"The surgery was not easy. We were working in a rudimentary OR with limited lighting, a malfunctioning anesthesia machine that emitted halothane vapor into the room and old instruments that were not always sharp enough," explained Faas. "Despite these limitations, we were still able to help this woman by providing surgical care, something that may not have been possible with the limited staff and resources available at this clinic."

This procedure was one of 45 surgeries Faas' team led at the Cooperative Services International (CSI) clinic housed in Preah Ket Mealea Hospital in Phnom Penh, Cambodia. The trip was sponsored by Christian Medical Ministry to Cambodia/Jeremiah's Hope (commonly called Jeremiah's Hope). This non-profit Christian medical missionary organization has been working in Cambodia since 2000 to provide surgical care and medical education.

Faas' recent trip was one of several medical missions she has participated in throughout her career as a nurse with the Navy and private hospitals. She is currently General Manager for AORN Management Solutions, a subsidiary of AORN, which provides perioperative management and consultation services.

"Medical mission work gives me such a different perspective on healthcare. It shows me what I take for granted and gives me a chance to give back and provide care that is so appreciated," acknowledged Faas.

Giving back"You want to move your life from success to significance," said Daniel Smith, MD as he shared his reasons for leading medical missionary trips to Cambodia as co-director of Jeremiah's Hope.  Smith is also a cardiothoracic surgeon in Denver, Colo. However, seeking more significant work, he and his colleague Mark Sheehan, MD founded Jeremiah's Hope after visiting Cambodia through an invitation from a Cambodian pastor who asked the doctors to come to his country and evaluate the medical conditions.

"Because of the deplorable things we found, we felt called to try to do something about it, even if it was very small," explained Smith. "The impact we have had on several Cambodian medical students and physicians for better medicine . . . has been amazing to us."

Through Jeremiah's Hope Sheehan and Smith have coordinated 12 surgical missionary trips to Cambodia, bringing with them donated medical supplies and volunteer perioperative teams, including surgeons, nurses, anesthesiologists and educators.

These perioperative professionals provide needed medical care for patients, as well as education for young healthcare professionals working in a city still reeling from the mass genocide led by the Khmer Rouge in the late 1970s. Urban professionals, including physicians and healthcare workers were among the millions of people killed in this genocide in sites throughout Cambodia known as the killing fields.

Faas took a break from her 12-hour days working in the CSI clinic to visit a killing fields monument near Phnom Penh.

It's important to look at Cambodia's current healthcare situation in the context of this country's history, she noted. "Visiting the killing fields was a way to pay homage to an entire generation of physicians, nurses and educators lost to this genocide."

The loss of these professionals is one of the barriers that have prevented Cambodia from developing the level of healthcare we are accustomed to, Faas added, noting "I feel I have a responsibility to share my skills with my colleagues in Cambodia and provide needed patient care." 

Working with what you haveOne of the greatest values of medical mission work for Faas is the opportunity it gives her to round out her practice and hone her skills.

CSI clinic relies on supplies donated through non-profit organizations, such as Project C.U.R.E. Each healthcare professional participating with a medical mission through Jeremiah's Hope brings a suitcase full of surgical supplies, including gloves, masks, sutures and other necessities. When supplies are not available, surgeons and nurses work with facility staff to make do with what they can find.

"Many times we had to get creative and improvise with instruments we wouldn't normally use. We also had to rely on our assessment skills in place of monitors and reuse masks that would normally be disposed of between cases," Faas said.

She admits these limitations were a challenge, as was working with limited supplies, lighting and air ventilation.

"It takes a special person to work in these conditions and to provide the best care possible in a way that is respectful to the patients and the facility staff who may not be familiar with our standards of care," Faas acknowledged.

She says working in Phnom Penh was a refreshing experience because she wasn't pressured to turn over ORs. "This gave me an opportunity to spend time getting to know my patients and their families and I learned so much from them, about their lives, their community and their respect for the care we were providing-this was so rewarding for me," Faas said.

Looking beyond the ORIn addition to providing surgical care, the healthcare professionals working in Phnom Penh through Jeremiah's Hope are also focusing their efforts on working with leaders from schools of nursing in Cambodia to standardize nursing education and extend training into baccalaureate programs.

However, implementing such programs is a challenge for nurse educators here, explained Gabriela Stevens, RN, BSN, a perianesthesia nurse who runs a surgical nursing agency in Denver, Colo., when she is not working in Phnom Penh through Jeremiah's Hope. "Nurses in Cambodia are treated like third-class citizens. They receive minimal wages and no standardized nursing education to prepare them for practice," she stressed.

Following her first medical mission to Cambodia in 2004, Stevens continues to spend more time working with nurses and nurse educators in Phnom Penh and surrounding communities to address the needs of nurses.

"Against all odds, there is a strong community of educators and students eager to improve healthcare conditions in Cambodia. By working with and mentoring these fellow members of the nursing community and helping them to see that they are not alone, I can make a difference in the lives of these professionals, as well as their patients," she stressed.

Currently Stevens is working to establish a nursing agency in Phnom Penh that will provide more standardized nursing education and job placement with increased pay for young nurses.

"Whether you are working in a clinical or an education role, the bottom line is that working through medical missions gives us a chance to help people. This impact is what inspires each of us to give our time for such worthy work," says Faas. "Working in Cambodia is one way that I can promote and enhance the nursing profession worldwide."

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