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Host Country Regulation of Short‑Term Medical Missions: Evidence from Three Countries
Globally there is a grown concern about the ethics and effectiveness of short-term global health activities, also known as short-term medical missions (STMMs). Guidelines for better practices have been developed exclusively by organizations in the Global North, with no mechanisms to enforce and monitor any of these.
The goal of this study is to analyze regulations in three host countries where such STMMs take place.
Researchers from Ghana, Uganda, and Guatemala were recruited to investigate regulations affecting STMMs. Interviews were performed with 129 participants, including policymakers, health services staff and administrators, patients, and community leaders. Data was analyzed using NVIVO and R Package for Qualitative Analysis, having as the foundation grounded theory and sentiment analysis for identification of patterns in responses.
In all three countries, there are regulations regarding the practice of health care generally, as well as governing the importation of medications, but these are rarely enforced when it comes to STMMs, and many participants were unaware of them. In Ghana and Uganda, there is no specific regulation for STMMs. In Guatemala, specific and detailed regulations do exist governing the practice of STMMs, but participants did not report awareness of these regulations.
The lack of explicit regulation of STMMs in some countries and the lack of enforcement of existing professional regulations and rules on importation of medications can easily be exploited by those volunteers who prefer not to follow them. All three countries studied do have procedures to be followed by any person who intends to perform STMMs.
Journal Article
Short-Term Medical Service Trips: A Systematic Review of the Evidence
Short-term medical service trips (MSTs) aim to address unmet health care needs of low- and middle-income countries. The lack of critically reviewed empirical evidence of activities and outcomes is a concern. Developing evidence-based recommendations for health care delivery requires systematic research review. I focused on MST publications with empirical results. Searches in May 2013 identified 67 studies published since 1993, only 6% of the published articles on the topic in the past 20 years. Nearly 80% reported on surgical trips. Although the MST field is growing, its medical literature lags behind, with nearly all of the scholarly publications lacking significant data collection. By incorporating data collection into service trips, groups can validate practices and provide information about areas needing improvement.
Journal Article
Charitable Platforms in Global Surgery: A Systematic Review of their Effectiveness, Cost-Effectiveness, Sustainability, and Role Training
Objective
This study was designed to propose a classification scheme for platforms of surgical delivery in low- and middle-income countries (LMICs) and to review the literature documenting their effectiveness, cost-effectiveness, sustainability, and role in training. Approximately 28 % of the global burden of disease is surgical. In LMICs, much of this burden is borne by a rapidly growing international charitable sector, in fragmented platforms ranging from short-term trips to specialized hospitals. Systematic reviews of these platforms, across regions and across disease conditions, have not been performed.
Methods
A systematic review of MEDLINE and EMBASE databases was performed from 1960 to 2013. Inclusion and exclusion criteria were defined
a priori
. Bibliographies of retrieved studies were searched by hand. Of the 8,854 publications retrieved, 104 were included.
Results
Surgery by international charitable organizations is delivered under two, specialized hospitals and temporary platforms. Among the latter, short-term surgical missions were the most common and appeared beneficial when no other option was available. Compared to other platforms, however, worse results and a lack of cost-effectiveness curtailed their role. Self-contained temporary platforms that did not rely on local infrastructure showed promise, based on very few studies. Specialized hospitals provided effective treatment and appeared sustainable; cost-effectiveness evidence was limited.
Conclusions
Because the charitable sector delivers surgery in vastly divergent ways, systematic review of these platforms has been difficult. This paper provides a framework from which to study these platforms for surgery in LMICs. Given the available evidence, self-contained temporary platforms and specialized surgical centers appear to provide more effective and cost-effective care than short-term surgical mission trips, except when no other delivery platform exists.
Journal Article
Brain Gains: a literature review of medical missions to low and middle-income countries
Background
Healthcare professionals’ participation in short-term medical missions to low and middle income countries (LMIC) to provide healthcare has become common over the past 50 years yet little is known about the quantity and quality of these missions. The aim of this study was to review medical mission publications over 25 years to better understand missions and their potential impact on health systems in LMICs.
Methods
A literature review was conducted by searching Medline for articles published from 1985–2009 about medical missions to LMICs, revealing 2512 publications. Exclusion criteria such as receiving country and mission length were applied, leaving 230 relevant articles. A data extraction sheet was used to collect information, including sending/receiving countries and funding source.
Results
The majority of articles were descriptive and lacked contextual or theoretical analysis. Most missions were short-term (1 day – 1 month). The most common sending countries were the U.S. and Canada. The top destination country was Honduras, while regionally Africa received the highest number of missions. Health care professionals typically responded to presenting health needs, ranging from primary care to surgical relief. Cleft lip/palate surgeries were the next most common type of care provided.
Conclusions
Based on the articles reviewed, there is significant scope for improvement in mission planning, monitoring and evaluation as well as global and/or national policies regarding foreign medical missions. To promote optimum performance by mission staff, training in such areas as cross-cultural communication and contextual realities of mission sites should be provided. With the large number of missions conducted worldwide, efforts to ensure efficacy, harmonisation with existing government programming and transparency are needed.
Journal Article
Host Country Views of Short-Term Medical Missions: Community-Based Research in Ghana, Uganda, and Guatemala
Growing attention to the proliferation of short-term medical missions (STMMs) in the Global South has increasingly taken the form of critiques of inadequately prepared volunteers, lack of community control and continuity. In response, scholars and practitioners in high-income countries have created guidelines for best practices. These have rarely incorporated the views of host community members and leaders. While research has begun to address what host countries want from STMMs, these projects have also been carried out almost exclusively by scholars from the Global North.
The aims were to provide additional insights into host views in three countries that are frequent destinations for STMMs and to explore the possibility that design and direction by host country researchers would yield new perspectives.
Scholars from Ghana, Uganda, and Guatemala designed and directed studies of medical staff, public officials, and patients from multiple locations around each country. Interviews and focus groups were carried out with a total of 129 people.
All three studies found widespread appreciation of STMMs for providing needed medical services. In Ghana and Guatemala, language differences were cited as a major barrier, while Ugandan participants criticized volunteers' lack of skills and mismatch between their expertise and community needs. Ghanaian and Ugandan participants voiced resentment of patients' preference for white volunteers and the arrogance of some visitors. The amount of time and effort required to host was a common theme.
The findings confirm the importance for STMMs of understanding the local health context and language and working collaboratively and respectfully with hosts. Direction by host country researchers enhanced the value in several ways, including access to officials and establishment of trust with interviewees.
Journal Article
Medical students’ experience and learning outcomes of overseas community involvement project: a qualitative study
Background
Medical students in Singapore engage in short term medical missions, locally known as Overseas Community Involvement Projects (OCIPs). Little is known about the learning outcomes of an OCIP and how this complements their medical education back home. Understanding this can help the medical educators structure the OCIP to optimise its learning value.
Objectives
This study aims to gain an in-depth understanding of the experiences and learning outcomes of the medical students who participated in the OCIP.
Methods
This was a qualitative study involving Singaporean students from one medical school travelling to Nepal. Data was collected from reflective journals, overall group reflections and two focus group discussions. The data was thematically analysed using the Accreditation Council for Graduate Medical (ACGME) core competencies for medical professionals.
Results
The data could be classified under various themes within the six domains of the ACGME framework. The study revealed themes of: humanism, socioeconomic and cultural determinants of health under the domain of patient care, application of medical knowledge, investigating and evaluating the needs of a population and feedback to drive improvement under the domain of practice-based learning and improvement, use of non-verbal cues and communicating across language barriers under the domain of interpersonal and communication skills, healthcare systems and delivery, resourcefulness and adaptability, health equity and accessibility under the domain of systems-based practice, ethics, role-modelling, teamwork and leadership skills, interprofessional skills and resilience under the domain of professionalism. Understanding the students’ motivations, utilising reflections, and following the patients’ journey facilitated attainment of these outcomes.
Conclusions
This OCIP experience translated to learning outcomes aligned with the ACGME framework. There is great potential for the experiential learning from a well-structured OCIP to help with personal and professional development and global health education.
Journal Article