Medical Missions

[candav]

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Yes, there is something arrogant about that -- which is why it's important to go in with the realization that they may very well do more for you than you do for them. Service is not a one-way street; it's a relationship, a chance for two very different worlds to meet and try to understand each other.

The attitudes of individuals on the trips don't negate the value of the trips themselves. (Though some trip organizers may encourage that attitude more than others.)

I agree very much with the bolded, and that's been my own experience coming away from my international work. What I've taken away from this work has changed me immensely, and (I hope) has better equipped me to do something more substantial in the future.

 

[kansaskid]

Wow. Good arguement against supporting charity. 😱

It may not be available online right now but do try to find a hard copy of
Collaterals an essay by M. Allison Arwady, MD, MPH that appeared in JAMA. 2010;303(22):2229-2230. It reflects on being a resident on a rotation in a hospital in Africa. One snippet:

If it helps, I have a friend who went to one of the Central American countries. He paid about $2000 for a ten-day trip 😱
Later when he came back he told me how life-changing it was, how he wants to do another one before he graduates, and basically how amazing this experience was.
When he showed me the pictures from the trip, they were mostly pictures taken on the beautiful beaches, a night at a local bar, and some famous tourist sites. He did have some pictures of him and others in scrubs at a local clinic they volunteered at but they didn't really do anything but hand out pills.

It's your money to spend if you want to, but I don't see why anyone would go there for ten days once a year and make the local people become more dependent on foreign sources. If you are truly interested in making their lives better, you should join the peace corps (or anything long term with a legitimate supporting organization) and work on community development or health education.
My volunteer coordinator was with the Peace Corps before and she worked on preventive medicine (eating healthy, washing hands etc) while some other members worked on local farming.

In the end, it's your decision to make but make the right decision.

I've said it before, but I'll say it again. Don't do it. It doesn't look that good, doesn't do that much good, and is expensive. If you want to go international volunteer work, join the Peace Corps or other long term volunteer program and actually get to know your community and what they need from you. Unless you're a qualified physician (and even then the ethics are shady...see above) you can't do anything worthwhile. Trust me. I've seen the volunteers who come through here for just a few weeks. They are more overwhelmed and touristy than effective at doing anything at all and it's just embarrassing. I've been here a year and a half and I still struggle with making a tangible difference.

 

[keyinhand]

I went to a luncheon where the president of my medical school was addressing this very issue. He had very strong feelings about it, and mentioned a lot of things that LizzyM mentioned. He likened it to tourism, and said that schools don't like to see students go out of the country to volunteer, when there are lots of people in our own country hurting.

I am going to save my money, study hard and help people in my own community.

Just my two cents.

 

[LizzyM]

I doubt it looks bad, considering the number of applicants who have had such international experiences at the places I've interviewed at. I've been on several international "missions", although I would never call them that. Although my work did involve things like education, health programming, and assisting in clinics, I still find something very arrogant and almost colonialist in undergraduates heading to a foreign country, to which they've never been and often don't speak the language, with the notion of "helping" them. I think it's fantastic that people want to do so, but most of us don't have the tools for that yet. Rather, I'd suggest looking at these experiences as opportunities to learn, grow and expand your worldview.

Even if it looks bad, it is hard to discard an excellent applicant just because the applicant has gone on a foreign service trip. It is as if applicants are invited to interview despite (or regardless of) their experience with foreign trips rather than because of them.

 

[Starlightembers]

Even if it looks bad, it is hard to discard an excellent applicant just because the applicant has gone on a foreign service trip. It is as if applicants are invited to interview despite (or regardless of) their experience with foreign trips rather than because of them.

LizzyM, I know this thread is specifically about these two-week medical missions (which I do not agree with); however, does all volunteer and internship experience abroad look universally bad to adcoms? I ask because I am looking into a semester-long program in South Africa that, in addition to taking relevant course work through the local university, pairs you with an organization (usually a organization based, founded and run by those in that country) where you spend the majority of your day interning (both health and not health related). The intern does not do anything they are not legally allowed to do and, in fact, none of the intern sites involve medical and hospital work at all (though some do involve work with the sick and injured -- for example, refugees, children with severe burns, etc). This is still foreign/abroad work; however, there is nothing ethically questionable about it and it working to help organizations in the home country that will be there even when the intern leaves. Is this type of work OK?

 

[Miss Alyssa]

I cast a skeptical eye at medical mission trips as well. I, however, recognize that there are more ways to service medically than just "mission trips". (This is taking mission trip to mean <8 weeks where foreigners come in, diagnosis, give medications, and disappear)

I'm in a place in my medical career now where I know I want to enter 'global health'. When I look at fellowships, internships, and programs they invariably ask you to describe you experience working in resource poor settings, remote area medicine, tropical climates, developing countries etc. While you CAN get some of this experience domestically (and I have - I even go to a med school focused on serving disadvantaged people) there comes a time where you need to get on a plane and go.

When you do get on a plane and go it is your job to ensure that your experience is meaningful not only for yourself, but also for the community that you are entering. Things I would and do consider when looking for opportunities:

Longevity ---I do not think you need to spend 2 years to make an impact. You may only be able to spend 6 weeks. I think that's fine IF the organization you're working with is working there long term. Right now I volunteer at a running club for little girls. For several months I was going to their twice weekly practices. Then my schedule changed and I can't go to practices any more. But the organization is still up and running and having a significant impacting on teaching healthy active living in my absence. If the running club opened and closed in the 4 months I was there, it wouldn't be nearly as meaningful.
Bottom line: Find an organization that is there long term

Community based ---There are organizations/clinics/hospitals that are locally based locally run. They don't have the same feel as an outsider coming in to save the day. You might be able to assist on a project or study that they're doing.

 

[compshateme85]

I have gone to Mbarara, Uganda twice now with a team of surgeons on a medical mission.

The surgeons were Urogynocologists. The goal was to fix as many vesicovaginal fistulas as possible in our time there (a week).

The surgeons had set up a partnership with Mbarara University of Science and Technology, which has a teaching hospital. In return for using their lower operating theater for a week, the cost of the surgeries would be free to the women who needed them. The hospital sends out radio ads to inform "women who are leaking following a difficult birth" that we are coming and they should get to the hospital.

The other goal has been to give the Ugandan residents and surgeons training in how to repair fistulas, since, until recently, there has not been any doctor in the country who knew how.

When we leave, the patients are monitored for another 3 weeks by the hospital, and send us information about which surgeries were successful and which failed. From the trip two weeks ago, 28 were successful and 9 had failed, 3 of which had such damaged vaginal tissue their surgeries were known to be a long shot. That is 28 women who don't have urine dripping down their legs all day, who can now try and find jobs and rejoin society, which they were essentially cast out of because of the stigma and the smell.

I'm a licensed paramedic, so I assisted with the patients in pre-op and post-op, starting IV's, placing catheters, and assisting in the OR so the US surgeons would have someone who quickly understood what they needed, as the language barrier sometimes causes miscommunications.

I refuse to believe that these women would have been better off in the long run if this medical mission didn't happen. As to the women whose surgeries failed, they will be operated on again in 6 months when we return, as many times as it takes or until it's determined surgery will not repair their fistula.

If these trips had hurt my application, I would still have gone, because I believe that strongly that what we were doing was improving lives. Maybe it did hurt my app, but I wouldn't trade it for anything.

 

[Narmerguy]

I refuse to believe that these women would have been better off in the long run if this medical mission didn't happen. As to the women whose surgeries failed, they will be operated on again in 6 months when we return, as many times as it takes or until it's determined surgery will not repair their fistula.

If these trips had hurt my application, I would still have gone, because I believe that strongly that what we were doing was improving lives. Maybe it did hurt my app, but I wouldn't trade it for anything.

This is the whole problem. You need to understand how short term improvements can bring long term hardships to these communities. You cannot think only of the ones you worked with, but how it impacts their entire community, their ability to develop...so many things. I'm not passing judgement on your specific project because I don't know enough. However, I am disappointed in the unwillingness of many to acknowledge the truth behind the reservations many people have towards international service projects.

The health of developing countries is complicated and affected by multiple, fluctuating variables. Injecting yourself into the midst of it all and saving every baby you can isn't necessarily the most beneficial in the short term or beneficial at at all in the long term when looking at the whole community.

 

[compshateme85]

This is the whole problem. You need to understand how short term improvements can bring long term hardships to these communities. You cannot think only of the ones you worked with, but how it impacts their entire community, their ability to develop...so many things. I'm not passing judgement on your specific project because I don't know enough. However, I am disappointed in the unwillingness of many to acknowledge the truth behind the reservations many people have towards international service projects.

The health of developing countries is complicated and affected by multiple, fluctuating variables. Injecting yourself into the midst of it all and saving every baby you can isn't necessarily the most beneficial in the short term or beneficial at at all in the long term when looking at the whole community.

Fixing a vaginal fistula isn't a short term improvement. Did you even read what we did?

I agree that some medical missions don't have clear, long term goals and are more for the experience of the participants than the local population. I also think each medical mission needs to be evaluated on it's own, and not lumped together.

 

[LizzyM]

Someone with the credentials to start IVs, etc being supportive of a surgical program aimed at helping disabled people re-enter society is a different kettle of fish than a short term medical program that sees aches and pains, hands out nearly expired aspirin tablets and vitamins and leaves until next year.

At the same time, why do African women still suffer fistulas? What is the underlying cause? I know what it is and I wonder where we are lacking the political will to make services available that would eliminate that preventable cause of maternal morbidity. Any thoughts, compshateme85?

A six month study abroad gig is a different situation as well and one that is much different than the 7-12 day "spring break" situation.

 

[IlDestriero]

Bashing the surgical mission trips that, through a single surgery, cure significant disability is ridiculous.
I've gone out on trips to Asia fixing cleft lips and for ortho/burn surgeries. They turn outcasts into productive and accepted members of the community. They return improved functionality in one step. It would be nice to have 6 months of in country PT support, but it's not necessary. It's absolutely worth it for the patients and their families, and the local society, that now gain a more productive member of the community. I've got a photo somewhere of a teenaged double cleft kid. Before = shunned, shut in. After = handsome young man, with 2 small scars and a normal appearing nose. He now is free to function in society. A society that was completely closed to him days before.
These surgical trips are about as far away from handing out vitamins and antibiotics as you can get.
Having said that, there's really no room for untrained students. Residents aren't even very useful, and they usually only want board certified physicians.
Not mine:

Clearly the white man's folly.
The plastic surgeon that did one of my friends surgeries in LA retired to do nothing but mission work. He used to command 150% of the going rate, now be provides world class facial plastics for free.

 

[compshateme85]

Someone with the credentials to start IVs, etc being supportive of a surgical program aimed at helping disabled people re-enter society is a different kettle of fish than a short term medical program that sees aches and pains, hands out nearly expired aspirin tablets and vitamins and leaves until next year.

At the same time, why do African women still suffer fistulas? What is the underlying cause? I know what it is and I wonder where we are lacking the political will to make services available that would eliminate that preventable cause of maternal morbidity. Any thoughts, compshateme85?

A six month study abroad gig is a different situation as well and one that is much different than the 7-12 day "spring break" situation.

From my time there, I would have to say it's a combination of things that create fistulas. The number one being a lack of infrastructure in the country. These women labor for days at home with no access to a hospital. Fixing this requires roads and public transportation.

One of the other major issues is the age at which many of these women are giving birth. Eastern African women tend to have a more narrow pelvis than Caucasian or Hispanic women, and combined with a young, underdeveloped pelvis leads to more obstructed childbirths than you see in other, underdeveloped countries.

Fistulas themselves don't cause maternal mortality. The women who develop fistulas are the ones who survived an obstructed childbirth. So to eliminate a preventable cause of maternal mortality, you have to eliminate obstructed childbirth. Efforts are being made by the government to inform the population about fistulas and how to prevent them, but there is a long way to go.

 

[LizzyM]

From my time there, I would have to say it's a combination of things that create fistulas. The number one being a lack of infrastructure in the country. These women labor for days at home with no access to a hospital. Fixing this requires roads and public transportation.

One of the other major issues is the age at which many of these women are giving birth. Eastern African women tend to have a more narrow pelvis than Caucasian or Hispanic women, and combined with a young, underdeveloped pelvis leads to more obstructed childbirths than you see in other, underdeveloped countries.

Fistulas themselves don't cause maternal mortality. The women who develop fistulas are the ones who survived an obstructed childbirth. So to eliminate a preventable cause of maternal mortality, you have to eliminate obstructed childbirth. Efforts are being made by the government to inform the population about fistulas and how to prevent them, but there is a long way to go.

I called it maternal morbidity, not maternal mortality.... but you are correct, obstetrical services are needed along with a society that puts a priority on delaying first births until women are fully matured.

 

[compshateme85]

I called it maternal morbidity, not maternal mortality.... but you are correct, obstetrical services are needed along with a society that puts a priority on delaying first births until women are fully matured.

Sorry, I misread the word, but it's true for both.

 

[dani6706]

c

 

[DrSteven]

I completely agree that going abroad for a week to just hand out meds at a free clinic is bad for that community. It makes them dependent on us to get these meds and they often abuse them. However, I don't think all abroad trips should be frowned upon. As IIDestriero pointed out, some of these trips are some people's last shot at making a life for themselves. I went abroad to Honduras for three weeks to volunteer in a Missionary Hospital where Orthopedic Surgeons from Mayo came down and repaired people's limbs who haven't been able to walk for years and who did knee and hip replacements for the absolutely desperate. I don't think these experiences are unethical, because the whole community can't just come flocking in for a hip replacement, because most of them don't need it. But the ones who REALLY do and who are sadly rotting away because of their disability, DO get the help. I believe these types of trips are completely ethical, and something that Medical Schools wouldn't shake their head at an applicant for participating in.