Volunteer Operator Doctor Application


Dear colleague,
As part of the Africa Cataract Project, a different and scheduled system is being established. With this system, it is being planned that the project will comprehend whole Africa with the precedence of ten countries. The most important factor that makes the project so powerful is the self sacrifice of you and your voluntary doctor fellows. It is necessary for doctors that want to take charge voluntarily in the project to apply with filling in the accompanying form.
In application section the information that our voluntary doctors give, will determine in which conditions we implement our cooperation best. For this reason, we aim to provide you a professional working atmosphere with supplying about natural and humanitarian circumstances, medical attention conditions and social facilities. If you fill in the form completely, firstly a communication through the phone will be done with you. A Medical Committee that connected to Africa Cataract Project Coordination will assess applications done. It will be formed a personal information file by Medical Committee and send you via email. You will find all detailed information about the project in this file.
Thanks for your contribution to Africa Cataract Project.
Medical Committee
Africa Cataract Project

BRIEFING INFORMATION:

  • Travel expenses will be paid by the project.
  • Working period is completely depending on voluntary employee. (Min 1 month)
  • The date of your presence in Africa will be confirmed mutually and included in the coordination of the project.  At these date, after that stage it will not be done any changes.
  • Africa Cataract Project will firstly comprehend 10 African country and then all the continent. These countries are: GHANA, NIGERIA, TOGO, SUDAN, MALI, BURKINA FASO, CHAD, SOMALIA, and BENIN. Sudan is first priority.

All collected information is treated as confidential; it will be assessed only in Africa Cataract Project.

Verbal, written, visual (photo and camera) information about the project can not be done without the permission of authorized person in Africa Cataract Project.
 
Kişisel Bilgiler
Name Surname Area of Specialization
Date of Birth Gender
Worked Institution Date of Specialization :
Business Address : Registration Number :
GSM (1) : Home phone : email (1)
GSM (2) : Work phone. : email (2) :
Graduated faculty : Year :
Establishment that specialization gained from : Year :

TICK THE DATE THAT YOU WANT TO BE IN AFRICA (Min.20 days – max. unlimited)
2007
2008
2009
December
January
February
March
April
May
June
July
August
September
October
November
December
January
 
Mesleki Bilgiler
Average number of polyclinic daily : The number of cataract operation that you can perform in a day
Which phaco equipment have you used? : 1
Could you bring your own cataract set? :  
How many doctors are there in your department including you? :
What is the upper time limit if you will be charged with duty? :

Last 3 employment place
Name of organization
City
Duration
Number of operation /day
1
2
3
       
Foreign language
Languages
Reading
Writing
Speaking
Learning place
To whom it may concern,
I got all the information about conditions and possibilities in Africa. I want to take charge in Africa as a volunteer and attend activities in Africa with priority of durations I mentioned above. I request further action regarding the point.
... / ... / 2008
Name and Surname
Signature
 
Kimlik / Sağlık Bilgileri
Identity No :
Life insurance :
Marital status : Number of Children :
Home address : Home phone :
Do you have a chronic illness?
Do you smoke?
Do you have an allergy?
Do you have a permanent medicine?
 
Sosyal aktiviteler
Associations and establishments that you have a membership :
Other countries that you travelled
Persons that can be reached in urgency
First name and family name
Degree of closeness
Phone number

Hobbies :
 
Afrika Katarakt Projesi ile ilgili bilgiler
From where did you hear the project?
Have you ever attend a project like this?
Do you accept the membership of "ÇÖL DOKTORLARI"
Why do you attend the Africa Cataract Project?  
Do you know that “TURKISH DESERT DOCTORS” is not limited to Africa only and consist of voluntary doctors who are ready to help in urgent situations in national and international incidents?
Your general opinion about the project?
What are your suggestions to announce the project to other doctors?
 
Your business references
Name and surname
Organization
Duration of work
Phone number