Guidelines for short-term medical missions: perspectives from host countries

Machines matter too: including biomedical engineering partnerships in global health initiatives

As the global burden of disease shifts from communicable to non-communicable diseases and trauma-related debility, the global health-care community has increasingly advocated for equitable access to surgical services. Much of this attention has focused on bolstering clinical and research expertise through the expansion of clinical training programmes and research resources. However, despite the crucial role of equipment, including medical devices, in safe clinical care, comparatively little attention has been paid to sustainably bridging the biomedical and technical gaps that exist in global health. Although closing these gaps with locally driven solutions is the goal, the reality in many settings is that partnerships between institutions in high-income countries and low-income and middle-income countries currently remain necessary. Thus, this Viewpoint provides guidelines conscious to biomedical engineering for institutions looking to expand or begin global health initiatives with the Partners In Health Five S's-staff, stuff, space, systems, and social support-framework for health systems strengthening as a guide. We focus first on initiatives involving staff, stuff, and space, encouraging institutions to ask, listen, and enable, through a set of questions and actionable recommendations. Then, we urge institutions to strengthen systems and social support, underscoring the need for wider societal scaffolding to support and sustain initiatives beyond initial efforts.

A Cosmopolitan Argument for Temporary "Diagonal" Short-Term Surgical Missions as a Component of Surgical Systems Strengthening

We propose an argument for “diagonal” short-term surgical missions as a stop-gap component of global surgical systems strengthening based upon the political justice theory of moral cosmopolitanism

Time trends and advances in the management of global, regional, and national diabetes in adolescents and young adults aged 10-24 years, 1990-2021: analysis for the global burden of disease study 2021

BACKGROUND

Estimation of global diabetes burden in adolescents and young adults (10-24 years) from 1990 to 2021.

METHODS

Data were extracted from the 2021 Global Burden of Disease Study. Joinpoint regression analysis was employed to examine trends over the past 30 years, frontier analysis identified regions with potential for improvement, and the slope index of inequality and the relative concentration index were used to assess health inequalities.

RESULTS

From 1990 to 2021, the age-standardized prevalence rates (ASPR) and age-standardized disability-adjusted life years rates (ASDR) of diabetes in adolescents and young adults increased globally, while age-standardized death rates (ASMR) remained stable. Oceania bore the highest burden regionally, East Asia experienced the fastest rise in ASPR and ASDR, and High-income Asia Pacific saw the most significant decrease in ASMR. Among 204 countries, Marshall Island and Hait reported the highest ASPR, ASDR, and ASMR in 2021. Health inequality analysis confirmed that the burden was concentrated in countries with lower Socio-Demographic Index (SDI). Frontier analysis showed that ASMR and ASDR were negatively correlated with SDI, with Yemen and Honduras, which have lower socio-demographic indices, exhibiting more smaller overall differences from frontier boundaries.

CONCLUSIONS

The analysis revealed a sharp increase in the global ASPR and ASDR of diabetes in adolescents and young adults. Additionally, the disease burden is typically concentrated in countries with lower SDI, highlighting an urgent need for governments to develop flexible health policies to mitigate the escalating threat of diabetes in this demographic.

Global Neurology: The Good, the Bad, and the Ugly

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.

Border Health Training for Family Physicians: Is There a Need and Interest?

BACKGROUND AND OBJECTIVES

The United States-Mexico border has unique health care challenges due to a range of structural factors. Providers must be trained to address these barriers to improve health outcomes. Family medicine as a specialty has developed various training modalities to address needs for specific content training outside of core curriculum. Our study assessed perceived need, interest, content, and duration of specific border health training (BHT) for family medicine residents.

METHODS

Electronic surveys of potential family medicine trainees, faculty, and community physicians assessed appeal, feasibility, preferred content, and duration of BHT. We compared responses from participants from the border region, border states and the rest of the United States in their opinions about modality, duration, content of training, as well as perceived barriers.

RESULTS

Seventy-four percent of survey participants agreed that primary care on the border is unique; 79% indicated a need for specialized BHT. Most border-region faculty were interested in participating as instructors. Most residents expressed interest in short-term rotation experience, yet most faculty recommended postgraduate fellowship. Respondents selected language training (86%), medical knowledge (82%), care of asylum seekers (74%), ethics of cross-cultural work (72%), and advocacy (72%) as the top-five needed training areas.

CONCLUSIONS

Results of this study indicate a perceived need and sufficient interest in a range of BHT formats to warrant developing additional experiences. Developing a variety of training experiences can engage a wider audience interested in this topic; that should be done in a way ensuring maximum benefit to border-region communities.

Impact and Sustainability of Foreign Medical Aid: A Qualitative Study with Honduran Healthcare Providers

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.

Implementing electronic health records on a medical service trip improves the patient care process

Background

The efficiency of the patient care process of short-term medical service trips is often not assessed. The Gregory School of Pharmacy has organized annual medical camps in rural Uganda, however, the paper health records used for documentation and communication between stations have shown several limitations that hinder an optimal patient care process. Therefore, our objective was to implement an electronic health record system in these medical camps to improve the workflow and optimize the patient care process.

Methods

An electronic health record system that functioned over a battery-operated local area network was developed and implemented. Patient health information was entered and reviewed at the different stations using mobile devices. The impact of electronic health records (used in 2019) on the patient care process was assessed using the number of patients served per physician per hour and the number of prescriptions filled per hour and comparing these to paper records (used in 2017).

Results

Electronic health records were successfully implemented and communication across stations was fluid, thus improving transitions. Importantly, 45% more patients were served per physician per hour and 38% more prescriptions were dispensed per hour when using electronic (2019) compared to paper records (2017), despite having a smaller team in 2019.

Conclusion

Implementation of electronic health records in rural Uganda improved the patient care process and the efficiency of the medical camp.