Caitlin Whyte (Host): Welcome to the Obstetrics Podcast, where we dive into crucial conversations with clinicians, hospital executives, and industry experts. I'm Caitlin Whyte, your host.

Today, we are thrilled to have renowned OB-GYNs, Dr. Benjamin DeLisa and Dr. Scott Ellis with us. Together, they will share their transformative experiences with medical missions, offering insight into reinvigorating one's passion for medicine, particularly in overcoming burnout.

Well, Dr. DeLisa, I'll start with you today. Can you start by sharing what inspired you to pursue medical mission work? Was there a specific moment or influence that led you to say yes to that first trip?

Dr. Benjamin DeLisa: Yeah. So, it was probably about six or seven years into being out of residency in practice. I was practicing in Hawaii. At that time, I think I was starting to feel just a little bit of a sense of burnout even that early into my career. And it was a little troubling, because it just seemed a little bit too early for that. And at the time, one of my partners had just gotten back from a mission trip that she had been on to the Philippines, and she immediately came to my office and said, "This is something you might love." And at that time, I was already an avid traveler. Loved to travel. Really enjoyed the gynecological surgery that I was doing. It was mostly the red tape of medicine, I think, that was causing the burnout. She said, "This is a really great way to kind of recharge your batteries and refocus your perspective."

So, the following year, I went, I tagged along. That was, I think, 2013. And I've been going on the missions ever since. I was completely hooked from the first one. When I got back from that mission, all of the things that she had promised about it-- it kind of recharging your batteries-- were true. I felt a renewed kind of sense of interest and brought back the passion that brought me into medicine in the first place. It was a really rejuvenating experience in that way.

Host: That is wonderful. And Dr. Ellis, can you share about how you got into medical mission trips?

Dr. Scott Ellis: Yeah. Medical missions has always been something that I've wanted to do, for personal and professional reasons. Growing up in the church, mission's work was always important to me. So, I've looked in the past towards Christian-oriented missions work, but never really had done anything. I had a career in the military. I've been around the world, and I've been to some pretty desolate places and been involved in relief efforts elsewhere, usually during times of conflict. But I've never been anywhere as a civilian.

So when this opportunity came up to go to El Salvador, which is a country that's kind of near and dear to my heart, simply because when I was in the military, El Salvador was an area that was war-torn in civil war, a lot of strife, not exactly a safe place to be. The opportunity came to go back to that country and see it in a different state. And certainly, there's still a huge need there. There's, you know, a fair amount of poverty and disease need there. But for me, it was a way to reconnect with a place that had been through some pretty difficult and pretty rough times. I wanted to see what it was like now.

Host: Well, tell us, Dr. DeLisa, a bit about the types of medical missions that you've participated in. Where have you traveled and what kind of care did you provide while you were there?

Dr. Benjamin DeLisa: Currently, the one and only medical mission I've been doing, I kind of do the same thing each year. I actually started participating with a mission group out of Hawaii, called the Aloha Medical Mission. It's actually a non-denominational mission, which is to say that there's no religious component to it. It started out as actually a dental clinic in Hawaii, a free dental clinic on Oahu. And then, sometime in the '80s, a general surgeon got interested in it and they started some early mission trips to Philippines and some other areas. And by the time I got hooked up with them, it was a pretty well-run mission. I mean, it was kind of right in my backyard, and it was exactly what I wanted to be doing, which was pure gynecological surgery.

One of the reasons I think that that was appealing to me-- number of things-- I think number one, as physicians, I think we get into the field at least initially, because we want to help people. And I think that may be true for all physicians or healthcare providers on some level, and certainly was true for me. And this seemed like a great way to go out in the world and share the gift of medicine and, you know, the surgical skills that I had spent. My early lifetime honing, and provide a service for people who would otherwise not be able to afford it. So, that was very appealing to me.

Number two was the adventure travel. Scott alluded to it a little bit there, talking about going back to El Salvador, a place that's near and dear to his heart. For me at the time, the Philippines was a place that I'd never been. I would say probably at least 60% of my patients in Hawaii had filipino roots. So, going to a place like that for me was a really cool way to not only go and help some people out in the world that needed it badly, but also to connect with my patients back home in a way that I was never able to before. So, that was a big part of it.

The third thing that really attracted me to hooking up with this group, Aloha Medical Mission, was it's such an amazing group of doctors and nurses and also lay people. Every year that I go, I just can't get over the level of teamwork that is on display when we get there. I mean, to be part of a group of people that completely has your back 100% and everything that you're doing from the day one of the mission till the end, it's a remarkable experience and it's really one that I've worked hard to try to bring back to the teams that I work on, back here in the United States.

So, it's a really great way to not only expose myself to the world, but also to give back and then also get back. I bring so much back with me, in terms of knowledge and skills and especially knowledge about how to run an effective team. So, it's been invaluable in that way.

Host: Great. And Dr. Ellis, you mentioned El Salvador, but tell us a bit more about where you've traveled and what kind of care you provided.

Dr. Scott Ellis: Well, as a civilian, El Salvador has been really the only place I've done mission work in. In the army, there were many places around the United States in the world that I've been providing relief efforts.

Host: I would love to hear about both of your first mission trips. So Dr. DeLisa, what was that like for you? Was there a patient story or experience that has really stuck with you since that very first trip?

Dr. Benjamin DeLisa: Landing in Manila was definitely thrilling. Like, Manila, if listeners have never been there, is a fascinating city and just bustling like I've never seen before. But then, quickly going from that main island way down south into the southern part of the Philippines to a very rural island, and coming from Hawaii, seeing a place that kind of looked a little like Hawaii, but then also instead of the usual, you know, resort type situation you might find on Hawaii, a very poor area. I remember being kind of surprised and also intrigued by just how people lived in this area to kind of give an idea about what the kind of areas we traveled to. Some of the spots where our patients came from, you know, over 60 to 70% of the people living in that area didn't even have indoor plumbing. So, it definitely was a little bit of a culture shock when it came to that. I mean, that still sticks with me and something I still recognize when I go there. And it makes me very grateful for the things that I have here in this country for sure.

In terms of other things I remember from that early mission, I remember, when I started the first few surgeries, feeling incredibly out of my comfort zone, all of the usual kind of support and instruments and various things that you might have in an American operating room were absent and even a specialist to call on, for example. So if we were doing a tough surgery, and most of the surgeries that we did there were challenging to say the least. You know, if you got into something-- like got into the bladder or you dissected or cut a ureter, there was nobody to call in to help put it back together. You have to put it back together. And so, it's one of those things that getting out of the comfort zones. I mean, that, that's still something even to this day. Although I'm much more comfortable now operating in those types of environments, I remember it being one thing that was definitely scary at first, but also what an amazing way to kind of further my surgical skills, is to completely jump out of my comfort zone and do something that was, you know, well off the beaten path for what I was used to from the United States.

Host: How about you, Dr. Ellis? What stuck with you since your very first trip?

Dr. Scott Ellis: I think flying over the country, El Salvador, initially and looking down and just seeing the beauty of that country, when I, you know, know what it was like in the late '80s and really all the '90s and early 2000s, it was a war-torn area just to look down and see the beauty was magnificent for one.

But I think the thing that sticks with me the most was when I got off the airplane, and the CEO of the company, Lenny, and I got off and walked outside and met the folks that were waiting for us. There was a big crowd of people with signs and banners, and I just remember the faces, the smiles, and the joy on the folks that were there. They were incredibly welcoming. Incredibly grateful to have anything and everything that we could offer to them. You know, my heart was full, I think, at that point to see the young people there as well. Again, it was the joy, honestly, the smiles, the kindness, and I guess I would call it de fruit of the spirit. I saw a lot of love, joy, peace, patience, kindness, goodness, gentleness, and self-control, and an environment that just a few years back was not very pleasant. So, that's what stuck with me.

Host: Well, medical missions are often described as a way to reconnect with the why behind practicing medicine, something that you both touched on already in your answers. So, how have these experiences impacted your sense of purpose as OB-GYNs? And again, Dr. DeLisa, I'll start with you.

Dr. Benjamin DeLisa: Practicing medicine in the United States currently, I don't think I need to explain this to most doctors, we deal with a lot of, I guess, what I would refer to as minutiae. Lots of rules about documenting, writing notes and doing procedures and things to cover yourself from litigation while also trying to provide top notch care. I think sometimes dealing with patients, colleagues, or even administration that doesn't fully appreciate all of the hard work sometimes one puts in. Going to a place like the Philippines-- Scott alluded to it a little bit with, you know, the smiling faces and whatnot-- seeing the joy on the people's faces. I mean, when you first arrive to the hospital, but also once you're caring for people and, you know, doing surgeries and just seeing the way that it can really-- I mean, doing these surgeries can change these people's lives and the amount of gratitude that they have afterwards, it somehow re-enlivens something with within me, like the caregiver within me, all of that minutiae stuff that kind of bogs one down in practicing from day to day in the U.S. melts away and the kind of the true essence of medicine, which is just caring for people, treating people, healing people. And I guess, at the same time, maybe healing oneself. It just comes through, you know, every day, multiple times a day. I think doing these missions, it just overflows in terms of that energy. It's something that, once you experience it, you almost want to get it again.

I mean, for me, I want to have it every year. I can't go through a year without doing a mission because I need to kind of, you know, refill my cup in that way year after year. And really, it's something that buoys me through the rest of the year. So when I am dealing with things that may give me a little bit of a headache back stateside, it carries me through those moments.

Host: Wonderful. And Dr. Ellis, how has doing these missions helped you reconnect with your why?

Dr. Scott Ellis: Well, like Ben says, it really recharges your batteries, I think, in a way that's hard to explain and describe. You know, more physicians, more clinicians, nurses, physicians, anybody that works in the Allied Health field and even someone who isn't health-related needs to do this kind of work.

For me, it helps me reconnect with each and every patient, just one patient at a time, one human being at a time, one heart and soul and spirit at a time. And remember that we have an impact on each and every person that we come across in our daily lives. For me, the folks that we're helping in some of these areas have so many challenges, whether it be physical or financial or both. You know, I thought it was amazing that they were still able to live in such a state of joy. And so, I think it allows me to kind of slow down, just kind of take things as it comes and not allow the crazy things in life and the crazy things in medicine that, like Ben says, just kind of weigh us down and gets us off purpose. I just take it one person at a time and try to leave them with something positive. And in the meantime, I don't know, it just always comes back to you in a way that it almost feels like you're getting more than you're giving oftentimes when you do this kind of thing. So, it's hard to explain that and how that works. I think oftentimes when you give, you wind up getting more than you're giving.

Host: Well, how does being an OB hospitalist, Dr. DeLisa, make it easier or more realistic to take part in global health work like this?

Dr. Benjamin DeLisa: Yeah. Well, OBHG has been, pretty amazing around the mission work. Number one, and the most obvious thing, is that because my schedule is far more open doing shift work than it was when I was in private practice, I'm able to schedule multiple weeks now to do the missions. It used to be that I had maybe a week and a few days and using my own vacation time and paying my own way to get to the missions, which was fine at the time. But now, I can book my shifts around my mission work, which is generally pretty easy to do.

So, it allows me a lot more time off to actually participate in the missions and then to actually do some traveling around the mission, which has been quite nice as well to go and visit some areas of the country, as a tourist and traveler. And also, I should add in that OBHG has even gone as far as to help support financially some of the mission work that a lot of the docs who are involved in missions are doing. And that's through a scholarship program where they are able to help fund some of the travel costs. So, last year, when I went on the mission, they covered majority of my flight in my hotel and even some of my expenses while on the mission. They've been nothing but supportive around the mission work. And I really think it's one of the areas where OBHG, when they talk about being a leader in women's care, not only in this country but around the world, they're putting their money where their mouth is literally. It's pretty fantastic.

Dr. Scott Ellis: Yeah. I think Ben said that really well. I'm not sure I could add a lot to that. You know, the nice thing about the work that I do, again, the shift work allows me to work with my fellow team members. We all have lives outside of the hospital and things that we like to do, so we're able to work with one another and allow for each other to have some extended time off when we want and to go and do these kinds of things. That would be really hard to do. I mean, it's doable, but it's very hard to do in private practice. And the structure of our schedules and our work makes it much easier to do that. And again, like you said, I really appreciate and commend OBHG for being supportive of those efforts around the world.

Host: Now, you both talked about how you're often working in high stakes environments, and even more so when resources are limited in many of these locations. So Dr. DeLisa, tell us how you adjust your clinical approach in these situations.

Dr. Benjamin DeLisa: That question makes me think immediately about the environment of the operating room. When we go on these missions, I think, the number one thing that we talk about as participants in the mission is how can we achieve the things that we want to achieve? But, most importantly, how can we achieve those things safely? Safety and safety concerns come up over and over again. We are constantly monitoring our environment and not only the OR environment, but the patients that we've selected for surgery, and continuingly kind of monitoring the environment that we're in to make sure that it's remaining safe.

I think because we are operating in a place where we don't have a lot of backup in terms of surgical backup or a major blood bank or Interventional Radiology or all of the kind of bells and whistles that might come along with operating in the United States, we really have to do things more methodically and slowly. We have to communicate in a way that is, even above and beyond how we communicate in the United States, because we constantly need to be checking in with each other to make sure that we're practicing within that safe zone that I referred to. Because the minute you get out of that safe zone, that's when accidents happen and things can go wrong. And when they go wrong in a place like the Philippines, where you're operating in this type of high-stake environment, things can go really wrong and really quickly, and be hard to recover from. So, kind of maintaining that safe edge is one of the things we're constantly striving to do.

Host: Thank you. And Dr. Ellis, how do you adjust?

Dr. Scott Ellis: Again, I think Ben put that really, really well. The first thing that comes to mind when you ask me that question is-- and this is something that I harp on with residents, especially if they're going to rural or critical access areas around the country-- is, you know, always remember where you're at. Remember where you're at. Make sure you're doing the right procedure at the right time for the right patient and the right place. The context of where you're at matters, because what might be appropriate and safe for me to do here where I'm at Monument Health, where I have a very large OR, and not just specialists, but subspecialists, a very large blood bank and all the equipment that I could want and need. I don't have that elsewhere. In some places we go to, it feels like you might have two sticks, a rock, and some duct tape to kind of make the comparison a little bit.

So, you know, again, just remembering where you're at. Making sure you're thinking three and four steps ahead of the game, which is what any good obstetrician does, and preparing for any potential scenarios that could come up and making sure you have the equipment and the wherewithal to manage any potential unexpected events, and minimize any risks to the patient. So again, it boils down to remembering where you're at that really matters.

Host: I love that perspective. Thank you. I'd also love to pivot and focus more on what happens after you return from these mission trips. Dr. DeLisa, have you noticed any changes in how you view your work here in the States? How has it influenced you to show up for patients or, just like you mentioned, ease that burnout.

Dr. Benjamin DeLisa: I think one of the things that I often bring home with me is, I think, a sense of feeling more patient myself, the little things that can sometimes add up to feeling stressed or anxious or, you know, what have you, that can build up over days. When I come back from missions, those things tend to be more in the background and they don't bother as much. And I think that probably comes from just feeling that we've talked about it a bit already, that feeling of, being recharged and the cup filled back up. When that cup is full, I think the little things don't make as big of an impact. And so, the little, the small annoyances and things, they don't go unnoticed, but they don't bother like they do. So, I think a sense of well-being, a sense of patience.

One thing that's opposite to that, that has come out of missions that's been interesting is that sometimes I come home, and I am amazed-- and this is true for myself, as well as, patients and other people that I come into contact with-- how entitled we are coming from the country that we do, in terms of what we expect and the things that we just take for granted in this country.

I often come back with just a deep gratitude that I think is instilled in me, because it's something that I see in the patients that we treat in the Philippines. There is such a deep gratitude that is relayed from the people that we're helping that one can almost not help but be almost infected by it. So when I come home, I think that's a big thing that I feel has changed in me and continues to evolve every time I go on the mission, is a deeper sense of gratitude every time I come home. That's helped me practice medicine and just to be a person in the world. It's been one of the best things that's come out of the missions, I think for myself.

Dr. Scott Ellis: Exactly the same. I was going to say, Ben kind of stole my thunder, because I was sitting here thinking, you know, what word would I use to describe what I was feeling when I was flying back on the airplane from El Salvador and coming back to the United States, and the one word that came to mind was gratitude.

It's hard, I think, to go somewhere like that and serve and see the things that you see and not come back with an overwhelming sense of gratitude. Not just grateful for the things that you have here in the United States, but just gratitude for having healthcare, gratitude for having, you know, a reasonably healthy body and legs to walk on. And you become so grateful for things that you take for granted. Just gratitude.

Host: Of course, that gratitude is so important and so significant to remember just for everyone really when we're over here in the States. Now, do you think experiences like this should be encouraged or supported more formally in OB-GYN training or early practice, Dr. DeLisa?

Dr. Benjamin DeLisa: Oh my gosh. Like, yes, absolutely. I think that I would almost go as far as to say it should be added into the curriculum of residency programs, at least to offer something like this. And actually, one of the things we started doing, back in, I think it was about 2015, I would say, is I graduated from the University of Connecticut. And since around 2015, we've been bringing two residents with us, two fourth year residents from my old program. And so, they come along and they do cases with us and they see patients with us. And not only has it been an awesome experience for me, because I don't work at a teaching hospital currently and I've always loved to teach. So, it's a huge opportunity for me to teach residents. But also, I learned a ton from them as well. So, I kind of remember what it was like to be a resident and kind of reminisce about the good old days.

One of the interesting things that I've seen out of that actually is these residents show up and most of the cases that we do are open surgery, so, you know, laparotomies with open hysterectomies. So, we're not doing a lot of any laparoscopic surgery. We do some vaginal surgery as well. So, in talking with these new residents, most of the cases that they've completed in residency are either laparoscopic or using the robot. The robot was something that was just starting to happen when I was graduating residency. So, I didn't really have much exposure to it, but it's fascinating to me to see these residents come out of training, almost done with their training, and they've done maybe six open hysterectomies or a couple of vag-hys. And whereas, you know, we had done hundreds. So, really, the things have switched in residency training to a lot more minimally invasive techniques.

And those are excellent and they're great things to have knowledge about. But at the same time, I think having knowledge about doing open surgery and vaginal surgery is essential. And so, I think, for these young guys and gals in training, going on a mission and doing these types of cases can be an essential part of their education

Host: Of course. And Dr. Ellis, your thoughts.

Dr. Scott Ellis: I would echo that. Where I was at in El Salvador and Suchitoto and San Salvador, we didn't really do much of anything surgical. It was all clinically based and a lot of education as well, with the organization that I was working with, Hope Worldwide, we do hope to be able to provide more surgical care to folks in El Salvador and Honduras and Nicaragua and most of the countries there in Central America.

And I really do-- I'm a little envious because I'm listening to Ben talk about his experience because, you know, I want to do more of that. I want to work with residents, doctors that are in training and be able to teach a little bit more. I have a certainly have a passion for that. And an environment, like where I was in El Salvador, would be absolutely priceless. I do think that this type of experience should be a part of postgraduate education for really all residents, if it's possible, but especially someone in the surgical field. You will see some things that you may not typically see stateside, and have an ability to interact with that pathology and surgical challenges that you may not get here.

Host: Great. Well, my last question for the both of you is a little bit of advice. Dr. DeLisa, what advice would you give residents or early career OB-GYNs who are interested in doing this sort of mission work but aren't sure where to start?

Dr. Benjamin DeLisa: If you're at a hospital or a practice and you catch wind of somebody that's been involved in mission work, I think that's a great place to start, is go and sit down with that person pick their brain, talk to them. That's kind of how I got involved with my colleague.

You know, having been doing the missions for a couple of years. And it was just something I was kind of remotely interested in and then talking with that person really started to pique my interest. If you hear of someone, you know, that you're working with that is involved, then go check it out. Or if there's a, you know, website you can go to, where you can find medical mission work, I think that's a great thing to do, is just to start talking to people who have been on missions and get an idea about what kinds of things they like about them, which missions are run really well, that can actually make a big difference for people, whether or not they have a good experience or a bad one.

There are certainly some stories I've heard from people coming back from missions where the missions were run horribly and they had a terrible experience and they felt things were unsafe and they never want to do it again. So, finding one where it's an established mission, where you can talk to people and get a sense of what they're doing there, how long it's been going, what kind of infrastructure they have set up or support for the mission itself, what kinds of patients you'll be seeing, how one stays safe while in the country, seeking information about it is probably the first step that I would recommend to anyone, is get as much information as you can.

Host: Great. And Dr. Ellis, same question to you. Any last thoughts or advice?

Dr. Scott Ellis: Yeah, initially, you know, I was going to say, just dive in somewhere. But as I listened to Ben speak, I think he brings up a good point. You want to make sure you're safe and you need to be able to be a little bit methodic about what it is you're looking to do, wanting to accomplish. You know, you do certainly have to consider the safety challenges. Some places where folks go, I mean, they travel with armed guards everywhere they go and that's okay. You can still do that, but not everybody is comfortable with that. El Salvador has gone from being one of the most dangerous countries in the world to now being one of the safest countries in the world. So, my experience there was actually somewhat surprising in a good way.

But yeah, I think you got to talk to some folks that have been been around a little bit and have been to maybe multiple places. Talk to the organizations. Every organization is different. Some organizations are faith-based, some are not. Get a sense of what it is that you want to get out of it. And I guarantee you, whatever it is, you're still going to get more than what you expected probably in a good way. But try to go into it with both eyes wide open, like Ben says.

Host: Well, thank you both so much for your insights today and for doing all of this work. We loved hearing your stories.

Are you ready to explore a different path that combines purpose with practice? Learn how you can make a global impact through medical missions and rediscover why you chose medicine in the first place by going to obhg.com/careers. Until next time, stay inspired and keep making a difference.