STMsOrganizing and involving yourself in trips that will have a lasting impact

Objectives

Identify common errors and misconceptions in STM planning

Identify the key features necessary with a non-surgical STM to make a sustainable and empowering impact

Discuss alternative STM models that have unquestionable long term value

Origin of STMs

Medical missionary work has existed for a long time

1960s-70s STMs began to appear

Currently 100-200 medical mission trips each month from North America

25-30% of these are surgical teams

Why STMs

Healthcare professionals want to help but for a variety of reasons they are unable/unwilling to put forth a long term commitment

Why short term missions

We want to help the less fortunate

We don’t want to live there

We want to make a difference and do something meaningful

What kind of skills do I have and where can I use them?

Can I do it in a short time period?

Is what I do going to make a difference?

Curative approach to STMs

Focus on dispensing of medications

Seeing large numbers of needy patients in a short time period

May not be integrated into ongoing healthcare or community development

Why can’t we keep doing it this way?

Harm from medications

Harm from medications

We should be more cautious and reluctant to give medications in a foreign land than in the US

Patients are at much greater risk of serious harm from drugs in the STM setting

Lack of knowledge of the patient

They are not known to us No medical records No med list No allergy records No list of medical conditions Our lack of knowledge of traditional

meds

Limited time/facility for complete H&P

Lack of lab testing

Lack of access to emergency care should a complication arise

Limited use of child safe containers

Confusion due to language and cultural differences

Patients and local health workers lack familiarity with our medication adverse effects

Lack of adequate time for counseling by physician or dispensary

Lack of availability of follow up

Emphasis on meds leads our patients to over-value them

Our meds may be sold on the “black market”

Why can’t we keep doing it this way?

Harm from medications

Curative focused STMs provide a poor teaching example for US students and are a poor example to local healthcare providers

A double standard?

Would we give a mother medication in a non-child safe container in the US?

Would we allow students/lay people to act as pharmacists or other healthcare professionals in the US?

Are we teaching our students that it’s OK to cut corners in patient care or patient safety?

Why can’t we keep doing it this way?

Harm from medications

Curative focused STMs provide a poor teaching example for US students and are a poor example to local healthcare providers

Providing relief when development is needed causes harm

Approach to helping- Relief

Essential to the well-being of a community in times of disaster

Providing a service that the local community does not have to work/pay for

A service that otherwise would not be provided from local resources

What happens when relief is provided in a time of stability

Paternalism

Dependency

Lack of ownership

Decreased self worth

Decreased creativity, ingenuity and problem solving

Increased apathy

What is development

Taking the resources from within the community and capitalizing on them

Building relationships to find out what skills and resources are available

Empowering the community to meet the needs that are present

NOT doing things for the community that they could do themselves

Building a foundation

Find a local healthcare provider(s) willing to work with your team and help direct it

Locate all health services in the local region and invite them to participate

Meet with community health leaders and learn their community health goals and direct your efforts towards meeting these

All of this is hard work, but NECESSARY

Maintain a listening and learning perspective

Encourage the health workers and promote the local health work to community members

Focus on long term and sustainable outcomes

Be knowledgeable of WHO standards

Key areas

HIV/AIDS Maternal mortality Infant/pediatric mortality

Education

Talk with the local health providers

What do they know

What does the local community know

What has been done already

What are the current educational needs?

Learn about them and their community

Understand worldview

Health fair

General or focused

Chart growth, identify undernourished children

Have villagers tell you where home visits could be needed (immobile patient)

Prenatal care and infant care education

Child vaccine education

Dental hygiene

Health fair

BP and glucose measuring and documenting

HIV testing/counseling

HIV anti-stigma education

Optical programs

Traditional STM Conclusions

Local healthcare providers should be involved and care integrated with ongoing healthcare

Shift STM focus away from dispensing medications and towards education/disease prevention

Community ownership and empowerment should be a key consideration in planning

Emphasis on pregnancy, HIV, and children

Consider utility of the health fair model

Alternative short term options

Become involved in development

Relieve a long term medical missionary

STMs in surgical specialties

Teaching opportunities

Become involved in disaster relief

How to find out more?

Attend conferences

Inmed.us

Kansas City May 31-June 1

Louisville, KY each November

International section of specialty organizations

What is poverty

Lack of material resources

Oppressive relationships

Unjust government systems

Lack of opportunity

References

When Helping Hurts, how to alleviate poverty without hurting the poor…and yourself -Steve Corbett and Brian Fikkert, 2012

Operating Responsible Short-Term Healthcare Missions-Gregory and Candi Seagar, 2010

Harm from Drugs in Short-Term Missions-Arnold Gorske, 2009