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The American Society of Anesthesiologists is an educational, research and scientific association of physicians organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.

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Published monthly, the NEWSLETTER contains up-to-date information on Society activities and other areas of interest. 

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N. Martin Giesecke, M.D., Chair

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March 1, 2013 Volume 77, Number 3
Residents' Reviews: Why Timing Really Is Everything: An Unexpected Lesson Learned in the Peruvian Mountains Meghan Michael, M.D.

Kristina Goff, M.D.



Last summer, we signed up for a bit of adventure in the form of a medical mission. We were headed to the mountains of Peru as part of a team performing cranio-facial surgeries for the indigent population there, which has no access to advanced surgical services. Neither of us had been on a trip of this kind before, but we had heard so many glowing accounts from faculty and residents in our program who had participated in years prior. We felt we knew, at least vaguely, what we would be facing.

We were told we would be tired, and sometimes frustrated. Proud, humbled, refreshed, inspired, fulfilled and, oh yes, very tired – certainly our experience delivered on all that was promised. But the value of our trip really became tangible the first afternoon in Ayacucho, as we sat organizing supplies in the hotel courtyard and fell into conversation with an older physician from California, who was also a member of our team.

This physician was a veteran of many mission trips, having spent more than 15 summers providing medical care to the people of this small town. She spoke about the obstacles encountered in the execution of a successful mission, and particularly new stumbling blocks that have recently arisen. While logistical issues of travel and communication have become less significant, the application of our training to the medical need of the developing world presents new challenges.

As residency training changes with the progress of modern medicine, a different population of physicians is created – a group of physicians who are remarkably talented in certain areas but who may find themselves quite overwhelmed if dropped into an O.R. in the third world. She mentioned laparoscopic surgery as an example, having seen young surgeons struggling with open operations in the absence of the laparoscope they have become so proficient in maneuvering. The situation is no different for the anesthesiologist standing across the table. After all our years of medical training, it is disappointing to find ourselves impotent to meet simple needs because, in a way, our training has become too advanced.

We knew that our participation in mission work would be personally meaningful, but we had never considered the timing of it to be critical. The fact of the matter is that had we postponed our travels until after residency, we might have missed an important window of opportunity. Had we chosen to embark on this trip later in our careers, we would have been left alone, staring in bewilderment at machines with indecipherable levers and gauges, using drugs we had only read about in textbooks, without the assistance of the many monitors we consider “standard.” In fact, we would have been of little use to anyone.

Instead, we had the benefit of traveling with faculty from our program who were able to teach us the necessary techniques to make our anesthetics both practical and safe for the setting we were in. Their knowledge in this area comes from training during a time when U.S. medical technology was more comparable to that currently used in the third world. It requires a skill-set we had never been taught to rely on. Because of their teaching, next time we go, not only will we know how to take care of our patients, we’ll be able to show others, too. What’s more, we have found ourselves to be more confident, intuitive and able in the operating rooms back in Texas.

As the importance of global health initiatives gains recognition, the necessity of exposing residents to third-world medicine early in our training becomes more and more obvious. Encouraging residents to take part in mission trips and international electives as much as possible offers a realistic hope of making a difference in underserved areas in the future. These experiences are also invaluable in creating capable, agile-minded anesthesiologists to care for patients closer to home.


March 2013 ASA Newsletter

Front entrance to the Ayacucho Regional Hospital. 

March 2013 ASA Newsletter

Caring for an 8-week-old undergoing primary cleft lip repair. 

March 2013 ASA Newsletter

Getting acquainted with the O.R., especially the old Dräeger machine. 

March 2013 ASA Newsletter



Meghan Michael M.D. is a CA-2 and Chief Resident (2013-14), Department of Anesthesiology and Pain Management, UT Southwestern, Dallas.

Kristina Goff, M.D. is a CA-2 and Chief Resident (2013-14), Department of Anesthesiology and Pain Management, UT Southwestern, Dallas.



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