Communication Is Everything

For the last week I’ve been with  International Relief Teams on a Head and Neck surgical volunteer mission in Sula, Honduras where we safely completed 120 consultations and 37 surgeries in 5 days.

Part of the Internal Relief Team to Honduras 2013

Part of the Internal Relief Team to Honduras 2013 Dr. Whitten is on the right.

Most of the 6 team members had never worked together before, let alone met before. This is typical of most of the volunteer teams I’ve worked with. We meet for the first time at the airport, yet we arrive in country, set up a safe perioperative environment, complete our surgeries and manage sometimes serious intraoperative and postoperative excitement and complications as a cohesive unit. If you think about all of the politics and petty squabbles that occasionally occur in our home ORs areas this is pretty remarkable, given the challenges in communication that such groups face.

Special Problems With Communication On Volunteer Missions

Working in the developing world is difficult.

  • The medications, equipment, monitors and safeguards we take for granted, and indeed cannot envision being without, are often not there. I have practiced without reliable suction or oxygen sources, the lack of EKG and pulse oximetry, and the need to manually ventilate patient in the postoperative period. That create a lot of stress and anxiety.
  • Strangers on a Team: Most of us meet for the first time at the airport, or when we arrive at the site. We must learn to deal with our unique personalities, behaviors, and history in the space of hours before we start performing in a difficult environment.
  • Distractions abound, including but not limited to:
    • Fatigue from long hours of work and jet lag
    • Exposure to waste anesthetic gases, which may not be scavenged
    • Hunger: Many hospitals are poor and food may be in short supply
    • Culture: unfamiliar dress, food, decorations
    • Noise: Portable suction, air conditioning units (if you’re lucky enough to have them), torrential rain on a tin roof, multiple teams conversing in the same OR when more than one OR table is present can all make it hard to hear
  • Language barrier: You will probably not speak the same language as your patient, or the local nurses and doctors. You also may not speak the same native language as some of your international volunteer team members.
  • Local Beliefs: Patients, and providers, may have different beliefs about treatment than you do. Honduran doctors were telling patients not to look at a computer screen for at least  two weeks following a general anesthetic because it could cause blindness.
  • Cultural communication style. Many asian providers really don’t want to say no to you. They will often go out of their way to subtly tell you about the problem with your plans while avoiding telling you why it won’t work. If you don’t pick up on the real message, you can find out the hard way that your oxygen tank is running low.

Good Communication is Challenging

How do we take strangers and quickly transform them into a cohesive, well-functioning team in a difficult environment? Let’s look at some of the tools we use.

  • Learn about each other as a person. We spend a lot of time learning each others names, finding out our background, and discovering a little about our strengths and weaknesses. We learn a lot about our own strengths and weaknesses in the process.
  • Courtesy: Be polite at all times, no matter what is going on. Being polite and kind to people is not negotiable, at home or abroad.
  • Respect: Treating people with respect means valuing each others points of views. It means being open to being wrong . It means accepting people as they are.
  • Listen deeply and with understanding. Don’t just listen superficially to the words; listen to the real meaning behind the words. Listen for that person’s core values: patient safety?, family?, honesty?, faith and belief?, healthy work/life balance. If you listen hard you will learn what that person really cares about. And if you understand those core values, then you will  understand how to better communicate with that person.
  • Realize that most of the time dysfunctional behavior may actually be a poor compensatory mechanism for dealing with fatigue, stress and anxiety. A surgeon getting ready to take a patient apart and reassemble him, an anesthesia provider getting ready to induce a controlled coma in a patient and then revive her, or a nurse caring for a patient recovering from such insults are all under a great deal of pressure and stress. Give each the benefit of the doubt.
  • Be clear in all your instructions and comments: don’t be subtle.
  • Repeat any instructions you have been given to ensure you heard them correctly before executing them.
  • Be Flexible: Whatever can go wrong will eventually go wrong. Especially in the developing world you must be prepared at all times for things like power failures and managing complications without all of our more modern treatments.
  • Be calm: Not everyone deals with such stresses as well as others. If you project calm confidence, everyone around you will follow your lead.
  • Don’t let fear keep you from transmitting vital information. Don’t be the one to let the pilot crash the plane because you were afraid to tell her that she was about to run  into the mountain

Good communication takes work, and the principles of good communication can and should be used everywhere, including your workplace, your home and your town.

May The Force Be With You