Medical missions: A therapeutic primer

Short-Term Medical Relief Trips to Help Vulnerable Populations in Latin America. Bringing Clarity to the Scene

Non-profit organizations provide international medical relief trips to low/middle-income countries (LMIC) in order to provide healthcare to medically underserved areas. Short-term medical relief trips (STMRT) take a large amount of time and resources, and arouse concerns about their actual effectiveness. Here we develop a novel tool for consistently assessing how U.S. organizations provide primary care to Latin America through short-term medical relief trips. First, in Part 1, we create a “Best Practice” (BP) framework focused on the efficacy, sustainability, and long-term impact of the organizations based on a review of the last 27 years of available literature published in peer-reviewed journals. Second, in Part 2, out of 581 total medical relief organizations in the US, we identify the 19 organizations currently providing short-term primary care services to Spanish-speaking countries in Latin America. We use the BP framework to analyze the website content and secondary sources of these 19 organizations. We find that only three of the 19 organizations met 80% or more of the criteria defining BP according to the framework and four out of the 19 did not perform well in any of the framework’s three aspects of efficacy, sustainability, and long-term impact. Because there exists no current standardized way of assessing the methods implemented and services offered by STMRT, we provide suggestions about using this novel framework as a self-assessment tool for STMRT organizations.

A systematic review of social, economic and diplomatic aspects of short-term medical missions

BACKGROUND

Short-term medical missions (STMMs) represent a grass-roots form of aid, transferring medical services rather than funds or equipment. The objective of this paper is to review empirical studies on social, economic and diplomatic aspects of STMMs.

METHODS

A systematic literature review was conducted by searching PubMed and EBSCOhost for articles published from 1947-2014 about medical missions to lower and middle income countries (LMICs). Publications focused on military, disaster and dental service trips were excluded. A data extraction process was used to identify publications relevant to our objective stated above.

RESULTS

PubMed and EBSCOhost searches provided 4138 and 3262 articles respectively for review. Most articles that provide useful information have appeared in the current millennium and are found in focused surgical journals. Little attention is paid to aspects of volunteerism, altruism and philanthropy related to STMM activity in the literature reviewed (1 article). Evidence of professionalization remains scarce, although elements including guidelines and tactical instructions have been emerging (27 articles). Information on costs (10 articles) and commentary on the relevance of market forces (1 article) are limited. Analyses of spill-over effects, i.e., changing attitudes of physicians or their communities towards aid, and characterizations of STMMs as meaningful foreign aid or strategic diplomacy are few (4 articles).

CONCLUSIONS

The literature on key social, economic and diplomatic aspects of STMMs and their consequences is sparse. Guidelines, tactical instructions and attempts at outcome measures are emerging that may better professionalize the otherwise unregulated activity. A broader discussion of these key aspects may lead to improved accountability and intercultural professionalism to accompany medical professionalism in STMM activity.

Organizing a dermatology service mission

BACKGROUND

There are few published guidelines that describe the forethought and logistical considerations needed to create a dermatology-specific medical mission.

OBJECTIVE

To report the experience of planning and executing a successful medical mission to an underserved community in Puerto Rico.

METHODS

We identified an area of need and projected the volume of patients and diseases to be treated. After recruiting medical staff, pharmaceutical and surgical supplies were collected. Important concerns included establishing the scope of medical and educational services to be rendered, advertising the clinic, arranging for biopsy processing, ensuring follow-up, and selecting a method for medical documentation. We tracked the number of patients seen, diagnoses made, and materials used to prepare for future missions.

RESULTS

We recruited 12 physicians and 25 ancillary (i.e. nonlicensed physician) staff members, including: six dermatologists, four internists, one pathologist, one psychiatrist, 23 medical students, and two medical assistants. We secured 12 examination rooms in an existing medical facility. Two pharmaceutical companies and two pathology companies provided the medications and surgical supplies with the remainder coming from the volunteer physicians' offices. Three thousand dollars were raised and used toward purchasing additional supplies. Advertising via public announcements resulted in the attendance of 166 patients during the 1-day clinic. A total of 41 procedures were performed, including 14 biopsies, five excisions, three incisions and drainage, and 19 electrodessications and curettage.

CONCLUSION

Proper planning is critical in creating a successful dermatology mission. Documenting the care given and supplies used helps to identify needs and optimize limited resources for future missions. The goal of a self-sustaining public health service starts with patient education and coordination with the local healthcare providers.