STMs Organizing 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 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