For those really interested or considering a medical mission, I would again strongly suggest reading the
thread linked to previously, as a lot of these same issues are fleshed out there.
It's always been interesting to me that it seems that whenever this topic comes up its customary 3-4 times a semester/summer, the vast majority of those in favor are those that have gone or are planning to go, and those that are against it (usually equally strongly so) are those that have not gone and have no intention of going. [...] Similarly, I have very very rarely seen the situation where someone that hasn't been able to go on one of these trips still feels that it's a great opportunity and a productive use of one's time.
Those who think medical missions are good ideas but haven't been on one probably don't have much to say about it on SDN – those with strong and extreme opinions tend to pipe up more in any forum. Most of the people I know or have seen post on SDN threads who question the effectiveness and/or ethics of medical missions are those who have spent significant time in "medical mission" receiving countries. I haven't been following these threads on SDN for all that long, but I think these people (and their concerns) can be differentiated from those that express personal concerns of costs or preference to work in U.S. communities, etc. This has nothing to do with "5 years abroad is better than 1 yr is better than 3 months is better than 10 days" but rather, comes from the nuanced perspectives gained over significant time in the country in question -- politics, government, culture, medicine, health systems, beliefs, development (the list goes on) -- and north-south and intercultural dynamics more generally (or west-rest or developed-developing, whatever binary terminology one prefers, as long as we are forcing ourselves into a binary nomenclature). These perspectives most often come after living long-term in a poorer "medical mission" receiving country, though it is certainly possible to question medical missions on these grounds without that experience, it just appears to be less common. This is also not to say that all Americans or Canadians or rich westerners living long-term in poor countries share these views. I think most importantly, after long-term stays and developing such perspectives, one of the strongest impression that one comes away with is, often, how much one still has to learn about said country. The perspectives gained, questioning of self and world, and recognition of how little you know, are among the reasons I think spending time outside of your country can be a highly rewarding and "life changing" experience – the value is NOT necessarily in directly "helping the poor" or "doing something is better than nothing" or "gaining experience" but rather in the long-term impact in your life and how that influences what you do and how you go about doing it. But such experiences should not be sought at the expense of the health of the countries visited.
Your post reveals what the adcom is to think when she sees that a student participated in a medical mission- this applicant is incapable of deciphering productive from unproductive, helpful from unhelpful. What makes this disheartening, is that you will not be familiar with the details of the trip, and, in all likelihood, not bother to research what actually occurred on the medical mission.
Given the only scant attention medical missions have been given in the literature, I wonder how many ADCOMMs would think poorly of any and all medical missions? Perhaps someone could comment on this, as I am just speaking from what I have observed among the general health care sector--as another poster mentioned, lots of MDs, nurses and others go on such trips--but ADCOMMs are regular people too! Many might have concerns about appropriate supervision/activities for students and pre-departure preparation, as these are issues that are beginning to be more thoroughly discussed and addressed in medical schools and in the literature, but I wonder if a blanket disapproval of all medical mission trips is common? I think it'd be useful to hear from some more ADCOMMs about this here. If an applicant is concerned about these issues and believes that their health-related activity in a developing country (short term mission or other type) was particularly well designed and executed and addressed the ethical issues at question here, then they could mention these details in the EC description. Certainly some groups, such as Shoulder to Shoulder, have been cited often as examples of better models.
I think the justification is that the cash is your contribution to the mission. [...] most of what you're giving in exchange for your changed perspective and resume enhancement is the money that buys the manpower and materials that gets the work done. The challenge, of course, is verifying that that's where the money actually goes.
It would be great if this were the case. Even if the money goes to the right place, as Perrotfish rightly questions, these schemes set up dependency that in my opinion is far worse than the same questions one might have about welfare programs in developed countries, because the communities served are far more vulnerable, marginalized, and have less agency and resources to wield on their own behalf. (see post #59 and beyond of the above thread for much more eloquent discussions of this). But all things being equal (which they most certainly are not) and if dependency is not created (jury is out for any particular trip given the lack of program evaluation and long-term research), the inefficiency of this form of resource delivery is breathtaking. Number crunching alone won't answer this – I think an important point of this entire discussion of medical missions is that healthcare in any society, much less in extreme poverty in a society foreign to us, is far more complex than we can imagine. But to give a crude example: the cost of airfare for one person on a medical mission could probably pay for a full-time physician in a rural health center for 2-5 months in most places. This is just a math game, plenty of other non-monetary factors play into staffing that health center, but there are certainly plenty of great organizations that can use that cash to the benefit of the public health somewhere. To give another example of inefficiency, donated supplies are more often than not (so I am told by those that work in this field) not worth the energy and admin costs of getting them through customs (this obviously varies a lot by country), then to where they need to go (transportation networks are not what one would expect in rich countries), and properly utilized. This is the case when, for instance, meds are close to expiring, donated supplies have no basis in actual needs or capacity for utilization, involve equipment that cannot be maintained or supplies that cannot be obtained in country, etc. Most Ministries of Health do not have the resources to keep tabs on the dozens of foreign medical groups/supplies that arrive weekly, although some do try. In a pediatric hospital where I work there is an entire room packed floor to ceiling with brand-new-in-the-box donated toys. Fisher Price play kitchen for children whose mothers cook over wood fires in dirt-floor homes and wash their clothes in the river; blond-haired blue-eyed dolls for dark-skinned children. Periodically they are given away and I'm sure a lot of the kids appreciate them greatly and have fun playing with them. A lot of families of patients in this same hospital barely scraped together the money to travel to the city, rely on a locally-funded charity shelter for accommodations and food, and can't afford medications that are prescribed while hospitalized let alone when they go home. These children, whose imaginations and creativity have developed playing with whatever odds and ends they found around the house instead of talking dolls or board games, probably could use a lot of things before a fisher price kitchen set. I digress (and am probably preaching to the choir on this last point).
For the many visiting medical groups that are more careful about the donations they bring, all the other issues mentioned in the thesis linked to by
LizzyM as well as the thread linked to above become factors that in my opinion make few such trips worth the while, or even ethically defensible. When I first started researching medical missions I was surprised by the lack of published research on these trips, and am very glad to see the level of reflection that is going on in the SDN community and on medical school campuses, and to be part of it.
(posted by someone who has lived in a latin american country for 3 years working in public health research and capacity building and is confronted every day with the fact that she does not have very many answers)
