A Protocol to Develop Practice Guidelines for Primary Care Medical Service Trips

A qualitative narrative review of protocols for women's health on short-term medical missions in Latin America and the Caribbean

BACKGROUND

Women's health conditions are commonly encountered on short-term medical missions (STMMs) in Latin America and the Caribbean. There have been no previous attempts to describe women's health protocols used by volunteer clinicians. This qualitative study aimed to describe areas of agreement between unpublished women's health protocols from different North American STMM organizations and assess their concordance with published WHO guidelines.

METHODS

A systematic web search was used to identify North American STMM sending organizations. Clinical protocols were downloaded from their websites and organizations were contacted to request protocols that were not published online. The protocols obtained were summarized, analysed thematically and compared to existing WHO guidelines.

RESULTS

Of 225 organizations contacted, 112 (49.8%) responded and 31 of these (27.7%) had clinical protocols, of which 20 were obtained and analysed. Nine (45%) discussed sexually transmitted infections, six (30%) discussed pelvic inflammatory disease, two (10%) discussed prenatal care and two (10%) discussed menstrual disorders. None were the product of systematic literature searches and most were not referenced.

CONCLUSIONS

To avoid ineffective treatment and related harms to women, volunteer clinicians would benefit from the adaptation and distribution of guidelines for STMMs that are based on existing WHO guidance and acceptable to clinicians, patients and organizations.

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

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.

Using a Health Equity Lens to Evaluate Short-Term Experiences in Global Health (STEGH)

Background:

The growing popularity of short-term experiences in global health (STEGH) has given rise to increasing criticism around their purported benefits and outcomes. With the global health and development community’s growing focus on improving population health and equity worldwide as outlined in the United Nation’s Sustainable Development Goals, there is a growing opportunity to examine and optimize the conduct of STEGH using an outcomes and equity focused lens.

Objectives:

This viewpoint aims to develop a framework that can be used to plan and evaluate STEGH on outcomes underpinned by a health equity focus.

Methods:

Drawing on logic model theory, the analysis first identifies extant issues and their drivers around the planning, implementation, and evaluation of tradition STEGH (focused on clinical service provision.) The analysis then explores various definitions of health equity, settling on a broad definition around context that promotes health for all as opposed to equity of access to healthcare services. With that definition as the ultimate benchmark of success, the analysis then proposes questions that can be used to determine how and when a STEGH might best be deployed to meet that goal.

Findings:

Traditional reliance on process outputs from service-based approaches have historically limited an understanding of if and how STEGH might advance health equity. Using an outcomes-focused approach identifies critical questions around the value of such experiences, when weighed against a broad definition of equity and other key global health themes such as sustainability, cultural humility, and impact. Measuring STEGH against the goal of improving population health status and equity worldwide allows careful consideration of the appropriateness and effectiveness of such efforts on their own and in concert with other interventions.

Conclusions:

The extent to which health equity is advanced should be the ultimate metric used to evaluate not only STEGH, but any global health endeavours.

A narrative review of dermatologic protocols for primary care medical service trips in Latin America and the Caribbean

BACKGROUND

Skin disorders are prevalent on primary care medical service trips in Latin America and the Caribbean and commonly include scabies, superficial mycoses, and pyoderma. There have been no previous attempts to describe protocols that international volunteer clinicians use in managing these patients. The purpose of this study was to collect North American clinical protocols used by sending organizations in their volunteer operations in Latin America and the Caribbean, summarize the most common pharmacologic and nonpharmacologic management strategies, and compare these to published international practice recommendations.

METHODS

A systematic web search was used to identify North American medical service trip-sending organizations. Clinical protocols were downloaded from their websites, and organizations were directly contacted to request protocols that were not published online. The protocols obtained were summarized, analyzed thematically, and compared to existing international guidelines.

RESULTS

Of 225 organizations contacted, 112 (49.8%) responded, and 31 of these (27.7%) claimed to possess protocols for their trips, of which 20 were obtained and analyzed. Ten (50%) protocols discussed scabies, eight (40%) discussed superficial mycoses, and five (25%) discussed pyoderma. The protocols discussed clinical assessment, pharmacologic and nonpharmacologic management with variable degrees of accuracy and thoroughness, and with important omissions when compared to international guidelines. None were the product of systematic literature searches, and most were not referenced.

CONCLUSIONS

To avoid ineffective treatment and related harms, context-specific clinical guidelines are needed for volunteer clinicians practicing in remote international settings, and such guidelines should be based on best evidence and stakeholder consensus.