Medical Missions and the

Emergency Physician

Organizing and involving yourself in medical

work that will have a lasting impact

No Financial Disclosures

Objectives

Identify common errors and misconceptions in STM

(short term mission) planning

Identify the key features necessary with a non-surgical

STM to make a sustainable and empowering impact

Discuss alternative STM work that incorporates EM

skills and has 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”

End Result

STMs perpetuate the irrational use of medicines,

resulting in long term healthcare that is of poor quality

Emphasis on medications by STMs impairs development

efforts and impedes WHO objectives

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

may cause long term 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

Education of health

workers Train the trainer

HIV (anti-stigma)

Palliative care training programs

IMCI training for health workers

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

Alternative short term options

Become involved in development

Relieve a long term medical missionary

Teaching opportunities

Become involved in disaster relief

Teaching Ultrasound

Teach ultrasound in developing world

Dr. Sachita Shah, U of Washington

World Federation for Ultrasound in Medicine and

Biology (www.WFUMB.org)

American Institute of Ultrasound in Medicine

Aium.org

http://www.pureultrasound.org/

Point of care Ultrasound in Resource-limited Environments

Teaching

Medical Education International

www.cmda.org

Teaching opportunities around the world

ATLS

Other EM Organizations

Global Emergency Care Collaborative

http://globalemergencycare.org/

Disaster Relief

International Medical Corps

internationalmedicalcorps.org

2-8 weeks

South Sudan, Syrian border

http://www.epmonthly.com/features/current-

features/homecoming-caring-for-south-sudans-returnees/

Samaritans Purse

www.samaritanspurse.org

How to find out more?

Attend conferences

Institute of International Medicine (Inmed.us)

Kansas City, May 29-31, 2014

Louisville, KY each November

www.medicalmissions.com

International section of specialty organizations

http://www.acep.org/InternationalSection/

http://www.emra.org/committees-

divisions/international-division/

Local Connections

Houston Global Health Collaborative

http://houstonglobalhealth.org/

SAEM Annual Meeting in Dallas

GLOBAL EMERGENCY MEDICINE PROJECT

SHOWCASE AND NETWORKING SESSION

Friday, May 16, 2014

5:00 - 7:00 pm

International EM Fellowships

Over 40 EM residency programs with International/Global Health EM Fellowships in the USA

Each program unique

Disaster preparedness/response

Residency/education development

EMS development

Various regions of the world

Baylor-Pediatric EM fellowship with global health track

UT Houston EM-Global health fellowship

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