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Hasan AI, Wajahath M, Nasser E, Nasser M, Saleh KJ. Transforming Global Orthopaedic Missions Through Adversity, Lessons Learned, and Sustainable Planning Using Quality Assurance Principles: The FAJR Methodology. J Bone Joint Surg Am 2024; 106:1338-1349. [PMID: 38723017 DOI: 10.2106/jbjs.23.01272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Affiliation(s)
- Ahmad I Hasan
- FAJR Scientific, Ann Arbor, Michigan
- Department of Orthopedic Surgery, Detroit Medical Center, Detroit, Michigan
| | - Muaaz Wajahath
- FAJR Scientific, Ann Arbor, Michigan
- Michigan State University College of Human Medicine, East Lansing, Michigan
| | - Elias Nasser
- FAJR Scientific, Ann Arbor, Michigan
- University of Texas Southwestern Medical School, Dallas, Texas
| | | | - Khaled J Saleh
- FAJR Scientific, Ann Arbor, Michigan
- Michigan State University College of Human Medicine, East Lansing, Michigan
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Dholakia K, Audette J, Gamble A, Hartman J. Examining Opportunities Offered Outside of Home Country in Physical Therapy Education: Considering the Colonial History of Global Health. JOURNAL, PHYSICAL THERAPY EDUCATION 2024:00001416-990000000-00113. [PMID: 38838289 DOI: 10.1097/jte.0000000000000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/04/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND AND PURPOSE Increasingly, PT programs in the United States are providing educational experiences outside of the home country (OHC) where faculty and students engage in global health initiatives. It is important to consider that the field of global health has its historical roots in colonialism, which has led to inequities and injustice. Those who are engaged in this work must assist in reversing this colonial legacy. The purpose of this position paper is to present the colonial history of global health, to provide context, and to spark critical reflection among PT educators about how OHC experiences are developed and configured. POSITION AND RATIONALE As a profession, we must educate ourselves about the history of global health and critically reflect on OHC engagements to ensure that we support equity and justice. DISCUSSION AND CONCLUSION We must start by grounding our OHC experiences in health equity and justice. This should be done by considering the colonial history of global health and the privileges we hold as members of academic institutions in the United States. Why we offer OHC experiences in PT education should be investigated and clear to both faculty and students. Excluding this colonial history and its impacts risks perpetuating the historical harms to the health and well-being of the populations we claim to be serving.
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Affiliation(s)
- Kripa Dholakia
- Kripa Dholakia is the assistant professor in the Institute for Physical Therapy Education at the Widener University
- Jennifer Audette is the associate professor in the Westbrook College of Health Professions in the Doctor of Physical Therapy Program at the University of New England, 716 Stevens Avenue, Proctor Hall 214A, Portland, ME 04103 . Please address all correspondence to Jennifer Audette
- April Gamble is the director of The American Center for Rehabilitation, physiotherapy director at Wchan Organization for Victims of Human Rights Violations, and the senior health advisor for Rehabilitation at UK-Med
- Jeff Hartman is the associate professor in the Doctor of Physical Therapy program at the Department of Family Medicine and Community Health in the University of Wisconsin School of Medicine and Public Health
| | - Jennifer Audette
- Kripa Dholakia is the assistant professor in the Institute for Physical Therapy Education at the Widener University
- Jennifer Audette is the associate professor in the Westbrook College of Health Professions in the Doctor of Physical Therapy Program at the University of New England, 716 Stevens Avenue, Proctor Hall 214A, Portland, ME 04103 . Please address all correspondence to Jennifer Audette
- April Gamble is the director of The American Center for Rehabilitation, physiotherapy director at Wchan Organization for Victims of Human Rights Violations, and the senior health advisor for Rehabilitation at UK-Med
- Jeff Hartman is the associate professor in the Doctor of Physical Therapy program at the Department of Family Medicine and Community Health in the University of Wisconsin School of Medicine and Public Health
| | - April Gamble
- Kripa Dholakia is the assistant professor in the Institute for Physical Therapy Education at the Widener University
- Jennifer Audette is the associate professor in the Westbrook College of Health Professions in the Doctor of Physical Therapy Program at the University of New England, 716 Stevens Avenue, Proctor Hall 214A, Portland, ME 04103 . Please address all correspondence to Jennifer Audette
- April Gamble is the director of The American Center for Rehabilitation, physiotherapy director at Wchan Organization for Victims of Human Rights Violations, and the senior health advisor for Rehabilitation at UK-Med
- Jeff Hartman is the associate professor in the Doctor of Physical Therapy program at the Department of Family Medicine and Community Health in the University of Wisconsin School of Medicine and Public Health
| | - Jeff Hartman
- Kripa Dholakia is the assistant professor in the Institute for Physical Therapy Education at the Widener University
- Jennifer Audette is the associate professor in the Westbrook College of Health Professions in the Doctor of Physical Therapy Program at the University of New England, 716 Stevens Avenue, Proctor Hall 214A, Portland, ME 04103 . Please address all correspondence to Jennifer Audette
- April Gamble is the director of The American Center for Rehabilitation, physiotherapy director at Wchan Organization for Victims of Human Rights Violations, and the senior health advisor for Rehabilitation at UK-Med
- Jeff Hartman is the associate professor in the Doctor of Physical Therapy program at the Department of Family Medicine and Community Health in the University of Wisconsin School of Medicine and Public Health
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Hartman J, Dholakia K. An Exploratory Study of Physical Therapists From High-Income Countries Practising Outside of Their Scope in Low and Middle-Income Countries. JOURNAL OF BIOETHICAL INQUIRY 2023; 20:543-562. [PMID: 37861947 DOI: 10.1007/s11673-023-10305-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 12/03/2022] [Indexed: 10/21/2023]
Abstract
PURPOSE To quantify how often physical therapists from high-income countries (HIC) travelling to low- and middle-income countries (LMIC) practise outside their scope of practice, in what circumstances, and their likelihood of doing the same in the future. METHODS An exploratory descriptive study using a survey. RESULTS One hundred and twenty-six licensed physical therapists from around the world participated. Physical therapists typically spent less than a month (73.8 per cent) in LMIC; 67.5 per cent believed that physical therapists practise outside of their scope, and 31.7 per cent reported doing so. Reasons were believing that something is better than nothing (47.5 per cent ), a mismatch between the physical therapist's and host's expectations (40.0 per cent ), and preserving their relationship with the host (25.0 per cent ). It was deemed appropriate by 64.5 per cent to practise outside of their scope in some situations and 53.8% considered repeating the activity in the future. Half of the respondent's first experience in LMIC occurred as a student or in their first decade of practice. CONCLUSIONS Working in LMIC requires a keen understanding of the risks and challenges associated with such experiences. To ensure best practice, a skill set that consists of critical self-reflection, systems thinking, and structural competency combined with clinical competency and accountability is imperative.
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Affiliation(s)
- J Hartman
- Department of Family Medicine and Community Health, Doctor of Physical Therapy Program, University of Wisconsin, School of Medicine and Public Health, 5110 Medical Sciences Center, 1300 University Ave, Madison, WI, 53706, USA.
| | - K Dholakia
- Institute for Physical Therapy Education, Widener University, One University Place, Chester, PA, 19013, USA
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Gichane MW, Wallace DD. Dismantling and reimagining global health education. Glob Health Action 2022; 15:2131967. [PMID: 36285634 PMCID: PMC9621231 DOI: 10.1080/16549716.2022.2131967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Global health emerged as a distinct public health discipline within the last two decades. With over 95% of Masters of Global Health degree programmes located in high-income countries (HICs), the area of study has been primarily pursued by White, middle and upperclass, citizens of Europe and North America. In turn, the global health workforce and leadership reflect these same demographics. In this article, we present several key arguments against the current state of global health education: (1) admissions criteria favour HIC applicants; (2) the curriculum is developed with the HIC gaze; (3) student practicums can cause unintended harms in low- and middle-income country communities. We argue that global health education in its current form must be dismantled. We conclude with suggestions for how global health education may be reimagined to shift from a space of privilege and colonial practice to a space that recognises the strengths of experiences and knowledge above and beyond those from HICs.
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Affiliation(s)
- Margaret W. Gichane
- Department of Obstetrics, Gynecology & Reproductive Sciences, Advancing New Standards in Reproductive Health, University of California, Oakland, OA, USA
| | - Deshira D. Wallace
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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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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Healthcare in Extreme and Austere Environments: Responding to the Ethical Challenges. HEC Forum 2020; 32:283-291. [PMID: 33011841 DOI: 10.1007/s10730-020-09427-3] [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] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
Clinicians may increasingly find themselves practicing, by choice or necessity, in resource-poor or extreme environments. This often requires altering typical patterns of practice with a different set of medical and ethical considerations than are usually faced by clinicians practicing in hospitals in the United States and Europe. Practitioners may be required to alter their usual scope of practice or their standard ways of medically treating patients. Limited resources will also often place clinicians in the position of having to make decisions about fairly allocating healthcare, which will alter the physician-patient relationship. This does not absolve physicians and other healthcare practitioners of providing the best quality of care that can be given under the circumstances. In addition, the lack of a well-developed healthcare infrastructure and limited resources will require working with established providers to determine the needs of the community, and what types of healthcare are feasible given these limitations. The essays in this issue of HEC Forum encourage readers to reflect on the unique ethical challenges faced in the extreme or austere environment.
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Huang CC, Torres V, Jacob E. Challenges and Lessons Learned From Short-Term Medical Service Trips in Global Communities. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2020.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chan K, Sisk B, Yun K, St Clair NE. Global Health Experience and Interest: Results From the AAP Periodic Survey. Pediatrics 2020; 145:peds.2019-1655. [PMID: 31822511 DOI: 10.1542/peds.2019-1655] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Interest and participation in global health (GH) experiences have increased over the past 30 years in both medical schools and residencies, but little is known at the level of practicing pediatricians. METHODS Data were compared from the American Academy of Pediatrics Periodic Surveys conducted in 1989 and 2017. The surveys had a response rate of 70.8% in 1989 and 46.7% in 2017. There were 638 and 668 postresidency pediatricians in the 1989 and 2017 surveys, respectively. Descriptive analyses were performed to look at changes in experience and interest in GH. A multivariable logistic regression was conducted specifically looking at characteristics associated with interest in participating in GH experiences in the next 3 years. RESULTS Pediatrician participation in GH experiences increased from 2.2% in 1989 to 5.1% in 2017, with statistically significant increases in pediatricians ≥50 years of age. Interest in participating in future GH experiences increased from 25.2% in 1989 to 31.7% in 2017, with a particular preference for short-term clinical opportunities. In the multivariable logistic regression model, the year 2017 was associated with an increased interest in future GH experience, especially in medical school, hospital or clinic practice settings, as well as among subspecialists. CONCLUSIONS Over the past 28 years, practicing pediatricians have increased their involvement in GH, and they are more interested in future GH experiences. The focus is on short-term opportunities. Our study reveals that practicing pediatricians mirror medical trainees in their growing interest and participation in GH.
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Affiliation(s)
- Kevin Chan
- Institute for Better Health and .,Department of Children's and Women's Health, Trillium Health Partners, Mississauga, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Blake Sisk
- American Academy of Pediatrics, Itasca, Illinois
| | - Katherine Yun
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Nicole E St Clair
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
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Zientek D, Bonnell R. When International Humanitarian or Medical Missions Go Wrong: An Ethical Analysis. HEC Forum 2019; 32:333-343. [DOI: 10.1007/s10730-019-09392-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Jimenez RR, Thal WR. Faculty Reflections on International Travel to Reach the Medically Underserved. Creat Nurs 2019; 25:138-143. [PMID: 31085667 DOI: 10.1891/1078-4535.25.2.138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
One approach to preparing students to engage in culturally diverse health-care settings around the world is to incorporate faculty-led short-term cultural immersion programs in medically underserved nations. This reflective summary analyzes the impact of a faculty-led international health-care trip on students' global health-care experience and needed health-care services in developing countries. A content analysis of the journals of two advanced practice registered nurse (APRN) faculty members was performed to gain perspectives on a trip with undergraduate and graduate nursing students and medical students to a small city in Nicaragua. This article examines the personal and professional growth achieved, and the challenges faced, when managing acute and chronic diseases with limited resources in an unfamiliar country. Themes identified included anxieties of planning, provider versus faculty role, students in action, networking, nurturing behaviors, advocating, and mentoring self-sustainability. Faculty-led international health-care trips both add a needed service to developing countries' health-care needs and offer students the experience of health care from a global perspective.
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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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12
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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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Dawson S, Elliott D, Jackson D. Nurses' contribution to short-term humanitarian care in low- to middle-income countries: An integrative review of the literature. J Clin Nurs 2017; 26:3950-3961. [DOI: 10.1111/jocn.13816] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Sonja Dawson
- Avondale College of Higher Education - Sydney Campus; Wahroonga NSW Australia
- Faculty of Health; University of Technology Sydney; Ultimo NSW Australia
| | - Doug Elliott
- Faculty of Health; University of Technology Sydney; Ultimo NSW Australia
| | - Debra Jackson
- Faculty of Health; University of Technology Sydney; Ultimo NSW Australia
- Faculty of Health & Life Sciences; Oxford Institute of Nursing & Allied Health Research; Oxford Brookes University; Oxford UK
- Oxford University Hospitals NHS Foundation Trust; Oxford UK
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Dainton C, Chu CH, Lin H, Cherniak W, Loh LC. A Protocol to Develop Practice Guidelines for Primary Care Medical Service Trips. Ann Glob Health 2017; 82:678-685. [PMID: 28283118 DOI: 10.1016/j.aogh.2016.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND North American clinicians are increasingly participating in medical service trips (MSTs) that provide primary healthcare in Latin America and the Caribbean. Literature reviews have shown that the existence and use of evidence-based guidelines by these groups are limited, which presents potential for harm. OBJECTIVE This paper proposes a 5-step methodology to develop protocols for diagnosis and treatment of conditions encountered by MST clinicians. METHODS We reviewed the 2010 American College of Physicians guidance statement on guidelines development and developed our own adaptation. Ancestry search of the American College of Physicians statement identified specific publications that provided additional detail on key steps in the guideline development process, with additional focus given to evidence, equity, and local adaptation considerations. FINDINGS Our adaptation produced a 5-step process for developing locally optimized protocols for diagnosis and treatment of common conditions seen in MSTs. For specified conditions, this process includes: 1) a focused environmental scan of current practices based on grey literature protocols from MST sending organizations; 2) a review of relevant practice guidelines; 3) a literature review assessing the epidemiology, diagnosis, and treatment of the specified condition; 4) an eDelphi process with experts representing MST and Latin American and the Caribbean partner organizations assessing identified guidelines; and 5) external peer review and summary. CONCLUSIONS This protocol will enable the creation of practice guidelines that are based on best available evidence, local knowledge, and equitable considerations. The development of guidelines using this process could optimize the conduct of MSTs, while prioritizing input from local community partners.
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Affiliation(s)
- Christopher Dainton
- Department of Emergency Medicine, Grand River Hospital, Kitchener, Ontario, Canada.
| | - Charlene H Chu
- Lawrence S. Bloomberg Faculty of Nursing, Institute of Aging, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Henry Lin
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA
| | - William Cherniak
- Department of Family and Community Medicine, University of Toronto and Bridge to Health Medical and Dental, Toronto, Ontario, Canada
| | - Lawrence C Loh
- Clinical Public Health Division, Office of Global Public Health Education and Training, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Bauer I. More harm than good? The questionable ethics of medical volunteering and international student placements. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2017; 3:5. [PMID: 28883975 PMCID: PMC5531079 DOI: 10.1186/s40794-017-0048-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 02/24/2017] [Indexed: 03/14/2023]
Abstract
It has been argued that much of international medical volunteering is done for the wrong reasons, in that local people serve as a means to meet volunteers’ needs, or for the right reasons but ignorance and ill-preparedness harm the intended beneficiaries, often without volunteers’ grasp of the damage caused. The literature on ethical concerns in medical volunteering has grown tremendously over the last years highlighting the need for appropriate guidelines. These same concerns, however, and an appreciation of the reasons why current aid paradigms are flawed, can serve as indicators on how to change existing practices to ensure a better outcome for those who are in need of help. Such paradigm change envisages medical assistance in the spirit of solidarity, social justice, equality, and collegial collaboration.
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Affiliation(s)
- Irmgard Bauer
- Division of Tropical Health and Medicine, College of Healthcare Sciences, James Cook University, Townsville, Qld 4811 Australia
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Roche SD, Ketheeswaran P, Wirtz VJ. International short-term medical missions: a systematic review of recommended practices. Int J Public Health 2016; 62:31-42. [PMID: 27592359 DOI: 10.1007/s00038-016-0889-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/22/2016] [Accepted: 08/23/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To identify practices for conducting international short-term medical missions (STMMs) recommended in the literature and examine how these link STMMs to recipient countries' existing health systems. METHODS Systematic review of PubMed-indexed articles on STMMs and their bibliographies using preferred reporting items for systematic reviews and meta-analyses guidelines. Recommendations were organized using the World Health Organization Health Systems Framework. RESULTS In 92 publications, 67 % offered at least one recommendation that would link STMMs to the recipient country's health system. Among these recommendations, most focused on service delivery and few on health financing and governance. There is a lack of consensus around a proper standard of care, patient selection, and trip duration. CONCLUSIONS Comprehensive global standards are needed for STMM work to ensure that services are beneficial both to patients and to the broader healthcare systems of recipient countries. By providing an overview of the current recommendations and important gaps where practice recommendations are needed, this study can provide relevant input into the development of global standards for STMMs.
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Affiliation(s)
- Stephanie D Roche
- Department of Health Care Quality, Beth Israel Deaconess Medical Center, 20 Overland Street, 5th Floor, Boston, MA, 02215, USA.
| | - Pavinarmatha Ketheeswaran
- Herbert Wertheim College of Medicine, Florida International University, 11200 Southwest 8th Street, Miami, FL, 33199, USA
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, CT 363, Boston, MA, 02118, USA
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Nouvet E, Chan E, Schwartz LJ. Looking good but doing harm? Perceptions of short-term medical missions in Nicaragua. Glob Public Health 2016; 13:456-472. [PMID: 27545146 DOI: 10.1080/17441692.2016.1220610] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In this paper, we present findings from a qualitative study that gathered Nicaraguans' perceptions of short-term foreign medical missions, towards deepening the understanding of what Nicaraguans value or find limited in the work of such foreign missions operating in their country. Fifty-two interviews were conducted with patients, relatives of patients, Nicaraguan physicians and nurses who partnered with or observed missions at work, 'beneficiary' community leaders, and individuals who were unable or unwilling to access mission-provided healthcare. Factors underlying participants' positive and more critical accounts of foreign primary and surgical missions are described and analysed. Empirical investigation on how, whether or not, or on what bases short-term medical missions (STMs) have been perceived as beneficial, harmful, or otherwise by those on the receiving end of these efforts is limited. This study aims to contribute to the evidence base for reflecting on the ethical performance of trans-national STMs.
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Affiliation(s)
- Elysée Nouvet
- a Department of Clinical Epidemiology and Biostatistics , McMaster University , Hamilton , ON , Canada
| | - Elizabeth Chan
- b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Lisa J Schwartz
- a Department of Clinical Epidemiology and Biostatistics , McMaster University , Hamilton , ON , Canada
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Olenick P, Edwards JE. Factors to Consider When Planning Short-Term Global Health Work. Nurs Womens Health 2016; 20:203-209. [PMID: 27067936 DOI: 10.1016/j.nwh.2016.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 11/11/2015] [Indexed: 06/05/2023]
Abstract
Volunteer opportunities in short-term global health work can be rewarding experiences, but careful planning and preparation are vital. Potential problems to avoid include ineffective, harmful care; cultural ego-centrism; and lack of sustainability and cost effectiveness. Short-term global health work is most effective when the focus is on ongoing sustainable projects that include a long-term commitment and partnership with host communities.
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Abstract
Responding to disparities in health, thousands of health care providers volunteer annually for short-term medical service trips (MSTs) to serve communities in need as a result of environmental, geographic, historical, or sociopolitical factors. Although well intentioned, short-term MSTs have the potential to benefit and harm those involved, including participants and communities being served. The contexts, resource and time limitations, and language and cultural barriers present ethical challenges. There have been increasing requests for standardized global guidelines, transparency, and open review of MSTs and their outcomes. Principles of mission, partnership, preparation, reflection, support, sustainability, and evaluation inform and equip those engaging in medical volunteerism.
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Affiliation(s)
- Geren S Stone
- Department of Medicine, MGH Center for Global Health, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Kristian R Olson
- Department of Medicine, MGH Center for Global Health, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Dainton C, Chu CH, Lin H, Loh L. Clinical guidelines for Western clinicians engaged in primary care medical service trips in Latin America and the Caribbean: an integrative literature review. Trop Med Int Health 2016; 21:470-8. [DOI: 10.1111/tmi.12675] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Henry Lin
- University of Pennsylvania; Philadelphia PA USA
- 53rd Week; New York NY USA
| | - Lawrence Loh
- Grand River Hospital; Kitchener ON Canada
- University of Toronto; Toronto ON Canada
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21
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Coors ME, Matthew TL, Matthew DB. Ethical precepts for medical volunteerism: including local voices and values to guide RHD surgery in Rwanda. JOURNAL OF MEDICAL ETHICS 2015; 41:814-819. [PMID: 26066361 DOI: 10.1136/medethics-2013-101694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 05/13/2015] [Indexed: 06/04/2023]
Abstract
At the invitation of the Rwandan Government, Team Heart, a team of American healthcare professionals, performs volunteer rheumatic heart disease (RHD) surgery in Rwanda every year, and confronts ethical concerns that call for cultural sensitivity. This article describes how five standard bioethical precepts are applied in practice in medical volunteerism related to RHD surgery in Rwanda. The content for the applied precepts stems from semiscripted, transcribed conversations with the authors, two Rwandan cardiologists, a Rwandan nurse and a Rwandan premedical student. The conversations revealed that the criteria for RHD surgical selection in Rwanda are analogous to the patient-selection process involving material scarcity in the USA. Rwandan notions of benefit and harm focus more attention on structural issues, such as shared benefit, national reputation and expansion of expertise, than traditional Western notions. Harm caused by inadequate patient follow-up remains a critical concern. Gender disparities regarding biological and social implications of surgical valve choices impact considerations of justice. Individual agency remains important, but not central to Rwandan concepts of justice, transparency and respect, particularly regarding women. The Rwandan understanding of standard bioethical precepts is substantively similar to the traditionally recognised interpretation with important contextual differences. The communal importance of improving the health of a small number of individuals may be underestimated in previous literature. Moreover, openness and the incorporation of Rwandan stakeholders in difficult ethical choices and long-term contributions to indigenous medical capacity appear to be valued by Rwandans. These descriptions of applied precepts are applicable to different medical missions in other emerging nations following a similar process of inclusion.
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Affiliation(s)
- Marilyn E Coors
- Department of Psychiatry and Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Thomas L Matthew
- Department of Surgery, Heart Center of the Rockies, Longmont, Colorado, USA
| | - Dayna B Matthew
- University of Colorado School of Law, Boulder, Colorado, USA
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22
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Byrne SK, Collins SD, Martelly M. Sustainable Global Health Outreach in Haiti: Service Learning for Primary Care Nurse Practitioner Students. J Nurse Pract 2014. [DOI: 10.1016/j.nurpra.2014.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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23
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Health Care Voluntourism: Addressing Ethical Concerns of Undergraduate Student Participation in Global Health Volunteer Work. HEC Forum 2014; 26:285-97. [DOI: 10.1007/s10730-014-9243-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Abstract
Short-term medical service trips (MSTs) aim to address unmet health care needs of low- and middle-income countries. The lack of critically reviewed empirical evidence of activities and outcomes is a concern. Developing evidence-based recommendations for health care delivery requires systematic research review. I focused on MST publications with empirical results. Searches in May 2013 identified 67 studies published since 1993, only 6% of the published articles on the topic in the past 20 years. Nearly 80% reported on surgical trips. Although the MST field is growing, its medical literature lags behind, with nearly all of the scholarly publications lacking significant data collection. By incorporating data collection into service trips, groups can validate practices and provide information about areas needing improvement.
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Affiliation(s)
- Kevin J Sykes
- Kevin J. Sykes is with the Department of Health Policy and Management in the School of Medicine at the University of Kansas Medical Center, Kansas City
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25
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Rocque BG, Lam S. A case for international neurosurgical experience: US resident experiences with pediatric spinal dysraphism cases. Neurol Res 2014; 36:903-5. [DOI: 10.1179/1743132814y.0000000379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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26
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DeCamp M, Enumah S, O'Neill D, Sugarman J. Perceptions of a short-term medical programme in the Dominican Republic: voices of care recipients. Glob Public Health 2014; 9:411-25. [PMID: 24617943 DOI: 10.1080/17441692.2014.893368] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Participation in short-term global health programmes for low-income countries is increasing amongst practising clinicians and trainees from high-income countries. However, few studies explicitly examine the perceptions of programme recipients. In July 2012, we conducted semi-structured interviews with a purposive sample of 47 adults receiving care from Medical Ministry International, an international non-governmental organisation providing short-term medical programmes in the Dominican Republic. Thirty interviews met criteria for inclusion. Transcripts were independently coded using a descriptive approach. After thematic saturation, 20 interviews were included in the final analysis. Nine major themes were identified: misidentification, access, identified needs, social determinants, faith, language, student involvement, areas for improvement and respect. Recipients were reluctant to discuss programme improvement directly and frequently misidentified the researcher as a caregiver, suggesting a need to separate clearly programme evaluation from care provision. They viewed student involvement positively in a setting where supervision is emphasised, suggesting a potential to develop measures of supervision's adequacy. Finally, recipients' perceptions of respect as an important but intangible programme element encourage broadening the ethical discourse around short-term programmes beyond only tangible goods and services. Our findings support the usefulness of qualitative methods for short-term programme evaluation and generate important hypotheses for future research.
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Affiliation(s)
- Matthew DeCamp
- a Berman Institute of Bioethics and Division of General Internal Medicine , Johns Hopkins University , Baltimore , MD , USA
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27
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Asgary R, Junck E. New trends of short-term humanitarian medical volunteerism: professional and ethical considerations. JOURNAL OF MEDICAL ETHICS 2013; 39:625-31. [PMID: 23236086 DOI: 10.1136/medethics-2011-100488] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Short-term humanitarian medical volunteerism has grown significantly among both clinicians and trainees over the past several years. Increasingly, both volunteers and their respective institutions have faced important challenges in regard to medical ethics and professional codes that should not be overlooked. We explore these potential concerns and their risk factors in three categories: ethical responsibilities in patient care, professional responsibility to communities and populations, and institutional responsibilities towards trainees. We discuss factors increasing the risk of harm to patients and communities, including inadequate preparation, the use of advanced technology and the translation of Western medicine, issues with clinical epidemiology and test utility, difficulties with the principles of justice and clinical justice, the lack of population-based medicine, sociopolitical effects of foreign aid, volunteer stress management, and need for sufficient trainee supervision. We review existing resources and offer suggestions for future skill-based training, organisational responsibilities, and ethical preparation.
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Affiliation(s)
- Ramin Asgary
- Department of Medicine, New York University School of Medicine, , New York, New York, USA
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