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Huerta S, Huchim-Peña CJ, Ta T, Quiñones ME, Mendoza JA, Corzo VF, Ortiz C. Patients', Local Staff, and Medical Students' Perceptions on a Medical Mission Trip to Guatemala. Curr Probl Surg 2023; 60:101378. [PMID: 37993236 DOI: 10.1016/j.cpsurg.2023.101378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Sergio Huerta
- Department of Surgery, VA North Texas Health Care System, Dallas, TX; Hospital Nacional de San Benito, El Peten, Guatemala.
| | - Cristian J Huchim-Peña
- Federico Gomez Children's Hospital of Mexico, Mexico City, Mexico; Faculty of Medicine, Autonomous University of Yucatan, Merida, Yucatan, Mexico
| | - Timothy Ta
- Texas A&M University, College Station, TX
| | | | | | | | - Cesar Ortiz
- Hospital Nacional de San Benito, El Peten, Guatemala
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Johnston JC, Sartwelle TP, Zebenigus M, Arda B, Beran RG. Global Neurology: The Good, the Bad, and the Ugly. Neurol Clin 2023; 41:549-568. [PMID: 37407107 DOI: 10.1016/j.ncl.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Global health programs engaging in isolated or short-term medical missions can and do cause harm, reinforce health care disparities, and impede medical care in the regions where it is so desperately needed. Related ethical, medical, and legal concerns are reviewed in this article. The authors recommend abandoning these ill-considered missions and focusing attention and resources on advancing neurology through ethically congruent, multisectoral, collaborative partnerships to establish sustainable, self-sufficient training programs within low- and middle-income countries.
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Affiliation(s)
- James C Johnston
- Auckland, New Zealand and San Antonio, TX, USA; Department of Neurology, Addis Ababa University School of Medicine, Ethiopia.
| | | | - Mehila Zebenigus
- Department of Neurology, Addis Ababa University School of Medicine, Ethiopia; Yehuleshet Higher Clinic, Addis Ababa, Ethiopia
| | - Berna Arda
- Department of Medical Ethics, Faculty of Medicine, Ankara University, Turkey
| | - Roy G Beran
- University of New South Wales, Sydney, Australia; Western Sydney University, Sydney, Australia; School of Medicine, Griffith University, Queensland, Australia
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Impact and Sustainability of Foreign Medical Aid: A Qualitative Study with Honduran Healthcare Providers. Ann Glob Health 2023; 89:17. [PMID: 36876301 PMCID: PMC9983504 DOI: 10.5334/aogh.3995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/02/2023] [Indexed: 03/06/2023] Open
Abstract
Background There is growing concern about the sustainability and long-term impact of short-term medical missions (STMMs)-an increasingly common form of foreign medical aid-given that brief engagements do little to address the underlying poverty and fragmented healthcare system that plagues many low- and middle-income countries (LMICs). In the absence of formal evaluations, unintended but serious consequences for patients and local communities may arise, including a lack of continuity of patient care, poor alignment with community needs, and cultural and language barriers. Objective We conducted semi-structured interviews with Honduran healthcare providers (n = 88) in 2015 to explore local providers' perceptions of the impact and sustainability of foreign medical aid on patient needs, community health, and the country's healthcare system. Methods Respondents represented a random sample of Honduran healthcare providers (physicians, dentists, nurses) who worked for either a government-run rural clinic or non-governmental organization (NGO) in Honduras. Findings Honduran healthcare providers largely framed foreign medical teams as being assets that help to advance community health through the provision of medical personnel and supplies. Nonetheless, most respondents identified strategies to improve implementation of STMMs and reduce negative impacts. Many respondents emphasized a need for culturally- and linguistically-tailored medical care and health education interventions. Participants also recommended strengthening local partnerships to mitigate the risk of dependence, including on-going training and support of community health workers to promote sustainable change. Conclusions Guidelines informed by local Honduran expertise are needed to increase accountability for more robust training of foreign physicians in the provision of context-appropriate care. These findings provide valuable local perspectives from Honduran healthcare providers to improve the development and implementation of STMMs, informing strategies that can complement and strengthen healthcare systems in LMICs.
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Lindert J, Sharma D, Cotton M. Minding the Ps and Qs in global surgery outreach programmes. Trop Doct 2023; 53:1-3. [PMID: 36519189 DOI: 10.1177/00494755221144679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Judith Lindert
- Clinic for Paediatric Surgery, University Hospital Rostock, Rostock, Germany Vice-Chair, German Society for Global and Tropical Surgery, Rostock, Germany
| | - Dhananjaya Sharma
- Head Department of Surgery Government NSCB Medical College, Jabalpur, India 482003
| | - Michael Cotton
- Professor of Clinical Practice, Consultant Surgeon, Quai Santé, Montreux, Switzerland
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Dainton C, Jessani G, Hircock C. Resilience of the medical mission model: assessment of the perceived impact of the COVID-19 pandemic on short-term medical missions to Latin America and the Caribbean. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.55762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background COVID-19-related travel restrictions profoundly impacted short-term medical missions (STMMs) abroad. This study describes the effect of the pandemic as perceived by STMM organisations serving Latin America and the Caribbean (LAC). Methods Information was updated for 359 primary care STMM organisations previously active in 2015, which were contained within an existing online database. Organisations were contacted to complete an online survey that gathered quantitative and qualitative descriptions of pandemic-related adaptations and program changes. Results 22.5% (73/324) of previously active organisations had no website activity since 2020 or earlier, no longer existed, or had unclear website activity. Eighty-seven organisations responded to the survey. Ninety-six percent indicated that they would definitely (72/86, 84%) or probably (10/86, 12%) return to sending STMMs in the next five years, and most (46/83, 55%) of these intended to send an STMM within the next six months. Seventy-two respondents (93%) reported new adaptations, including direct funding for local healthcare professionals, sending equipment to host communities, focusing on training and teaching, and incorporating virtual care and electronic medical records. Conclusions The results demonstrate resilience, flexibility and optimism among STMM organisations and an intent to return to pre-pandemic programming rapidly.
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Affiliation(s)
- Christopher Dainton
- McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Canada
| | - Ghazal Jessani
- Michael G. DeGroote School of Medicine, McMaster University, Canada
| | - Caroline Hircock
- Michael G. DeGroote School of Medicine, McMaster University, Canada
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Aguirre DL, Perez C, Burkett EK. Stability, security, and the social determinants of health. GLOBAL SECURITY: HEALTH, SCIENCE AND POLICY 2022. [DOI: 10.1080/23779497.2022.2047092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Diana L. Aguirre
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States of America
| | - Casey Perez
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States of America
| | - Edwin K. Burkett
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, United States of America
- Defense Institute for Medical Operations, United States of America
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7
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Guidelines for short-term medical missions: perspectives from host countries. Global Health 2022; 18:19. [PMID: 35183205 PMCID: PMC8857875 DOI: 10.1186/s12992-022-00815-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/26/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In the past decade, there has been increasing guideline development for short-term medical missions (STMMs) traveling from high-income to low- and middle-income countries for the purpose of supporting health care services. The ethics of STMMs is criticized in the literature and there is frequently a lack of host country collaboration. This typically results in guidelines which are developed through the lens of the sending (high-income) countries’ staff and organizations. The aim of this paper is to evaluate an existing best practice guideline document from the perspective of host country participants with knowledge of STMMs from Honduras, Malawi, and the Philippines.
Methods
The guideline used for the evaluation consisted of nine best practice elements that were discerned based on literature and the experience of those working within the field. Semi-structured interviews were conducted in a cross-sectional study with participants (n = 118) from the host countries. Thematic analysis was conducted by two researchers and the results were assessed by working group members to confirm interpretations of the data.
Results
Overall, participants expressed a strong interest in having more structured guidance surrounding STMM practices. There was a positive response to and general acceptance of the proposed STMM guidelines, although participants found the 24-page document onerous to use; a companion checklist was developed. The key themes that emerged from the interviews included collaboration and coordination, care for hard-to-reach communities, capacity building, critical products and essential medical supplies, and opportunity and feasibility.
Conclusions
Host input suggests that the guidelines provide structured regulation and coordination of the medical mission process and have the potential to improve the way STMMs are carried out. The guidelines have also proven to be a useful tool for the actual implementation of STMMs and can be a tool to strengthen links and trust between mission teams and local health staff. However, local contexts vary considerably, and guidelines must be adapted for local use. It is recommended that STMM teams work in conjunction with host partners to ensure they meet local needs, increase capacity development of local health workers, and provide continuity of care for patients into the local system.
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Dainton C, Gorman C, Cherniak W, Lopez L, Chu CH. Reliability of the Service Trip Audit Tool to assess the quality of short-term medical missions. Int Health 2021; 13:606-614. [PMID: 32176774 PMCID: PMC8643480 DOI: 10.1093/inthealth/ihaa006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/27/2019] [Accepted: 01/22/2020] [Indexed: 11/28/2022] Open
Abstract
Background We aimed to assess the adherence of short-term medical missions (STMMs) operating in Latin America and the Caribbean (LAC) to key best practices using the Service Trip Audit Tool (STAT) and to calculate the inter-rater reliability of the data points. This tool was based on a previously published inventory of 18 STMM best practices. Methods Programme administrators and recent volunteers from 335 North American organizations offering STMMs in LAC were invited to complete the STAT anonymously online. Adherence to each of 18 best practices was reported as either ‘yes’, ‘no’ or ‘not sure’. Fleiss’ κ was used to assess inter-rater agreement of the responses. Results A total of 194 individuals from 102 organizations completed the STAT (response rate 30.4%; 102/335 organizations) between 12 July and 7 August 2017. Reported adherence was >80% for 9 of 18 best practices. For 37 non-governmental organizations (NGOs) with multiple raters, inter-rater agreement was moderate to substantial (κ>0.4) for 12 of 18 best practices. Conclusions This is the first study to evaluate adherence to STMM best practices. Such an objective evaluation will be valuable to governments, volunteers and NGO donors who have an interest in identifying high-quality partners. Assessment and monitoring of STMMs through self-audit may be foundational steps towards quality improvement.
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Affiliation(s)
| | - Christina Gorman
- Department of Public Health Sciences, University of Toronto, 155 College Street Toronto, ON M5T 3M7 Canada
| | - William Cherniak
- Department of Family and Community Medicine, Division of Emergency Medicine, Markham Stouffville Hospital, 381 Church St, Markham, ON L3P 7P3, Canada.,Bridge to Health Medical and Dental, 491 Lawrence Avenue West Suite 301 M5M 1C7, Toronto, ON
| | - Lorena Lopez
- Universidad Privada Antenor Orrego, Avenida América Sur 3145, Trujillo 13008, Peru
| | - Charlene H Chu
- Department of Public Health Sciences, University of Toronto, 155 College Street Toronto, ON M5T 3M7 Canada.,Lawrence S. Bloomberg Faculty of Nursing, 155 College St, Toronto, ON M5T 1P8, Canada
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9
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Plastic Surgery in Camps in Rural India. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02681-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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10
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Compton B, Colatrella B, Hamilton L, Monahan JT, Sam P, Taylor K. Improving Short-Term Medical Engagements with Low-to-Middle-Income Countries. NAM Perspect 2021; 2021:202103b. [PMID: 34532692 DOI: 10.31478/202103b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | | | - Liza Hamilton
- National Academies of Sciences, Engineering, and Medicine
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Casimir TV. Mete Tèt Nou Ansanm (Putting our heads together): Global health capacity building within short-term medical missions. Glob Public Health 2021; 17:1252-1266. [PMID: 34044746 DOI: 10.1080/17441692.2021.1931400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Short-term medical missions (STMMs) have the potential to increase local health care capacity in low resource settings. Few studies have examined capacity building within STMMs from the perspective of both donor and host providers. A qualitative study using a transcendental method for research with human subjects examined the experiences of 21 North American 'donor' and Dominican 'host' health care providers who participated in STMMs in the Dominican Republic. Perry and Ojemeni's levels of capacity building for human good provided the theoretical framework, proposing a three-level approach: (1) augmenting local health care delivery capacity (2) assisting local communities to develop their own capacities and (3) transforming barriers to capacity. Findings are grouped into five themes and their subthemes: (1) making a difference (2) education and knowledge transfer, (3) acknowledging barriers, (4) host empowerment and (5) personal and interpersonal development. An overarching paradigm of 'Mete Tèt Nou Ansanm', or 'putting our heads together', emerged from the data, reflecting a dynamic process in which donor and host participants evolved their collaborative partnerships. STMMs have the potential for addressing global health capacity at all three levels. Mission compatibility with the local health system, host empowerment and repeated interactions over time are noteworthy determinants for STMMs sustainability.
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Affiliation(s)
- Tara V Casimir
- University of Massachusetts Medical School, Graduate School of Nursing, Worcester, MA, USA
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12
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MacDonald M, Phan JT, Chen L, Jarvill TL, Yee S, Wells PJ, Mhaskar R. Recommendations to Medical Mission Trip Teams: A Retrospective Study of an Annual Medical Student-Run Mission Trip to Jarabacoa, Dominican Republic. Cureus 2020; 12:e11852. [PMID: 33409088 PMCID: PMC7781550 DOI: 10.7759/cureus.11852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction There are more than 6,000 international medical mission trips that are conducted annually by United States medical teams. Successfully planning a medical mission trip relies on careful preparation. The objective of this study is to elucidate common chief concerns, diagnoses, and prescription patterns so that medical mission trip teams can effectively prepare for future medical mission trips in Jarabacoa, Dominican Republic, or similar international sites. Methods A retrospective chart review of 940 patient charts was conducted from two University of South Florida Latino Medical Student Association medical mission trips to Jarabacoa, Dominican Republic (DR) that took place during October 2017 and 2018. A coding system was utilized to categorize the data. The most common chief concerns, diagnoses, and medications prescribed were revealed. Findings were stratified further by age (<18 vs ≥18 years old) and sex. Results Our study reveals that 68.6% (n=597/870) of the patients were female and 59.2% (n=161/870) of males were under 18. The most common chief concerns were “cold/flu” (33.2%,n=289/870), gastrointestinal problems (20.3%, n=177/870), headache (20.0%, n=174/870), and musculoskeletal problems (12.0%, n=104/870). The most common diagnoses were viral syndrome (25.4%, n=221/870), presumed parasitic infection (16.9%, n=147/870), hypertension (12.6%, n=110/870), headache (10.6%, n=92/870), and musculoskeletal disorder (8.5%, n=74/870). The most frequently prescribed medications were acetaminophen (18.3%, n=291/1,587), albendazole (15.2%, n=241/1,587), nonsteroidal anti-inflammatory drugs (NSAIDs) (10.5%, n=166/1,587), antihistamines (6.1%, n=97/1,587), and antibiotics (5.9%, n=93/1,587). Conclusions Our study reveals potential areas for improvement of an annual, medical student-run medical mission trip to Jarabacoa, DR. Dedicated efforts should be made to address long-term management of chronic conditions identified or treated on medical mission trips. Community partnerships should be established to facilitate this. We hope this will encourage other medical mission trip teams to analyze their data in order to be more prepared for their trips.
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13
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Penney D. Ethical Considerations for Short-Term Global Health Projects. J Midwifery Womens Health 2020; 65:767-776. [PMID: 33247528 DOI: 10.1111/jmwh.13162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/18/2020] [Accepted: 06/28/2020] [Indexed: 01/21/2023]
Abstract
Various types of health professional volunteers from high-income nations are increasingly engaged in short-term global health projects in low- and middle-income countries. The goal of global health projects is to improve health for all people and address health inequities. Short-term projects lasting days to months can create challenges for volunteers and hosts. Despite attempting to do good, volunteer efforts may unwittingly cause harm to host organizations by planning projects without consideration for the local infrastructure, the community, and the health care staff. Although well-intentioned and often beneficial, volunteer efforts can fail to provide adequate follow-up or may disrupt or override local health efforts. In some low-resource settings, dire health needs and lack of supervision may result in volunteers practicing beyond their professional scope. Recently published guidelines, competencies, and position statements have addressed ethical behaviors for short-term global health experiences. Partnerships that are founded on principles of justice and autonomy provide an avenue for mutual collaboration. Short-term global health projects that focus on host needs are likely to strengthen local capacity to improve health outcomes. This article reviews guidelines for short-term global health experiences and addresses the ethical principles for planning effective projects.
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Affiliation(s)
- Debra Penney
- University of Utah College of Nursing, Salt Lake City, Utah
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Bae C, Naik N, Misak M, Barnes SL, Verceles AC, Papali A, McCurdy MT, Losonczy LI. Assessment of Local Health Worker Attitudes toward International Medical Volunteers in Low- and Middle-income Countries: A Global Survey. J Epidemiol Glob Health 2020; 10:230-235. [PMID: 32954714 PMCID: PMC7509097 DOI: 10.2991/jegh.k.200605.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/18/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND International Medical Volunteers (IMVs) positively and negatively impact host countries, and the goals of their trips may not always align with the interests of the hosts in Low- and Middle-Income Countries (LMICs). We sought to better understand local physicians' interest of hosting IMVs and what type of support they desired. METHODS This study was a convenience sample survey-based needs assessment. The surveys were distributed to local physicians by 28 professional society groups in LMICs. FINDINGS A total of 102 physicians from 51 countries completed the survey. Despite 61.8% participants having no experience with IMVs, 75% were interested in hosting them. Host physicians most desired clinical education (39%), research collaboration (18%), and Systems Development (11%). The most requested specialties were obstetrics and gynecology (25%) and emergency medicine (11%). Respondents considered public hospitals (62%) to be the most helpful clinical setting in which IMVs could work, and 3 months (47%) as the ideal length of stay. Respondents expressed interest in advertising the specific needs of the host country to potential IMVs (80%). Qualitative analyses suggested hosts wanted more training opportunities, inclusion of all stakeholders, culturally competent volunteers, and aid focused on subspecialty education, health policy, public health, and research. CONCLUSION Hosts desire more bidirectional clinical education and research capacity building than just direct clinical care. Importantly, cultural competence is key to a successful host partnership, potentially improved through IMV preparation. Finally, respondents want IMVs to ensure that they stay within their scope of practice and training.
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Affiliation(s)
- Crystal Bae
- Department of Emergency Medicine, Temple University, Philadelphia, PA, USA
| | - Nehal Naik
- Department of Emergency Medicine, George Washington University Hospital, Washington, D.C., USA
| | - Monika Misak
- Department of Emergency Medicine, George Washington University Hospital, Washington, D.C., USA
| | - Sean L. Barnes
- Department of Decision, Operations & Information Technologies, Robert H. Smith School of Business, University of Maryland, MD, USA
| | - Avelino C. Verceles
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alfred Papali
- Division of Pulmonary & Critical Care Medicine, Atrium Health, Charlotte, NC, USA
- Division of Pulmonary & Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Michael T. McCurdy
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lia I. Losonczy
- Department of Emergency Medicine, George Washington University Hospital, Washington, D.C., USA
- Department of Anesthesia & Critical Care Medicine, George Washington University School of Medicine, Washington, D.C., USA
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Abstract
Global public health has several persistent challenges that require partnerships to properly solve. A global institution with the resources and influence of the Catholic Church, even though its health-related efforts have traditionally focused on the provision of direct medical care, could be a more valuable partner for global public health than it traditionally has been. The challenges are not technical in nature, but are conceptual ones that prevent global public health from achieving its full potential. For example, the intellectual resources of the Church could help cultivate a sense of vocation among public health professionals, similar to the awareness of vocation enjoyed in healing professions. Additionally, the social teaching of the Church, particularly the preferential option for the poor, could help shift the enduring issue that global resources often flow where they are least needed. Further, dignity and solidarity could provide the conceptual grounding needed to invest more energy in capacity building in low-resource settings. Such efforts also require conversion within the Church itself, suggesting that deeper partnership could benefit both the Church and global public health.
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Affiliation(s)
- Michael Rozier
- Department of Health Management and Policy, Saint Louis University College for Public Health and Social Justice, St. Louis, MO, US
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16
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Mitchell R, Mitchell R, Phillips G, Jayaratnam S. Demand for global health training among obstetrics and gynaecology trainees in Australia and New Zealand: Insights from the TIGHT study. Aust N Z J Obstet Gynaecol 2020; 60:616-621. [PMID: 31997340 DOI: 10.1111/ajo.13122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Global health (GH) training aims to equip clinicians with the skills and knowledge to practise in international and cross-cultural environments. Interest among obstetrics and gynaecology trainees is unknown. AIMS The Trainee Interest in Global Health Training (TIGHT) study aimed to assess demand for GH training among specialty trainees in Australia and New Zealand. The primary objective was to quantify the number of trainees interested in undertaking a rotation in a resource-limited environment (RLE) in a low- or middle-income country during specialty training. This paper reports the results of a planned sub-group analysis of Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) trainees. MATERIALS AND METHODS A cross-sectional study was conducted between August and October 2018. Data were collected using an anonymous, self-reporting, web-based survey. RESULTS There were 210 respondents among 698 RANZCOG trainees, equating to a response rate of 30.1%. Overall, 77% (157/204) of respondents were keen to undertake a rotation in a RLE, with the vast majority (166/203, 81.8%) interested or very interested in having their GH accredited for training. Sixty-four percent (125/195) expressed interest in undertaking an integrated GH training or fellowship program as an adjunct to specialty training, and a majority (177/201, 88.1%) were keen to continue GH work as a specialist obstetrician and gynaecologist. CONCLUSION There is significant demand for GH training among RANZCOG trainees. These findings should inform the development of accredited rotations in RLEs and the cultivation of safe and effective global women's health training pathways. Ideally, these arrangements should be underpinned by mutually beneficial partnerships with both educational and development objectives.
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Affiliation(s)
- Rebecca Mitchell
- Department of Obstetrics & Gynaecology, Sunshine Hospital, Melbourne, Victoria, Australia
| | - Rob Mitchell
- Emergency & Trauma Centre, Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Georgina Phillips
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Emergency Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Skandarupan Jayaratnam
- Department of Obstetrics & Gynaecology, Cairns Hospital, Cairns, Queensland, Australia.,James Cook University, Cairns, Queensland, Australia
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Doobay-Persaud A, Evert J, DeCamp M, Evans CT, Jacobsen KH, Sheneman NE, Goldstein JL, Nelson BD. Extent, nature and consequences of performing outside scope of training in global health. Global Health 2019; 15:60. [PMID: 31675976 PMCID: PMC6823963 DOI: 10.1186/s12992-019-0506-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/11/2019] [Indexed: 01/31/2023] Open
Abstract
Background Globalization has made it possible for global health professionals and trainees to participate in short-term training and professional experiences in a variety of clinical- and non-clinical activities across borders. Consequently, greater numbers of healthcare professionals and trainees from high-income countries (HICs) are working or volunteering abroad and participating in short-term experiences in low- and middle-income countries (LMICs). How effective these activities are in advancing global health and in addressing the crisis of human resources for health remains controversial. What is known, however, is that during these short-term experiences in global health (STEGH), health professionals and those in training often face substantive ethical challenges. A common dilemma described is that of acting outside of one’s scope of training. However, the frequency, nature, circumstances, and consequences of performing outside scope of training (POST) have not been well-explored or quantified. Methods The authors conducted an online survey of HIC health professionals and trainees working or volunteering in LMICs about their experiences with POST, within the last 5 years. Results A total of 223 survey responses were included in the final analysis. Half (49%) of respondents reported having been asked to perform outside their scope of training; of these, 61% reported POST. Trainees were nearly twice as likely as licensed professionals to report POST. Common reasons cited for POST were a mismatch of skills with host expectations, suboptimal supervision at host sites, inadequate preparation to decline POST, a perceived lack of alternative options and emergency situations. Many of the respondents who reported POST expressed moral distress that persisted over time. Conclusions Given that POST is ethically problematic and legally impermissible, the high rates of being asked, and deciding to do so, were notable. Based on these findings, the authors suggest that additional efforts are needed to reduce the incidence of POST during STEGH, including pre-departure training to navigate dilemmas concerning POST, clear communication regarding expectations, and greater attention to the moral distress experienced by those contending with POST.
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Affiliation(s)
- Ashti Doobay-Persaud
- Division of Hospital Medicine, Departments of Medicine and Medical Education, Feinberg School of Medicine, Northwestern University, 51 E Huron St, Chicago, IL, 60611, USA. .,Institute for Global Health, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Suite 1058, Chicago, IL, 60611, USA.
| | - Jessica Evert
- University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA.,Child Family Health International, 400 29th St, Suite 508, Oakland, CA, 94609, USA
| | - Matthew DeCamp
- Center for Bioethics and Humanities and Division of General Internal Medicine, University of Colorado, 13080 E. 19th Avenue, Aurora, Colorado, 80045-2571, USA
| | - Charlesnika T Evans
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Dr, Chicago, IL, 60611, USA
| | - Kathryn H Jacobsen
- Department of Global and Community Health, George Mason University, 4400 University Dr, Fairfax, VA, 22030, USA
| | - Natalie E Sheneman
- Institute for Global Health, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Suite 1058, Chicago, IL, 60611, USA
| | - Joshua L Goldstein
- Departments of Neurology, Pediatrics, and Medical Education, Feinberg School of Medicine, Northwestern University, 303 E Chicago Ave, Chicago, IL, 60611, USA
| | - Brett D Nelson
- Divisions of Global Health and Neonatology, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua St, Boston, MA, 02114, USA.,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
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19
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Hendriks TCC, Botman M, Rahmee CNS, Ket JCF, Mullender MG, Gerretsen B, Nuwass EQ, Marck KW, Winters HAH. Impact of short-term reconstructive surgical missions: a systematic review. BMJ Glob Health 2019; 4:e001176. [PMID: 31139438 PMCID: PMC6509599 DOI: 10.1136/bmjgh-2018-001176] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/19/2019] [Accepted: 01/25/2019] [Indexed: 01/04/2023] Open
Abstract
Introduction Short-term missions providing patients in low-income countries with reconstructive surgery are often criticised because evidence of their value is lacking. This study aims to assess the effectiveness of short-term reconstructive surgical missions in low-income and middle-income countries. Methods A systematic review was conducted according to PRISMA guidelines. We searched five medical databases from inception up to 2 July 2018. Original studies of short-term reconstructive surgical missions were included, which reported data on patient safety measurements, health gains of individual patients and sustainability. Data were combined to generate overall outcomes, including overall complication rates. Results Of 1662 identified studies, 41 met full inclusion criteria, which included 48 546 patients. The overall study quality according to Oxford CEBM and GRADE was low. Ten studies reported a minimum of 6 months’ follow-up, showing a follow-up rate of 56.0% and a complication rate of 22.3%. Twelve studies that did not report on duration or follow-up rate reported a complication rate of 1.2%. Fifteen out of 20 studies (75%) that reported on follow-up also reported on sustainable characteristics. Conclusions Evidence on the patient outcomes of reconstructive surgical missions is scarce and of limited quality. Higher complication rates were reported in studies which explicitly mentioned the duration and rate of follow-up. Studies with a low follow-up quality might be under-reporting complication rates and overestimating the positive impact of missions. This review indicates that missions should develop towards sustainable partnerships. These partnerships should provide quality aftercare, perform outcome research and build the surgical capacity of local healthcare systems. PROSPERO registration number CRD42018099285.
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Affiliation(s)
- Thom C C Hendriks
- Plastic, Reconstructive and Hand Surgery, VU Medisch Centrum, Amsterdam, The Netherlands.,Global Surgery Amsterdam, Amsterdam, The Netherlands
| | - Matthijs Botman
- Plastic, Reconstructive and Hand Surgery, VU Medisch Centrum, Amsterdam, The Netherlands.,Global Surgery Amsterdam, Amsterdam, The Netherlands
| | - Charissa N S Rahmee
- Plastic, Reconstructive and Hand Surgery, VU Medisch Centrum, Amsterdam, The Netherlands.,Global Surgery Amsterdam, Amsterdam, The Netherlands
| | | | - Margriet G Mullender
- Plastic, Reconstructive and Hand Surgery, VU Medisch Centrum, Amsterdam, The Netherlands
| | | | - Emanuel Q Nuwass
- Department of Surgery, Haydom Lutheran Hospital, Haydom, Tanzania
| | - Klaas W Marck
- Department of Plastic Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Henri A H Winters
- Plastic, Reconstructive and Hand Surgery, VU Medisch Centrum, Amsterdam, The Netherlands.,Global Surgery Amsterdam, Amsterdam, The Netherlands
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20
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Martinez JJ, Rafael AY, Rodriguez JP, Davis JT, Murala JS. A Tribute to Dr Montesinos: 20 Years From Medical Missions to a Cardiothoracic Surgery Department. World J Pediatr Congenit Heart Surg 2019; 10:250-252. [PMID: 30841829 DOI: 10.1177/2150135119831965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Joseph J Martinez
- 1 Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aldo Y Rafael
- 2 Cardiac and Thoracic Surgery, Baylor Scott & White Heart and Vascular Hospital, Dallas, TX, USA
| | | | - John T Davis
- 4 Division of Cardiac Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - John S Murala
- 1 Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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21
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Eadsforth H. Professionalisation of International Medical Volunteer Work to Maintain Ethical Standards: A Qualitative Study Exploring the Experience of Volunteer Doctors in Relation to UK Policy. Med Sci (Basel) 2019; 7:medsci7010009. [PMID: 30646600 PMCID: PMC6359092 DOI: 10.3390/medsci7010009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/18/2018] [Accepted: 01/08/2019] [Indexed: 11/18/2022] Open
Abstract
Doctors from the United Kingdom are increasingly involved in international medical volunteerism in low- and middle-income countries (LMICs). Although supported by government policy this practice lacks infrastructure and coordination. Volunteer activities can have positive impact but also risk causing harm. Without external governance the responsibility lies with volunteers and their organisations to self-evaluate their activities. This study aimed to explore influences affecting volunteer engagement with ethical standards and evaluative practice. Semi-structured interviews were conducted with seven doctors working in the Scottish National Health Service with volunteer experience in LMICs. Findings were analysed thematically to explore this issue in view of ongoing policy development. Although ethical standards were valued by participants they were unaware of relevant government policy. Influences on volunteer development are unstructured and vary in quality. Evaluation lacks structure and framing. Volunteer physicians face a number of barriers to engaging in critical evaluation of their activities in LMICs. Development and professionalization of medical volunteering in LMICs needs to address volunteer preparation and evaluative practice to maximise the benefits of volunteering, reduce the risk of harm and maximise learning and accountability. Further areas of research are suggested to inform professionalisation of this sector.
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Affiliation(s)
- Holly Eadsforth
- Department of Anaesthetics, Glasgow Royal Infirmary, Glasgow G4 0SF, UK.
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22
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Development of a theoretical framework for assessment of quality of primary care medical service trips in Latin America. Int J Public Health 2019; 64:333-342. [DOI: 10.1007/s00038-018-1199-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/08/2018] [Accepted: 12/19/2018] [Indexed: 11/27/2022] Open
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23
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Roche S, Brockington M, Fathima S, Nandi M, Silverberg B, Rice HE, Hall-Clifford R. Freedom of choice, expressions of gratitude: Patient experiences of short-term surgical missions in Guatemala. Soc Sci Med 2018; 208:117-125. [PMID: 29803969 DOI: 10.1016/j.socscimed.2018.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 12/28/2022]
Abstract
Lack of surgical care has been highlighted as a critical global health problem, and short-term medical missions (STMMs) have become a de facto measure to address this shortfall. Participation in STMMs is an increasingly popular activity for foreign medical professionals to undertake in low- and middle-income countries (LMICs) where their clinical skills may be in short supply. While there is emerging literature on the STMM phenomenon, patient experiences of surgical missions are underrepresented. This research addresses this gap through thirty-seven in-depth interviews with patients or caregivers who received care from a short-term surgical mission within the three years prior to the four-week data collection period in July and August 2013. Interviews were conducted in Antigua, Guatemala and nearby communities, and participants came from 9 different departments of the country. These first-hand accounts of health-seeking through a surgical mission provide important insights into the benefits and challenges of STMMs that patients encounter, including waiting time, ancillary costs, and access to care. Patient agency in care-seeking is considered within the pluralistic, privatized health care context in Guatemala in which foreign participants deliver STMM care.
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Affiliation(s)
- Stephanie Roche
- NAPA-OT Field School, Guatemala; University of Washington, Department of Global Health, United States
| | | | | | | | - Benjamin Silverberg
- NAPA-OT Field School, Guatemala; Duke University, Global Health Institute, United States
| | - Henry E Rice
- Duke University, Global Health Institute, United States
| | - Rachel Hall-Clifford
- NAPA-OT Field School, Guatemala; Agnes Scott College Departments of Sociology and Anthropology and Public Health, United States.
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24
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Haranhalli N, Elahi E, Yassari R. A Reply to Commentaries on "Surgical and Teaching Mission to Mongolia: Experience and Lessons". World Neurosurg 2018; 111:437-438. [PMID: 29499605 DOI: 10.1016/j.wneu.2017.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/02/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Neil Haranhalli
- Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Global Health Center, Bronx, New York, USA
| | - Ebrahim Elahi
- Departments of Ophthalmic, Oculofacial Surgery and Global Health, Mount Sinai School of Medicine, New York, New York, USA
| | - Reza Yassari
- Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Global Health Center, Bronx, New York, USA.
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25
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DeCamp M, Lehmann LS, Jaeel P, Horwitch C. Ethical Obligations Regarding Short-Term Global Health Clinical Experiences: An American College of Physicians Position Paper. Ann Intern Med 2018; 168:651-657. [PMID: 29582076 DOI: 10.7326/m17-3361] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This American College of Physicians position paper aims to inform ethical decision making surrounding participation in short-term global health clinical care experiences. Although the positions are primarily intended for practicing physicians, they may apply to other health care professionals and should inform how institutions, organizations, and others structure short-term global health experiences. The primary goal of short-term global health clinical care experiences is to improve the health and well-being of the individuals and communities where they occur. In addition, potential benefits for participants in global health include increased awareness of global health issues, new medical knowledge, enhanced physical diagnosis skills when practicing in low-technology settings, improved language skills, enhanced cultural sensitivity, a greater capacity for clinical problem solving, and an improved sense of self-satisfaction or professional satisfaction. However, these activities involve several ethical challenges. Addressing these challenges is critical to protecting patient welfare in all geographic locales, promoting fair and equitable care globally, and maintaining trust in the profession. This paper describes 5 core positions that focus on ethics and the clinical care context and provides case scenarios to illustrate them.
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Affiliation(s)
| | - Lisa Soleymani Lehmann
- Veterans Health Administration, Washington, DC, and Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts (L.S.L.)
| | - Pooja Jaeel
- University of California, San Diego, La Jolla, California (P.J.)
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Dezena RA, Resende LO, David Reis RG. Strategic Planning of Surgical Missions. World Neurosurg 2018; 111:441. [PMID: 29499606 DOI: 10.1016/j.wneu.2017.11.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 10/17/2022]
Affiliation(s)
- Roberto Alexandre Dezena
- Division of Neurosurgery, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil.
| | - Laíse Oliveira Resende
- Division of Neurosurgery, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
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Guidelines for responsible short-term global health activities: developing common principles. Global Health 2018; 14:18. [PMID: 29415740 PMCID: PMC5803894 DOI: 10.1186/s12992-018-0330-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Growing concerns about the value and effectiveness of short-term volunteer trips intending to improve health in underserved Global South communities has driven the development of guidelines by multiple organizations and individuals. These are intended to mitigate potential harms and maximize benefits associated with such efforts. METHOD This paper analyzes 27 guidelines derived from a scoping review of the literature available in early 2017, describing their authorship, intended audiences, the aspects of short term medical missions (STMMs) they address, and their attention to guideline implementation. It further considers how these guidelines relate to the desires of host communities, as seen in studies of host country staff who work with volunteers. RESULTS Existing guidelines are almost entirely written by and addressed to educators and practitioners in the Global North. There is broad consensus on key principles for responsible, effective, and ethical programs--need for host partners, proper preparation and supervision of visitors, needs assessment and evaluation, sustainability, and adherence to pertinent legal and ethical standards. Host country staff studies suggest agreement with the main elements of this guideline consensus, but they add the importance of mutual learning and respect for hosts. CONCLUSIONS Guidelines must be informed by research and policy directives from host countries that is now mostly absent. Also, a comprehensive strategy to support adherence to best practice guidelines is needed, given limited regulation and enforcement capacity in host country contexts and strong incentives for involved stakeholders to undertake or host STMMs that do not respect key principles.
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Dezena RA, Elbabaa SK, Resende LO. The Development of Better Neurosurgical Care Around the World. World Neurosurg 2017; 104:975-976. [DOI: 10.1016/j.wneu.2017.04.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/06/2017] [Indexed: 10/19/2022]
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Geen O, Pumputis A, Kochi C, Costa A, Stobbe K. Assessing the Short-Term Global Health Experience: A Cross-Sectional Study of Demographics, Socioeconomic Factors, and Disease Prevalence. Am J Trop Med Hyg 2017; 97:596-601. [PMID: 28722615 DOI: 10.4269/ajtmh.16-0938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Interest in short-term global health experiences to underserviced populations has grown rapidly in the last few decades. However, there remains very little research on what participants can expect to encounter. At the same time, it has been suggested that in order for physicians and workers to provide safe and effective care, volunteers should have a basic understanding of local culture, health systems, epidemiology, and socioeconomic needs of the community before arriving. Our objective was to add to the limited literature on what short-term global health trips can expect to encounter through a cross-sectional study of patient demographics, socioeconomic markers, and the prevalence of diseases encountered on a short-term medical service trip to Lima, Peru. Descriptive analysis was conducted on clinic data collected from patients living in Pamplona Alta and Pamplona Baja, Lima, Peru, in July 2015. We found that volunteers encountered mainly female patients (70.8%), and that there were significant socioeconomic barriers to care including poverty, poor housing, environmental exposures, and lack of continuity of health care. Analysis of the disease prevalence found a high proportion of acute and chronic musculoskeletal pain in the adult populations (18.8% and 11.4%, respectively), and a high presentation of upper respiratory tract infections (25.4%) and parasites (22.0%) in the pediatric group. These findings can be used by future short-term medical service trips to address potential gaps in care including the organization of weekend clinics to allow access to working men, and the use of patient education and nonpharmacological management of acute and chronic disease.
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Affiliation(s)
- Olivia Geen
- Michael G. DeGroote School of Medicine, McMaster University, Waterloo Regional Campus, Kitchener, Ontario, Canada
| | - Allison Pumputis
- Department of Health Sciences, Brock University, Niagara, Ontario, Canada
| | - Cristina Kochi
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Andrew Costa
- Michael G. DeGroote School of Medicine, McMaster University, Waterloo Regional Campus, Kitchener, Ontario, Canada
| | - Karl Stobbe
- Michael G. DeGroote School of Medicine, McMaster University, Niagara Regional Campus, St. Catharines, Ontario, Canada
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30
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Haranhalli N, Gelfand Y, Abramowicz AE, Siyez A, Elahi E, Yassari R. Surgical and Teaching Mission to Mongolia: Experience and Lessons. World Neurosurg 2017; 102:191-199. [PMID: 28254543 DOI: 10.1016/j.wneu.2017.02.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 02/09/2017] [Accepted: 02/11/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND For decades, the disparity in medical care across the world along with the fundamental essence of medicine as service has laid the foundation for the global medical mission. Mongolia, a country often overlooked as an area in need of medical aid, harbors a fertile environment for long-term change. In the last 15-20 years, after the fall of the Union of Soviet Socialist Republics, Mongolia has turned to a free-market healthcare model and has been struggling with the transition from the formally state-run system. These changes have slowed the original progress noted among surgical specialties, namely neurosurgery, in Mongolia. A lack of resources, a desire for international interaction, and a need for technical mentorship remain a real struggle for local neurosurgeons. METHODS Under the auspices of the Virtue Foundation (www.virtuefoundation.org), we report on our 3-year experiences during our surgical and teaching mission to Mongolia and look towards long-term improvements in Mongolian neurosurgery. RESULTS A total of 15 operations were performed and more than 50 patients seen in clinic during the 3-year experience. Patients ranged from 1 to 77 years of age. No patients encountered any significant peri- or postoperative complications. CONCLUSIONS In our experience with the surgical and teaching mission to Mongolia, when directed appropriately, medical missions can serve as the perfect medium in fostering that environment, providing local healthcare professionals with the knowledge, skills, and motivation to create self-sustaining improvement in their own country, hence promoting intellectual and technological advancement and raising the standard of care.
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Affiliation(s)
- Neil Haranhalli
- Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Yaroslav Gelfand
- Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Abai Siyez
- Department of Neurological Surgery, Shastin Central Hospital, Ulaanbaatar, Mongolia
| | - Ebby Elahi
- Departments of Ophthalmic, Oculofacial Surgery and Global Health, Mount Sinai School of Medicine, New York, New York, USA
| | - Reza Yassari
- Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
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