If a natural or man-made disaster has just occurred and you have no experience working as a surgeon in a low resource setting but have been asked to join a team and are reading this chapter for insight, stop – now is not the time to gain experience and understanding. Being part of a disaster mission is nothing to take lightly, and requires planning and preparation to do well. Remember, primum non nocere, first do no harm. This concept is often ignored during disaster responses when ill trained and inexperienced volunteers rush to help. The rationale, something is better than nothing, is rarely true and often times do gooders without the proper support and experience do not actually help and can even make things worse.

Before heading into a disaster zone on a relief mission – be it natural or man-made – unless you are physically present on the site where this occurred, do not rush in. It is especially important to not rush in alone. Think about your family, your work and your reputation; rushing to help and ending up as a hindrance can lead to multiple problems for the people you were trying to help and for yourself.

Also consider the ethics of what you are doing and why. Most likely the people you will be trying to help have suffered. There will likely be a lack of water, food, shelter, fuel and health care. Make sure that you will be a net positive for the situation and not become a burden on those you are trying to assist.

As international disaster response has become increasingly common and advanced, several themes have emerged as critical to success:

As stated above, preparation is the key. Do not just run to a disaster zone because the opportunity presents itself. Make sure that you are adequately prepared and that there is some logistical backing or organizational structure to support you. There will certainly be a first time for everyone, but before volunteering for a relief mission, it is almost imperative that you have prior experience working in a low-resource setting environment. It is not appropriate that the first time you operate without electrocautery, suction or lights be during a disaster. Even though such skills are not difficult for most surgeons to gain, they still need to be learned and practiced. Volunteering in a stable, low-resource setting can begin to provide the background and understanding of what possible conditions will be like during a disaster relief mission. Further, depending on the stable low-resource setting and the organization that helps arrange the mission to the disaster, the circumstances in the disaster may be relatively better than the experience gained in the stable environment.

Additionally, it is important to go with a group that has prior experience not only in disaster relief missions, but also in similar locations so that they better understand governmental and cultural nuances. There are a number of well-respected organizations such as Médecins Sans Frontières (MSF), International Medical Corp, and the U.S. Government International Disaster Management Teams that have the technical experience and logistical framework to support volunteer surgeons on a relief mission. It is the logistics on the ground that will ultimately determine if your mission and the treatment your patients receive is successful. Other useful U.S.-based resources include the American College of Surgeon’s Operation Giving Back program (http://​www.​operationgivingb​ack.​facs.​org) and the Global Paediatric Surgery Network (http://​globalpaediatric​surgery.​org), both of which serve as clearinghouses for short- and intermediate-term surgical work in low- and middle-income country settings.

When assisting in a disaster situation, having some knowledge or special connection with the location is helpful. This can include a sociopolitical understanding of the affected region, cultural issues specific thereto, competence in a local language, and so on.

Prior to signing up for a relief mission, it is also useful to get some specialized training. Some groups such as MSF hold courses for new volunteers; other options include humanitarian surgery courses run by Stanford University or the American College of Surgeons. Many of the cases encountered in the field will likely include infected wounds, open fractures and maternal health care needs; therefore, some familiarity and comfort with trauma, orthopedics and obstetrics is mandatory. Other subspecialty skills that can be useful include: pediatric surgery, plastic surgery, neurosurgery and urology. Experience in these subspecialties can be gained by working with other colleagues at your home institution. Another option, which requires a significant time commitment, is a rural surgery fellowship. As of this writing, ten such fellowships are offered in the United States (see http://​www.​facs.​org/​residencysearch/​specialties/​rural.​html, accessed September 12, 2015). In addition, there are multiple online and in-print resources that address trauma and non-trauma surgery in austere settings, including the two-volume Primary Surgery text edited by Maurice King and the International Committee of the Red Cross’ War Surgery Manuals (see suggested readings).