Image courtesy of Red Floor Pictures

Living in Emergency: Stories of Doctors Without Borders will make its North American premier at the 20th Annual Palm Springs International Film Festival, January 15, 2009. VISTA has had the honor of supporting this film throughout its development.

The festival will showcase 209 films, culled from 73 countries. The roster will include 83 premieres (14 World, 49 U.S. and 20 North American), and 50 of the 67 films submitted for consideration in the Best Foreign Language Film category for the Academy Awards. The festival runs from January 8-19, 2009.

Living in Emergency: Stories of Doctors Without Borders screens as follows:

1/15/2009 4:00 pm

1/17/2009 1:00 pm

Camelot Theatres
2300 E. Baristo Road
Palm Springs, CA 92262

Here's how festival organizers describe the film: "Trailing two new recruits and two veteran aid workers at field hospitals in Liberia and the Congo, this candid and often shocking documentary gets inside the minds of the volunteers of Doctors Without Borders - people who push their own limits to make a difference."

Read more about the festival and the film, at http://www.psfilmfest.org/festival/film/detail.aspx?id=20671&FID=36

We'll provide information about additional screening opportunities as the film is introduced across the US. Check back for updates!

The Medical Council of New Zealand recently announced changes to its International English Language Testing System (IELTS) requirements. These changes will affect international medical graduates who are required to pass IELTS before applying for registration in New Zealand. Here is a quick look at the changes:

Current IELTS requirements
Under the council’s current IELTS requirements an applicant must score a minimum of seven in each of the four components (listening, speaking, reading and writing) of the test. A minimum overall average of 7.5 is required.

New requirements effective February 1, 2009
The new minimum scores are:
Reading 7.0
Writing 7.0
Listening 7.5
Speaking 7.5

There is no minimum overall average score requirement.

Why the change?
The council is required to make sure that every doctor registered to practice medicine in New Zealand is, “able to communicate in and comprehend English sufficiently to protect the health and safety of the public, and for the purposes of practicing within the scope of practice in which they are registered.”

The council reports that the most common complaints it receives, after clinical competence, are concerns about communication skills. Therefore, the council considers scores in listening and speaking the most important in terms of communication with patients and colleagues.
For more information about these changes click here to visit the council's website .

I was cheered to read that 20 men and women graduated from medical school in Somalia last week, becoming that country’s first new class of physicians in more than two decades. What a feat! Reports say they dodged firefights on the way to school, maneuvering through Mogadishu, one of the world’s most violent cities. The ceremony was held inside the barricaded walls of a hotel.

The World Health Organization estimates that half of the world’s population does not have access to basic health care. And the Global Health Workforce Alliance projects a global shortage of 4.3 million healthcare providers. Twenty new physicians may not seem like much, but their impact will be immense. After watching the documentary Living in Emergency—Stories of Doctors Without Borders, a film VISTA supported throughout its production, I am awed by the energy and contribution a tiny handful of care givers can make. Watch this space for information about distribution of the film.

In the meantime, I can’t resist encouraging physicians considering retirement to think about locum tenens as a way to continue making a contribution to the global healthcare workforce. Your skills and time are incredibly valuable to organizations trying to recruit full-time doctors, covering for doctors on medical leave or military deployment, and/or staffing up to serve huge volumes of patients. As a locum tenens, you don’t have to own or manage a practice. You can practice pure medicine, essentially where and when you want. I can assure you that you will feel the deep appreciation of patients, colleagues, and communities. We can also place locum tenens doctors in Australia and New Zealand, both of which also face extreme physician shortages.

PS: And if you happen to know a pediatric anesthesiologist, preferably with some academic affiliation or experience, our friends are IVUmed are urgently seeking a volunteer for their upcoming surgical workshop in Senegal, February 13-22, 2009. IVUmed is a non-profit organization that provides medical and surgical education to physicians and nurses, and quality urological treatment to thousands of suffering children and adults through outreach programs and surgical workshops worldwide. Find out more at http://www.ivumed.org/opportunities/ .

Locum tenens was a great semi-retirement option even before the financial crisis. It makes even more sense now.

Over the years we have talked with hundreds of physicians teetering on the brink of retirement. They wonder how quickly they might lose their skills. They wonder if it would really be ok not to earn an income. They wonder if people will still look up to them. They wonder if their spouses will throw them out of the house for organizing, and then reorganizing, the DVDs (by alphabet or genre, always a struggle.) They wonder how it will feel to NOT practice medicine every day.

Working as a locum tenens physician can be a great solution to this wondering. It gives you the ability to work part-time, when and where you choose. Near the grandkids, in the small town near your summer home, in the facility where your oldest child is completing residency (That would drive her nuts, wouldn't it?)

Locum tenens is a way to keep your skills sharp and learn new ones, treat unique patient populations, and practice pure medicine without the hassles of running a business/practice. It's a way to help out a community in need.

And yes, there's the financial component. Financial advisors are telling us all not to panic, to think long term, that this too shall pass. But if you had your sights set on retirement this year or next, those words don't mean much. You may feel trapped or, just as likely, really angry. If it was me, I think I'd alternate between the two.

That's why this is such a good time to consider locum tenens. Locum tenens gives you the ability to earn a competitive income that is overhead free. Your housing, travel, local transportation, and malpractice insurance are covered. (If you opt for an international assignment, we help you negotiate for an optimum package to assist with these things.) Locums can either help fund the plans you had for retirement, or open up a whole new world for adventure. Don't give up on your plans. Give us a call.

I have the great pleasure of serving on the board of IVUmed, an organization committed to making quality urological care available to people worldwide. This amazing corps of physicians, nurses, and other assorted volunteers provides medical and surgical education to physicians and nurses, and treatment to thousands of suffering children and adults through outreach programs and surgical workshops. They also sponsor a Resident Scholar program through which they have sent more than 120 urology residents to developing countries to teach surgical techniques and learn what it takes to operate in challenging, resource-limited settings. The 2007-2008 program included residents from 11 programs who traveled to eight countries in Africa and Asia. (The deadline to apply for the next session is Feb. 1, 2009. Watch this space for more information.)

Under the direction of Catherine R. deVries, MD, founder, president, and an amazing pediatric urologist, IVUmed assembles volunteer teams of urologists, urogynecologists, pediatric urologists, anesthesiologists, pediatric anesthesiologists, nurse educators, and surgical nurses for teaching/working missions. Here are the dates of their upcoming trips:

Upcoming IVUmed Surgical Workshops:
West Bank, Palestine – January 9-18, 2009
Dakar, Senegal – February 13-22, 2009
Kumasi, Ghana – February 22-27, 2009
Dharan, Nepal – March 18-31, 2009

Upcoming Resident Scholar Trips:
India – December 19-28, 2008
Haiti – January 23-31, 2009

Volunteers have been recruited for many of these trips. However, if you are interested in possibly adding volunteer service to your locum tenens or international locums career, please contact IVUmed to join their “pool” of potential volunteers so they can match you with future needs. They particularly appreciate the flexibility, energy, and sense of adventure they find in physicians who have worked locum tenens or international locums assignments. Email info@ivumed.org, visit www.ivumed.org, or call 801-524-0201.

Here’s an excerpt from the field notes from their recent trip to Ulaanbaatar, Mongolia:

IVUmed Team:
Catherine deVries, MD—pediatric urologist and team leader
Blake Hamilton, MD—urologist
Sujith Reddy, MD—IVUmed Resident Scholar
Norifumi Kuratani, MD—pediatric anesthesiologist
Janet Vogt, RN—nurse
Pamela St. Louis, RN—nurse
Edd and Ellen Thorp—trip secretaries

Mongolian Partners:
15 physicians
9 Nurses, technicians and other staff

Patients Served:
96 children and adults

Total Value of Service:
$312,935

“All of the patients are doing very well, which is great. Dr. deVries is a highly revered person. When we walk down the halls people look at her with gratitude and wonder. As one of the patients wrote on a thank you gift to her, ‘You are an angel sent down to us from heaven.’ The local surgeons were very happy to have mastered some new techniques. They were also pretty thrilled with the donations we were able to leave behind. There is a saying: ‘It's not where you go, it's what you do when you get there.’”
--Ellen Thorp, Trip Secretary

You can read field notes and see photos of all IVUmed trips on their blog, http://www.nexuscomputerconsulting.com/clients/ivumed/blog/ . And I encourage you to become a fan on their Facebook page so you can stay abreast of their programs and progress.

Welcome to the crazy time of year! Every year at this time VISTA Staffing Solutions sponsors a Holiday Health Drive to help keep our employees moving, eating as healthfully as possible, and managing their stress so they can provide great service to the physicians and healthcare organizations that rely on us. We award points for exercising, volunteering in the community, quitting smoking, maintaining a healthy weight, bringing a healthy treat to the office instead of cookies, achieving their work goals (the best way to beat stress) and more. Everyone gets into the special “VISTA spirit,” celebrates our successes, and wins prizes.

This year, by popular demand, we added a VISTA Biggest Loser contest to the mix. And what an amazing response! A total of 47 participants from across our divisions—locum tenens, extended locum tenens, international locums, and physician search and consulting—have jumped at the opportunity to learn, sweat, and lose together. We have broken them into teams, and unlike the television show, no one will get weighed in public or kicked out. They have access to a trainer/coach once or twice a week and have team meetings before or after work or during lunch. I’ve never felt such positive energy. The Pink Team was in the office at 7:30 this morning doing resistance training together. Our Travel Manager re-enrolled at her gym and swam for 30 minutes yesterday. Members of the International Team have been on the treadmills in our basement gym every day this week.

So from your locum tenens, physician staffing, and physician search pals at VISTA—we challenge you have a healthy holiday season. We will keep you posted on our progress. Please feel free to drop us a note and tell us how you worked a little more “healthy” into your November and December locum tenens assignments, international travels, or new permanent jobs. We would love to hear from you: facts@vistastaff.com.

Image courtesy of Red Floor Pictures

LIVING IN EMERGENCY: TRUE STORIES FROM DOCTORS WITHOUT BORDERS made its premier August 29th at the Venice International Film Festival. The film received a 10-minute standing ovation and very positive press attention. VISTA Staffing Solutions has had the opportunity to support this film throughout its production. It has been an intense process—and it is very gratifying to see such a great final product.

VISTA is co-sponsoring a screening of the film Dec. 11, at 7:30 p.m. at the Leonardo Building, 243 East 400 South, in Salt Lake City, Utah. A Q&A with Utah Doctors Without Borders will follow the screening. For more information go to www.slcfilmcenter.org. We will provide details about national and international distribution as soon as possible.

The film has also been slated to be the main feature on "Humanitarian Intervention" at the International Film Festival and Forum on Human Rights in Geneva in March. The concept of the festival is "One film, one subject, one debate," which takes place before the UN Human Rights Council's main session in Geneva. After the screening, there is a debate with the filmmaker and renowned specialists. This session will include director Mark Hopkins with Rony Brauman (MSF president 1982-1994), Gareth Evans (Former Attorney General and Foreign Minister of Australia) and Jean-Paul N'Goupande (Former Prime Minister of Central African Republic).The festival takes place before the UN Human Rights Council's main session in Geneva and therefore has important political and humanitarian impact.

To keep track of the film’s progress, visit www.livinginemergency.com.

Waiting
Waiting for!
Labyrinths of desert landscape
Where owls hoot from dusk to dawn
The hope of the lily go gay in the wind
Sprawling to fate of death and dry
When mortals shuffle in hunger pangs
In search of fruit from chlorophyll

Waiting for!
Night awake in search of dawn
When the cock crows
To the time voyage of time
When the new born wails
To a welcome into pains
For the earth is all blurred and gloom
To lavish expectations of darkness and night

Waiting for!
The rays of hope eternity
When the balloon of gloom
Bursts into a discharging sore
Of many sweet grapes!
Then agony with pride
Waiting ripples of the rising sun
Waiting!

Night
Trapped in nature’s superhighways
To commune with night in Ekpeke
Where the wild is awake in awe
When fight and death
Freeze in blocks of nothingness
When the unknown marries the subconscious
And sinister sisters stage a play
Riding the range of spirits immortal
When hell is loose on planet earth
For vulnerable mortals to watch in fright
And seek divine guidance at dawn

Agents of darkness plow and harvest
The devil’s Adams apple
Which denied mortal man
The glory and perfection of paradise
Turning our day into nightmares
Night!

“Waiting” and “Night” were written in 1996 in Nigeria.

Note: This is the seventh installment in a seven-part series Brian Doyle prepared to help colleagues make the most of an emergency medicine rotation Down Under. Click here to download the entire document.

Part VII:

Snakes, spiders, shark bites, manta rays, killer jellyfish!!

A lot is made in the American press about the dangerous animals in Australia. The reality is that the Australians are more fearful of the animals in the USA (killer bears and moose that will stomp you to death!) and gun-toting rednecks. The last recorded death from a snake bite in Tasmania was from a Tiger snake in 1966! You will quickly find that it is safer in Australia (especially Tasmania) when it comes to crime and wild animals. Much of what is written about Australia involves a lot of sensationalism… but heck… sensationalism sells!

There are three species of snakes in Tasmania (tiger, copperhead, and whip snake) and they are all poisonous. Takes the guess work out of the equation! They are very timid and usually run away unless they are provoked by drunk 25 y/o white males. The species are all elapids… not crotalids like the USA. This means they are primarily neurotoxic rather than tissue toxic. You cannot rely upon local findings and local symptoms to determine envenomation. You must rely upon labs and systemic symptoms. Constriction bands are used to prevent lymphatic flow in the prehospital setting and there are few other things that you can read about. In almost three years of working in Australia I have never had to give antivenin. Bites are VERY rare in Tasmania. I have perhaps seen 2 or 3 possible envenomations that turned out to be either dry bites or not bites at all.

Perhaps more dangerous is the “Jack-jumper” ant. They cause anaphylaxis just like our bee stings in the USA and are treated the same. Give adrenalin (epinephrine) and lots of it! I see a case every few months.

The most dangerous activity in Australia is driving your car. Not snakes, spiders, manta rays, killer jelly fish….

Bottom line: Don’t be intimidated!

As I have already mentioned, I have highlighted the differences. The reality is that there are far more similarities! Just practice the best medicine you already know and things will be fine.

And have fun!!! It’s sure the Australians will!!! Brian

Note: This is the sixth installment in a seven-part series Brian Doyle prepared to help colleagues make the most of an emergency medicine rotation Down Under. Click here to download the entire document.

Part VI:

Utilization of technology

Australians tend to rely more upon the clinical exam rather than advanced imaging. I have yet to see anyone in the Emergency Department order a CT scan to rule out appendicitis except after they have been seen by the surgeon. And most surgeons would rather take a patient straight to “theatre” (no… not a movie theatre… the operating theatre!) and take out their appendix rather than get a CT. I usually call the surgeon to see a patient with abdominal pain rather than order the CT scan. However, I don’t think I have changed my practice much for head CTs as compared to the USA.

It is not often that I get emergent ultrasounds (especially after hours) but I will get them if I think they are emergently indicated. After hours, low risk rule-out ectopics, and rule out DVTs generally come back the next day. Many EDs have ultrasound machines now… but ultrasound is not really considered part of the core curriculum for EPs like it is in the USA. They may actually be amazed by your ultrasound skills… (assuming you have these skills…)