The poor will always be with us. The images on our TV screens remind us daily of desperate need and published facts confirm that need for healthcare workers overseas has never been greater.[1] So how can I, as a trainee, get involved and when is the best time to go? Opportunities abound with government and NGOs, secular and mission agencies. Every agency has long lists of vacancies. Many LDCs (less developed countries) are dependent on mission agencies and NGOs to provide healthcare in their rural areas.[2]

The CMO and the DSS say 'Go'

Despite the difficulties that some foresee and others are experiencing, the DSS is encouraging NHS doctors to consider short spells working abroad. International Humanitarian and Health Work – a Toolkit to support good practice[3] emphasises the benefits to the NHS and individual. It contains excellent advice on how to develop and sustain skills for international work, a chapter on resources and detailed appendices on projects, placements and agencies to approach. The DSS has also produced a Compendium of the NHS's Contributions to Developing Nations[4] which lists the involvement of Hospital and PCTs in overseas work, the countries they have links with, the nature of the work undertaken and contact details.

'The ultimate beneficiaries from UK professional health workers gaining international experience are NHS patients in the UK' Liam Donaldson CMO3

VSO and the Royal Colleges

VSO (Voluntary Service Overseas) have established links with RCPCH and RCOG, offering 12 month training fellowships in selected placements in LDCs.[5] Two CMF members are currently working in Malawi on a Fellowship with VSO and the RCPCH – they can be contacted via the CMF Office. RCOG/VSO Fellowship Scheme offers one year taken as 'out of programme experience' that can be retrospectively assessed by the RCOG STC and may count towards CCST. VSO source the placement and provide the training and RCOG source the in-country mentors.[6] There are currently RCOG trainers in Kenya and Indonesia. The RCOG also resources shorter trips abroad. Time out is taken partly as annual and partly as study leave. The RCOG has sourced a Charitable Trust that will pay airfares for 3-4 trainees per year. Writing recently in RCOG News, Matt Carty, Senior Vice President states: 'I hope more trainees can get the opportunity to broaden their clinical and life experience [overseas through these 2 schemes], a wonderful experience which hugely influenced the whole of my professional life.'[7]

The Association of Surgeons of Great Britain and Northern Ireland strongly encourage trainee and established surgeons to spend time overseas. They organise an annual day conference at the RCS entitled 'Surgery in the Tropics – making it happen'.[8] The RCGP is similarly positive: 'Working overseas is a rewarding and challenging experience. Our College recognises that the experience doctors gain overseas contributes significantly towards their professional development.'[9]

So when should I go?

There never is (and never has been) a 'right time' to go. The development of structured training programmes, together with a shortage of trainees in some specialties, has meant that Deans are reluctant to extend training periods. But if you don't go now, you may never. If Jesus is calling you to go, procrastination is disobedience. There is a balance to be struck between the 'now' and the 'not yet' of your going. This is not in the response you make but rather in the preparation that needs to follow your decision to go. The time to go may depend on your specialty, training, family circumstances and the work you will be undertaking.

It would be unwise for Pre-registration House Officers to go overseas before completing registration in the UK. Options 2 or 3 are perhaps preferred. Discuss the matter with your regional postgraduate Dean well in advance. It may be possible to reserve a Calman number while you are abroad. If your college or postgraduate Dean won't agree with your plans, a step of faith (obeying God rather than man) may be needed but it would be wise to discuss the matter with a senior Christian who has experience both overseas and within the NHS.

'If you want to walk on the water, you've got to get out of the boat'[11] 'Do whatever he tells you' said Mary the mother of Jesus.[12] We can so plan and try to prepare for every eventuality that we give God very little say in the matter. Proverbs reminds us that 'There is a way which seems right to a man, but in the end it leads to death'.[13] The way to peace and fulfilment is to respond to God's call when he calls. That will often entail getting out of the security of the boat and stepping onto uncertain waters where he is holding out his hand to us. We read of Abraham that '(urged on) by faith, Abraham, when he was called, obeyed and went forth'.[14] Perhaps we should more readily seek to follow the immediacy of this response.

If going overseas is part of God's plan for your life, you can be assured that 'Those who honour me, I will honour'[15] and 'we know that in all things God works for the good of those who love him'.[16] That means your return to the UK and the finding of a future post back home are in his hands and he won't let you down.[17] Stepping out in faith can be scary but we know 'that underneath are the everlasting arms'.[18] You will be taking a risk but it's worth remembering that RISK is an alternative spelling of FAITH.

This article is intended to stir trainees into action but there is no doubt that it is easier for established Consultants and GPs to get involved in overseas visits – even obtaining study leave to do so or utilising 'sabbatical periods' for such trips. Your experience and wisdom is needed even more!