. So you know you're not alone. You know, depending upon whatever route, wherever design, there are people that out there who are out there, who are willing to help and guide you through whatever process they choose.

Speaker 2:

Yes, and I just I'm so excited about having CAA mentors, like having you know now people in our exact profession who others can look to and be like. Okay, you're expanding me. I just think that is a Untapped resource and that's really one of the largest motivations behind this podcast. So I'm just I'm really excited for other people to hear your story and I was hoping you could just leave us with the first thing that you would suggest a CAA does. If they want to go on medical missions like what, where's, what's the first step they should take?

Speaker 1:

The first step is you want to talk to somebody who's done mission work. Okay, come up with a list of questions, you know. If you're interested, talk to Someone you've done who's done the work, and then kind of do some research as well. You know, the ASA website has a list of Charities who they can, you know, reach out to to get involved and doing anesthesia.

Speaker 2:

Okay, great, that's fantastic. Are you open to a a's or CA students Contacting you if they have questions about medical mission work and, if so, what's the best way to do that?

Speaker 1:

Absolutely, they can reach out to me via email. My Nova email address SKACH WALLA at Novaedu. I'm sure you could probably Put that in writing so it's a little bit easier for everyone to get a hold of me. Yeah, but I would definitely be available. Make the time to Talk to somebody who's interested in getting involved.

Speaker 2:

Awesome. Thank you so much, sabina. I'm so grateful that you Accepted my request to be on this podcast and I'm just really excited to get this mission work episode out there, because I know there's a lot of a a's who are interested in this topic and just don't know where to start and Don't have anyone to talk to about it, and I just think it's gonna be so encouraging and expansive. So again, thank you so much and I'm really grateful to you.

Speaker 1:

Mary Jean, thank you so much for having me. It's been a pleasure, awesome All right, I'll talk soon.

Speaker 2:

Thank you, Bye, bye, bye. I Hope you were as wowed by Sabina's story as I was and her willingness to push limits To chase after what she truly wanted as a CAA. It was just really inspiring and and I also enjoyed hearing some of the nitty-gritty behind the scenes of the medical mission experience. That is the level of information sharing that I really hope to give you all as you listen to awaken a nest, this podcast. I'm not looking for sort of an overview, necessarily. I'm looking for the very specific information that matters to us as CAA's. There's just a lingo that we use, there's a personal understanding of what everyone kind of already understands, and there's so many podcasts out there that you can choose to listen to. So many other podcasts that I choose to listen to, but this is really the only podcast that assumes that everyone who's listening is a CAA and has curated content for CAA's. So if you appreciate that approach, I would really appreciate you all Sharing this episode with another CAA in your life or another AA student who you know. Tell them why you loved this episode and tell them why they should subscribe and listen to awaken a nest this podcast. That type of advertising is so much more effective than really anything that I could do on my own. And, as you heard me tell, sabina, it's been really hard to juggle Instagram and the podcast and you know the rest of my life and so I've really let Instagram kind of become a smaller portion of what takes up my time. I still love getting on Instagram to connect, especially around Friyay's or the release of these episodes. It's really such a direct connection to this CAA community that I don't want to give it up completely. But, just to be honest, I don't have a ton of extra time to give to it. So I'm really relying on you all to spread the message, to help me out, to tell the other CAA's in your life about the podcast, and then also send me your interest, send me the episode ideas that you're looking for, send me your recommendations for people that I should talk to. That's really how I'm going show to show. Finding people Really leads me to the next episode and to the next episode, and I'm having so much fun doing it and I just am really, really Encouraged for our CAA community that the purpose of this podcast, which is to expand our understanding of what's possible for us all, is Happening in real time and it's really such a payoff for me for putting the labor of love into this podcast To see its ripple effect. So I think this is all amounting to a thank you, and I'm really grateful again to Sabina and to the impact that I know this episode is going to make. I'm so appreciative of you all listening and listening to the bitter end here. Let's talk soon.

Speaker 1:

Well, how do you feel? Great, I hope you know. I hope this like sparks interest in people wanting to get involved and it's great seeing you after so long to I know.

Speaker 2:

Isn't that crazy. I was just like. I have a such clear memory of you and Daphne taking me to that restaurant and feeding me whatever that For our meat things called. It's like a delicacy.

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Mary Jeanne Roberts, CAA

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