Humanitarian medical missions form an integral part of reaching out to undeserved and vulnerable population groups.
Poor people have significant difficulties accessing good quality health care, especially in low- and middle-income countries. Effectively addressing the health needs of the poor is essential to improving the health of the population.
Humanitarian medical missions are an integral part of reaching underserved and vulnerable populations. Health teams carry out medical missions, the most common scenario being the delivery of direct health care from high-income countries to low- and middle-income countries. The US, UK, Canada and Australia are the source of most medical missions from high-income countries. Cuba is a notable example of a low-income country that has been the source of medical missions. For the most part, these missions are short-term and usually defined as lasting less than a year. Most of these medical missions last one day to four weeks (about 74 percent of the total). There is a wide range of medical and surgical care performed with varying degrees of complexity from primary care visits to cardiac/neurosurgical procedures. It is believed that the number of these medical missions has increased over time, but this remains an area that has been poorly researched, not only in terms of frequency, but also in terms of the quality of care provided and the impact on health – the care system in the recipient countries.
Benefits of medical missions to society
A clear advantage of medical missions is the direct recipients of the medical care. Medical missions generally take place in low- and middle-income countries (both in rural and urban settings) where a significant portion of the population is unable to access health care. The difficult access can be related to several factors, but poverty and low socio-economic status play a key role. The recipients of medical missions often gain access to treatment that is not available to them otherwise, or that may require a longer waiting time in trying to access the local health system. This delay in access to care often results in disease progression and excessive morbidity and mortality. In addition to the care provided, medical missions will sometimes provide medicine and equipment (eg, glasses, canes, syringes) to these patients. Studies have shown that apart from direct medical care, these visits have other less quantifiable benefits to society. These include feeling that people outside the community have an interest in their well-being, recognition of the circumstances of their lives, and feelings of increased hope for the future.
Benefits of Medical Missions for Providers
Several studies have looked at the motivation and rewards of doctors, nurses and support staff participating in medical missions. Not surprisingly, a common motivation is altruism. Most doctors and nurses enter the profession not primarily for financial rewards and status, but to alleviate suffering and to help patients achieve healthy lifestyles. The ability to help people who are truly poor (many times in ways that people in high-income countries can’t imagine) and who have no other access to the care they provide is often its own reward. Doctors and nurses are also excited about a simpler practice of medicine, free from the administrative, billing and charting tasks that make up an increasing part of the clinical workload. There is also the ability to see and treat diseases that are uncommonly seen or that are advanced due to the absence of early diagnosis and treatment. This has been cynically referred to in some circles as “surgical or medical tourism”.
Benefits for local health care providers and local health systems
Medical missions, if integrated with local health providers and facilities, can result in skills transfer for the benefit of the low/middle income country. A common example is a visiting surgeon who operates with and supervises a local surgeon. At the end of the medical mission, there is now an increase in human capital that would not have happened otherwise. Often there may be an opportunity to carry out educational outreach for both general practitioners and for local health organisations. Facilities will often receive scarce medical equipment or disposables that are either not available locally or only at prohibitive costs. There is also an opportunity to develop links between local health personnel/facilities with organizations in the developed world. These connections can often be leveraged to the benefit of the local facility. For example, they can result in additional medical missions, donations of equipment or money, telehealth opportunities, and opportunities for local doctors/nurses to receive training in the developed world. For governments that lack sufficient fiscal resources to provide health care, especially that which requires newer technology or simple primary care in rural areas, medical missions can be a welcome addition to local health care.
Medical missions have been used as a tool of diplomacy and influence by several countries. This can occur in the context of natural disasters, but is often a strategy used to develop relations between nations. Cuba, although a low-income country, has used its surplus of doctors and nurses to form relationships with other low- and middle-income countries. The United States, through its military, has also sent medical missions to less developed nations. However, it should be noted that most medical missions are suspected to originate from the non-governmental sector and appear to be “grassroots” efforts as opposed to being managed by governments. Medical education also appears to benefit from medical missions, although it is unclear how widespread this practice is. A study from 2002 showed that 40 percent of English medical students had gone on a medical mission during their education. Another study noted that 41 percent of orthopedic residents who trained at the University of California, San Francisco had been part of a medical mission. There is potential for medical education in low- and middle-income countries to benefit from skills transfer and exposure to a medical culture that is less affected by resource constraints and has access to newer technology.
There are tangible benefits to medical missions, especially when integrated with local health care. However, there are many questions about the magnitude of the benefits for the low- and middle-income country, especially in the long term in the absence of sustainable local infrastructure and human capital to continue to deliver quality care. As time has passed, it has become clear that there can be significant downsides to medical missions, and a current topic of much debate is how these downsides can be ameliorated and whether other avenues can be considered to improve access to healthcare in low- and middle-income countries. We will use our article next week to explore these issues.
The Heart Institute of the Caribbean and HIC Heart Hospital will host a four-day humanitarian medical mission from 26-30 October to provide care for the poor. Those interested can contact the office at 876-906-2105 to 2108 to register.
Dr. Ernest Madu, MD, FACC and Dr. Paul Edwards, MD, FACC is a consultant cardiologist for the Heart Institute of the Caribbean (HIC) and the HIC Heart Hospital. The HIC is the regional center of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Welfare and is the only heart hospital in Jamaica. Send correspondence to [email protected] or call 876-906-2107.