Medical Missions: Doc Dockery & IFAF

Dock Dockery, DPM, FACFAS is currently a Chairman of the  International Foot & Ankle Foundation (IFAF) for Education and Research. Here is his take on the importance of podiatrists attending in medical missions 

Q1. What medical mission did you attend? What got you interested? 

In 1996, 

while I was serving on the Board of Directors of the American College of Foot & Ankle Surgeons (ACFAS), I was invited to attend a mission trip to the Barry University’s Yucatán Crippled Children Project (YCCP), in Mérida, Yucatán, Mexico, by Dr. Keith Kashuk, who was also on the BOD of ACFAS, but was also the Co-Director of the YCCP. After volunteering for this first trip, I was so impressed with the need for medical and surgical care for the children of the Yucatán, that I volunteered to return on the next couple of mission trips. I then got the approval of the Founder and Director of the YCCP, Dr. Charles ‘Chip’ Southerland, a professor at the Barry University School of Podiatric Medicine, to attend on a full-time basis. 

In the early years, 

Dr. Southerland, as head of the “Miami Team”, along with Dr. Kashuk, was organizing 6 trips a year (one every other month). This ultimately went to four times a year. Eventually, by 1998, as Director of the International Foot & Ankle Foundation (IFAF), I organized a medical group from the Seattle area that included Dr. Byron Hutchinson, Dr. Craig Clifford, and myself, along with one resident from Swedish Medical Center and one resident from St. Francis Hospital. This “Seattle Team” started going to the YCCP twice a year since 1999, in April and in November, and this continues today. The IFAF also helps sponsor a “Denver Team”, headed by Dr. Daniel Hatch, with two residents, that goes in February and July.

Q2. What was your official title/role in the medical mission? What were your duties? 

My title for the YCCP missions was Seattle Team Leader and Head Surgeon. 

My duties were very complex and included organizing the arrangements for flights for the Seattle team, booking hotel rooms in Mérida, and creating a supply list of things that would be needed on each mission trip. The Miami Team usually supplies the bulk of surgical instruments and the Seattle Team brought special frames, plates or equipment specifically for each trip, along with a lot of extra supplies and surgical dressings. We also provided all of the surgical gowns, gloves, hats, masks, and booties for the Seattle doctors.

 Once we were in Mérida, my job was to coordinate a ‘cultural day’ for all of the attendings and residents to have an opportunity to better understand the Yucatán people. That usually involved visiting some of the smaller towns and villages, going to one of many Ancient Mayan Ruins and touring the grounds, visiting the Great Museum of the Mayan World (El Gran Museo del Mundo Maya), in Mérida, and then enjoying a local restaurant that specializes in Yucatecan Cuisine. All of these things provided a stronger sense of who these wonderful people are. I would then coordinate a meeting with the Miami Team Leader and the Mexican Pediatric Orthopedic Surgeon and the Red Cross hospital personnel, then help delegate the morning surgical cases and assign the surgeons/residents for each of the cases and, finally, plan the evening lectures for the residents and schedule dinner arrangements for the group.

Q3. How did a typical day look for you during the mission? 

Each trip consisted of:

  • Wednesday: a full Cultural day
  • Thursday & Friday: two full days of surgery at the Mexican Orthopedic Red Cross Hospital (Hospital de Ortopedia de la Cruz Roja Mexicana), in Mérida
  • Saturday: a full day of screening pediatric postoperative and new patients, at the Basic Rehabilitation Unit in Progreso, Yucatán. 

Typically, there would be from 5 to 8 surgical cases scheduled for each of the two hospital days. This might range from removing extra toes to very complex reconstructive surgery on deformed legs. The cases are almost all on congenital birth defects but may involve surgical care of trauma or other unusual lower extremity problems. 

There are commonly 60 to 100 pediatric patients seen in Progreso for evaluation of lower extremity deformities and several of the patients are postoperative follow-ups from previous trips. The Pediatric Orthopedist and his residents do the initial postoperative visits and change casts or remove sutures as needed. Once stable, the patients are referred back to the rehabilitation unit for follow-up and physical therapy. The rehabilitation unit has three treatment rooms with two examination tables in each room. With each room staffed with residents and attendings, the screening and follow-up of patients may take from 5 to 8 hours. New patients that qualified as needing surgery are then scheduled for the next team arriving from the states. 

Q4. What was one of the more memorable moments of the medical mission? 

After a few years of seeing a lot of pediatric patients with severe and complicated deformities, Dr. Hutchinson and I had become very confident that our surgical skills were good enough to take care of the cases that were coming in for surgery. Along with our skills and those of the other attendings from Barry University and the pediatric orthopedic surgeon, we thought that there was nothing we couldn’t handle. 

On one of our Progreso clinic days, the rehabilitation unit director came to us and said that there was a new patient that had just arrived, and the parents had brought their 14-year-old child to the clinic from many miles away, 

in a wheelbarrow. 

When we went into the treatment room, we saw the old rusted wheelbarrow with a young boy inside in a mangled pile of contractures and severe deformities, and it was apparent that he could not move any of his joints or sit and certainly could not stand. It turned out that he had been born with both arthrogryposis multiplex congenital and spina bifida and had been this way since birth. Dr. Hutchinson asked the interpreter to ask the parents what they wanted from us and the mother’s answer was, 

“We just want you to make him walk!” 

We were both taken back by this request and both of us immediately had tears in our eyes. We knew that there was absolutely nothing that we could offer this boy or his parents. It was heartbreaking.  We learned that there are simply some things that can’t be fixed, and we both had to learn to understand our own limitations and do whatever we could to help the others that came to see us.

Q5. Did you have any health or cultural challenges? Any struggles that you overcame individually or as a team? 

I spend a lot of time before and during each trip making sure that all of the team members understand and are careful about drinking water from some sources, eating certain foods, and paying attention to general hygiene on a regular basis. 

It is recommended to only drink fluids that are in pre-sealed containers (water, juice, soda, beer, etc.) and to eat foods that can be peeled or are cooked properly. Even though the main water supply in Mérida is filtered and considered safe for tourists, it is still best to use precautions. One of the easiest ways to drink contaminated water is to order drinks with ice, especially margaritas. The drink itself may be okay, but the ice might have been made from regular unfiltered/contaminated tap water. 

We always discourage our team members from eating anything from the numerous street vendors, particularly in the small towns outside of the city. Not speaking the language is a major disadvantage. For most of our mission trips to the Yucatán, there are residents that speak Spanish and there are usually 2 or 3 interpreters available for our use in Progreso. In the hospital, there are several Mexican doctors and residents that can assist us. So far, we have not had any major issues because of the language. 

Q6. What advice would you give to someone interested in doing a medical mission? Would you recommend it to others?

I think that every medical specialist should do at least one medical mission in their career.

 In most cases, you will find that it will be one of the most rewarding things you will do. Additionally, you should be ready to be fully funded, either personally or through a local service group or church organization. You should not, in any way, be counting on the mission coordinators to take care of your expenses. 

There are many different types of organizations running medical missions all over the world. Some are very restrictive, and others are more accepting. You have to do some serious investigation to find the one that will fit you and your goals. There are several that are specifically podiatry and orthopedic oriented and there are others that are purely medical in nature and offer no surgical options. There are some sponsored by the Rotary International or other similar service groups. There are some that are hospital or church-sponsored. Some are hosted by Christian groups and some are nondenominational. You could go online quickly and find more. Take a look at these: Mission of Hope. Volunteers in Medical Missions (VIMM). International Volunteer HQ.

Dock Dockery, DPM, FACFAS

Chairman, International Foot & Ankle Foundation for Education and Research

3131 Nassau Street, Everett, WA 98203

Interview by Roberto De Los Santos