A framework for short-term humanitarian health care projects

Pearls and Pitfalls of an Orthopaedic Mission Trip

Many physicians chose to pursue years of rigorous medical training because of an innate desire to care for others, which often translates into volunteering in their local communities. Some physicians take this a step further by contributing their time and skills to global health delivery through medical mission trips. The need is apparent: a 40-year discrepancy in average life span, 36 deaths versus 4 deaths per 1,000 births in low-income versus high-income countries, and over 70% of preventable pediatric deaths occurring in solely 15 countries. In addition, a remarkable gap exists in the access of care and resources, with the world's poorest countries receiving only 4% of surgical services. Orthopaedic missions are seldom because the cost and complexity of these trips supersede many other specialties. However, the care that orthopaedic surgery can provide restores an individual's function, allowing them to increase productivity in their personal lives and in their community. Addressing this disparity in health care is a great first step, but studies have shown that mission trips may have some serious downfalls. We aim to discuss these downfalls and provide recommendations to mitigate them.

Working with local nurses to promote hospital-nursing care during humanitarian assignments overseas: experiences from the perspectives of nurses

AIMS AND OBJECTIVES

To describe how Norwegian expatriate nurses engaged in humanitarian assignments overseas experience working with the local nurses promoting nursing care in the hospital ward.

BACKGROUND

Western countries have a long tradition of providing nurses with expert knowledge in nursing care for humanitarian projects and international work overseas. Studies from humanitarian mission revealed that health workers rarely acknowledge or use the local knowledge. However, there is a lack of studies highlighting expatriate nurses' experiences working with local nurses to promote nursing care in the hospital ward.

DESIGN

This study applies a descriptive explorative qualitative design.

METHODS

The data were collected in 2013 by means of seven semi-structured interviews and analysed using qualitative content analysis.

FINDINGS

The data analyses revealed three themes related to the expatriate nurses' experiences of working with the local nurses to promote nursing care in the hospital ward: (1) Breaking the code, (2) Colliding worlds and (3) Challenges in sharing knowledge. The findings reflect different challenges when working with the local nurses.

CONCLUSION

Findings indicate valuable knowledge gained about local nursing care and the local health and educational system. They also demonstrate challenges for the expatriate nurses related to the local nursing standard in the wards and using the local nurses' experiences and knowledge when working together.

RELEVANCE TO CLINICAL PRACTICE

The findings can inform nurses, humanitarian organisations and institutions working overseas regarding the recruitment and the preparation of nurses who want to work cross- culturally or in humanitarian missions overseas.

Survey of patient perceptions towards short-term mobile medical aid for those living in a medically underserved area of Swaziland

Background

An increasing number of short-term medical missions (STMMs) are being dispatched to provide humanitarian healthcare; however, extensive investigations on how recipient patients perceive STMMs are lacking. The current study evaluated the perceptions of patients toward medical services provided by a Taiwanese STMM in a resource-poor area of Swaziland.

Methods

A structured questionnaire survey was completed by patients who had received medical services from the medical mission of Taipei Medical University in Swaziland in July 2014.

Results

In total, 349 questionnaires were valid for the analysis. More respondents were female than male (69.6 % vs 30.4 %). The most common chief complaint was musculoskeletal problems (45.8 %), followed by respiratory symptoms (35.0 %). Most of the patients stated that their overall experience with the medical services was excellent (91.4 %). Universal patients would like to see the service provided in the future (99.7 %). Nearly 90 % of the patients were aware of how to take care of the medical problem they were diagnosed with. A majority of the patients comprehended what their medical providers said. Only a few patients did not understand what physicians said (5.2 %).

Conclusion

Medical services provided by the STMM were helpful in resolving patients’ problems. The data have crucial implications for evaluating overseas mobile medical aid from the viewpoint of patients.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-015-1186-4) contains supplementary material, which is available to authorized users.

Helping hands: a cost-effectiveness study of a humanitarian hand surgery mission

Purpose. Congenital anomalies and injuries of the hand are often undertreated in low-middle income countries (LMICs). Humanitarian missions to LMICs are commonplace, but few exclusively hand surgery missions have been reported and none have attempted to demonstrate their cost-effectiveness. We present the first study evaluating the cost-effectiveness of a humanitarian hand surgery mission to Honduras as a method of reducing the global burden of surgically treatable disease. Methods. Data were collected from a hand surgery mission to San Pedro Sula, Honduras. Costs were estimated for local and volunteer services. The total burden of disease averted from patients receiving surgical reconstruction was derived using the previously described disability-adjusted life years (DALYs) system. Results. After adjusting for likelihood of disability associated with the diagnosis and likelihood of the surgery's success, DALYs averted totaled 104.6. The total cost for the mission was $45,779 (USD). The cost per DALY averted was calculated to be $437.80 (USD), which is significantly below the accepted threshold of two times the per capita gross national income of Honduras. Conclusions. This hand surgery humanitarian mission trip to Honduras was found to be cost-effective. This model and analysis should help in guiding healthcare professionals to organize future plastic surgery humanitarian missions.

Humanitarian Nursing in Developing Countries: A Phenomenological Analysis

BACKGROUND

Surgical nursing within humanitarian contexts is complex, sporadically described in literature and little understood.

AIM

To achieve a deeper understanding of the lived experience of New Zealand nurses providing humanitarian aid within surgical settings and war zones in developing countries.

METHOD

In-depth conversational interviews were undertaken with four New Zealand nurses whose humanitarian experience lay in general surgical, military, and intensive care settings. A qualitative descriptive method as described by Sandelowski, informed by van Manen's phenomenology in terms of analysis, was used.

RESULTS

Specialized knowledge and nursing expertise are recognized to be essential but not sufficient for humanitarian work. Understanding local cultures contributes to positive feelings about work effectiveness. Themes included feeling anxious and misunderstood, practicing differently, and adjusting to life back home.

DISCUSSION

This study highlights the need to better prepare nurses who volunteer for humanitarian work, with implications for recruiting organizations, educators, and clinicians.

Expanding the scope of medical mission volunteer groups to include a research component

BACKGROUND

Serving on volunteer groups undertaking medical mission trips is a common activity for health care professionals and students. Although volunteers hope such work will assist underserved populations, medical mission groups have been criticized for not providing sustainable health services that focus on underlying health problems. As members of a volunteer medical mission group, we performed a bed net indicator study in rural Mali. We undertook this project to demonstrate that volunteers are capable of undertaking small-scale research, the results of which offer locally relevant results useful for disease prevention programs. The results of such projects are potentially sustainable beyond the duration of a mission trip.

METHODS

Volunteers with Medicine for Mali interviewed 108 households in Nana Kenieba, Mali during a routine two-week medical mission trip. Interviewees were asked structured questions about family demographics, use of insecticide treated bed nets the previous evening, as well as about benefits of net use and knowledge of malaria. Survey results were analyzed using logistic regression.

RESULTS

We found that 43.7% of households had any family member sleep under a bed net the previous evening. Eighty seven percent of households owned at least one ITN and the average household owned 1.95 nets. The regression model showed that paying for a net was significantly correlated with its use, while low perceived mosquito density, obtaining the net from the public sector and more than four years of education in the male head of the household were negatively correlated with net use. These results differ from national Malian data and peer-reviewed studies of bed net use.

CONCLUSIONS

We completed a bed net study that provided results that were specific to our service area. Since these results were dissimilar to peer-reviewed literature and Malian national level data on bed net use, the results will be useful to develop locally specific teaching materials on malaria prevention. This preventive focus is potentially more sustainable than clinical services for malaria treatment. Although we were not able to demonstrate that our work is sustainable, our study shows that volunteer groups are capable of undertaking research that is relevant to their service area.

Building clinical practice in the Palestine Red Crescent operation theatres in Lebanon: reflections from the perspective of an expatriate nurse

AIM

This paper, based on the experience of the first author as an expatriate nurse, aims to describe and discuss some aspects of collaboration that contributed to the building of clinical practice when implementing an operating theatre programme in the Palestine Red Crescent Society (PRCS) hospitals in Lebanon.

BACKGROUND

The operation theatre programme lasted for 8 months: 6 months in 2008 and 2 months in 2009. The programme was part of the partnership project 'Quality of care in the five PRCS hospitals in Lebanon' between the International Committee of the Red Cross and the PRCS Lebanon (PRCS-L) branch.

FINDINGS

The essential aspects that may have contributed to the building of clinical practice in the operation theatre programme included the expatriate nurse and the Palestine Red Crescent operating theatre nurses working together over time as colleagues, the socio-cultural pedagogic perspective selected for the implementation and the collaboration with the management of the hospitals and counterparts in the PRCS-L branch. One should also note the human and structural issues that seemed to influence the implementation of the programme in a more negative way.

CONCLUSIONS

This experience may provide insight for other nurses into the importance of working as colleagues, selecting an appropriate pedagogic perspective and establishing productive collaboration with all partners when building clinical practice during a humanitarian mission.

A comparative study of Taiwan's short-term medical missions to the South Pacific and Central America

Background

Taiwan has been dispatching an increasing number of short-term medical missions (STMMs) to its allied nations to provide humanitarian health care; however, overall evaluations to help policy makers strengthen the impact of such missions are lacking. Our primary objective is to identify useful strategies by comparing STMMs to the South Pacific and Central America.

Methods

The data for the evaluation come from two main sources: the official reports of 46 missions to 11 countries in Central America and 25 missions to 8 countries in the South Pacific, and questionnaires completed by health professionals who had participated in the above missions. In Central America, STMMs were staffed by volunteer health professionals from multiple institutions. In the South Pacific, STMMs were staffed by volunteer health professionals from single institutions.

Results

In comparison to STMMs to Central America, STMMs to the South Pacific accomplished more educational training for local health providers, including providing heath-care knowledge and skills (p<0.05), and training in equipment administration (p<0.001) and drug administration (p<0.005). In addition, language constraints were more common among missions to Central America (p<0.001). There was no significant difference in the performance of clinical service between the two regions.

Conclusions

Health-care services provided by personnel from multiple institutions are as efficient as those from single institutions. Proficiency in the native language and provision of education for local health-care workers are essential for conducting a successful STMM. Our data provide implications for integrating evidence into the deployment of STMMs.

Challenges in sharing knowledge: reflections from the perspective of an expatriate nurse working in a South Sudanese hospital

AIM

This account, based on the experience of the first author, aims to describe an example of practice from a hospital in South Sudan. The example illustrates a cross-cultural encounter and the challenges that a Sudanese nurse and an expatriate nurse face in sharing knowledge when providing patient care.

CONTENT

The constructed practical example between nurses with different knowledge bases and experiences was characterized by the expatriate nurse giving her instructions and not allowing the Sudanese nurse to respond to them. This 'one-way' communication demonstrated that the expatriate nurse considered herself to have the better knowledge of nursing care. These aspects of the encounter formed the basis for the following discussion, which sheds light on how the expatriate nurse ideally could have worked by using a dialogue instead of one-way communication. The importance of having knowledge and understanding of the context in cross-cultural encounters was also emphasized.

CONCLUSIONS

The discussion of this practical example can provide insight for other nurses when working in cultures other than their own into the importance of using a dialogue when sharing knowledge in a cross-cultural encounter. In addition, expatriates can be made aware of the importance of acquiring knowledge about the context for 'the other' when working cross culturally. Finally, it should be noted that the description and discussion of the experience reflect only the perspective of the expatriate nurse.

Perceptions and efficiency of short-term medical aid missions among key groups of health professionals

This study investigated the perceptions of short-term assignments of medical services among participating health care professionals dispatched from Taiwan to underdeveloped areas. Structured questionnaires were mailed to four groups of professionals (physicians, pharmacists, nurses, and public health personnel) who had participated in any of 88 medical missions dispatched to 24 allied nations. A total of 278 returns were valid for analysis. Among them, 222 respondents reported that they had participated in just one overseas medical mission (79.9%). The majority of physicians, pharmacists, and nurses listed humanitarianism as their foremost incentive for participation. In contrast, public health personnel most frequently reported that they had been assigned to the mission abroad. Pharmacists, nurses, and public health personnel most commonly stated that their top goal was health care; but physicians said that aiding Taiwan's diplomatic relations was their main motive. While all groups generally recognized language proficiency and cultural awareness as important for conducting successful short-term medical aid missions (STMMs), many members of groups did not rate their own capabilities in those area as sufficient, especially pharmacists (p < .001). Orientation for participants and training for local health workers were seen as relatively insufficient. In conclusion, there are considerable differences in the thoughts about STMMs across four key groups of heath personnel. The findings can help inform efforts to integrate evidence into the deployment of STMMs.

Core principles for developing global service-learning programs in nursing

Global service-learning enables nursing to develop its role in promoting global health and enabling vulnerable and marginalized global communities to develop their own capacity for growth and development. Global service-learning requires good planning that is based on sound best-practice principles. Drawing on the growing body of literature on service-learning, the authors outline and discuss seven key principles that can usefully guide global service-learning. These are: are compassion, curiosity, courage, collaboration, creativity, capacity building, and competence. These principles can form the basis for ethically sound program development, offer a means of standardizing program development, and provide common criteria with which to evaluate a program's success.

Patterns of community relationship: nurses, non-governmental organizations and internally displaced persons

BACKGROUND

Internally displaced persons (IDPs) are one of the largest at-risk populations in the world. Nurses provide health services to IDPs as staff of non-governmental organizations (NGO). IDPs are also employed to deliver NGO services. The way that NGOs and field staff (nurses and others) interact with employed IDPs can enhance or diminish IDP quality of life.

AIM

This report describes patterns of relationships in a community formed by an American NGO, its field staff and IDPs as they worked together in a refugee camp at the Thai-Cambodian border over 13 years.

METHODS

This qualitative case study describes relational patterns from the NGO perspective. Content analysis was used to process data from in-depth interviews with organizational leaders (n = 4) and organizational documents (n = 234).

FINDINGS

A health care training and service mission, carried out between an NGO, its field staff and IDPs, was based on a philosophy that turned programme activity and authority over to IDP staff. Over 400 IDPs, assisted by 235 field staff, delivered effective health care to 85,000 people over 13 years.

CONCLUSIONS

Work-centred relationships between NGOs, field staff and IDPs are significant; they can be consciously created to promote effective, autonomous IDP management of health care.