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.

Sustained impact of short-term international medical mission trips: resident perspectives

PURPOSE

To assess perspectives of residents: (1) who participated in short-term international medical mission trips (STIMMTs) as medical students regarding impact of the experiences on their professional development; and (2) who did not participate in STIMMTs regarding barriers to participation.

METHODS

Three hundred seventy-nine residents from 16 programs at two Florida institutions completed surveys requesting Participant and Trip Details and Impact of Participation (including items rating learning, cultural competency, and social responsibility).

RESULTS

One hundred thirty-one residents participated in at least one STIMMT. They identified improved adaptability to new healthcare settings, communication with patients and professionals from different backgrounds, and appreciation for the impact of culture on health as positive outcomes. Leading barriers to STIMMT participation included cost, timing, and lack of availability.

CONCLUSIONS

Years after participation in STIMMTs, residents perceived sustained benefits in cultural competency, communication skills, adaptability, and desire for service. Institutions may consider facilitating STIMMTs as one way to address standards specified by accrediting authorities to provide training in cultural competency, social responsibility, altruism, and understanding the importance of caring for underserved populations. Barriers to STIMMT participation may be reduced through availability of institution-sponsored scholarships, identification of external grant and scholarship opportunities, and coordination of fund-raising activities.

[Ultrasound in East Africa]

Ultrasound is poorly established in East Africa because of missing finances and medical staff. The Foundation for medical know how transfer SmW installed in the last 3 years an ultrasound department in all District Hospitals in the South Province Mombasa in Kenya and was teaching the medical staff 2-3 times an year according the guidelines of SGUM and EFSUMB. The project is based on the idea that knowledge transfer is more efficient than money transfer. The project is supervised by public health studies. The first results show that non physicians are able to perform good quality ultrasound examinations. 75% of the obstetrical and 50% of the abdominal ultrasound examinations show therapy-relevant findings. Ultrasound is going to rise to the position of the most important imagine system in developing countries.

Implementation of an international short-term dental mission

Dental professionals serve across the globe, working to alleviate the pain and suffering caused by dental disease. Many dental professionals serve on international mission trips, yet little has been published in the professional literature to guide dentists in establishing and operating a volunteer dental clinic in an international mission setting on a short-term basis. This article reports on multiple aspects of planning a short-term dental mission trip, including considerations in the selection of an indigenous national partner, concerns regarding the safety of patients and participants, scope of care decision-making, and the requisite equipment and supplies.

Volunteering in Nha Trang, Vietnam: senior medical students' perspectives of a surgical mission trip

Vietnam has had a long history of international mission teams that volunteer needed surgical care to underserved populations for various medical problems. As senior medical students, we joined a non-profit organization's surgical mission trip led by a community practice surgeon and staffed by 32 health care professionals to provide cleft lip and palate reconstructions for 75 patients at a local hospital in Nha Trang, Vietnam. As a surgical mission team in a resource-poor country, we intended to fill gaps and unmet areas of need by offering care that patients would otherwise not receive. But in doing so, we encountered other gaps in health care for which we did not have adequate preparation or solutions: insufficient primary care, lack of understanding of others' cultural contexts, absence of knowledge of patients' socioeconomic contexts, and problems in other countries' health care systems. Although the purpose of our mission was to provide a specific service, we felt it is important to examine the service in the context of these broader issues. We considered these concerns from two different perspectives: what a medical mission gives and what it does not. In this article, we present several issues that our medical mission confronted and how they were both addressed and overlooked.

Surgical missions to developing countries: Ethical conflicts

Each year scores of American physicians and nurses travel overseas, usually at their own expense, aiming to improve the lot of desperate patients in developing countries. Our journals are filled with images of smiling children who have benefited from these gifts of care. Still, practicing medicine, and especially surgery, in a sporadic fashion in distant lands can lead to poor outcomes. It does little to improve public health or advance medical education. We address some of the ethical dilemmas intrinsic to international surgical missions and discuss how we might redirect our resources to provide better care to more people.

Fifty years of Cuba's medical diplomacy: from idealism to pragmatism

Medical diplomacy, the collaboration between countries to simultaneously produce health benefits and improve relations, has been a cornerstone of Cuban foreign policy since the outset of the revolution fifty years ago. It has helped Cuba garner symbolic capital (goodwill, influence, and prestige) well beyond what would have been possible for a small, developing country, and it has contributed to making Cuba a player on the world stage. In recent years, medical diplomacy has been instrumental in providing considerable material capital (aid, credit, and trade), as the oil-for-doctors deals with Venezuela demonstrates. This has helped keep the revolution afloat in trying economic times. What began as the implementation of the one of the core values of the revolution, namely health as a basic human right for all peoples, has continued as both an idealistic and a pragmatic pursuit. This article examines the factors that enabled Cuba to conduct medical diplomacy over the past fifty years, the rationale behind the conduct of this type of soft power politics, the results of that effort, and the mix of idealism and pragmatism that has characterized the experience. Moreover, it presents a typology of medical diplomacy that Cuba has used over the past fifty years.

Educational, personal, and cultural attributes of dental students' humanitarian trips to Latin America

This article evaluates the educational, personal, and cultural attributes that motivate or inhibit dental students' participation in humanitarian and educational trips to underserved communities in Latin America. Interviews, concentrating on students' expectations and experiences, were conducted with students who participated in the trips and with those who did not. A survey of a larger group of students (including those interviewed) was also conducted; the survey included demographic data, ethnic affiliation, cultural competence, motivators and inhibitors to attend trips, and trip attributes. One hundred and seventy-four students at one dental school completed the survey; the group interviews were conducted with twenty-three students who attended humanitarian and educational trips and nine students who did not. This research found that skill development, educational opportunity, and philanthropy were the most important motivators for trip participation. Cost and time commitments were the strongest inhibitors to participate. Exposure to infectious diseases, substandard working and living conditions, threat of crime, and language barriers were mostly considered as "not important." However, female dental students were more concerned than males about crime, living conditions, and infectious diseases during the trips. Cultural education, increased knowledge, cross-cultural professional relationships, increased self-confidence, and public health awareness were the most important attributes of the trips. This study indicates that the undergraduate humanitarian educational trips to underserved Latin American communities have a most significant personal, professional, and social impact on dental students.

A medical tourism primer for U.S. physicians

As healthcare in the United States has been changing rapidly over the past few decades, so has the manner in which healthcare has been provided, billed, and paid for. There is an increasing need for Americans to reach beyond domestic borders to the international community for certain medical procedures, treatment, and care at more affordable costs. This impacts not only consumers and their physicians, but also employers, benefit plan payors, administrators, and other industry stakeholders-including America's hospitals. This article provides a framework for discussion points for physician-patient communications regarding medical tourism.

A Cost Analysis of Training Expenses versus the Value of Medical Care Provided during West Africa Training Cruise 2004: Senegal

A medical civic assistance program (MEDCAP) visit was conducted by naval reservists in eight villages in Senegal, West Africa. More than 6,000 patients were treated by MEDCAP team members. Medical and dental care, eyeglasses, vitamins, medications, educational material, and mass casualty training were provided. Major challenges confronting the mission were to provide care in makeshift clinics in remote villages in an arduous sub-Saharan climate, where more than one-half of the population lacks adequate public health funding to address basic medical and dental needs. To estimate the economic costs and benefits of the mission, as a guide to future planning, we calculated the total costs of the mission and its economic benefits. Total costs were found to be $502,500. We estimated that the monetary value of the medical services provided was $730,090. Additional nonquantifiable value was created through training and development of military and professional partnerships. In a post-September 11 world, the MEDCAP is an important and cost-effective vehicle to advance U.S. foreign policy in a nonthreatening manner. Countless lasting friendships can be won with bandages and medicines.

[A three-year aid program for plastic surgery in Peshawar (Pakistan). Ongoing management of severely injured patients of the Afghanistan war: 1,528 large operations, 5,171 smaller interventions, 15,932 patients examined]

Since 1980 Interplast Germany has sent many plastic surgeons to developing countries. In 1989 a new Interplast Germany program for helping Afghan refugees in Pakistan's Peshawar was started. The Federal Republic of Germany financed the first two years; thereafter, the European Community and Help supported the project. Twenty-four teams with 123 nurses, surgeons and anesthesiologists operated on 1,528 patients in two hospitals. In the same period 5,171 smaller operations have been performed and 15,932 patients have been examined. Low expense for the teams, good support by officials, and professional administration have made this project highly effective for 3 years.

The maturing of MEDRETEs

The Medical Readiness Training Exercise (MEDRETE) is generally regarded as an effective tool for enhancement of U.S. foreign policy in developing nations. However, if MEDRETEs are evaluated with parameters other than emotion, there is found to be little durable effect and virtually no improvement in the health status of the host nation. The classic MEDRETE is ineffective, costly, and provides only an evanescent benefit to the served population. It should be replaced by PMRETEs (Preventive Medicine Readiness Training Exercises) targeting preventive medicine concerns which would provide low-cost, durable contributions to the health status of growing nations.