Planning a Successful Mission Trip: The Ins and Outs

I N T E R N A T I O N A L N U R S I N G

Authors: Jeff Solheim, RN, CEN, and Penny Edwards, RN,

BScN, CEN, Keizer, Ore

Section Editor: Pat Clutter, RN, MEd, CEN, FAEN

Jeff Solheim, Oregon State Council, is Director, Project Helping Hands,and Educational Consultant, Solheim Enterprises, Keizer, Ore.

Penny Edwards, Mid Valley Coastal ENA and Oregon State Council, isClinical Director, Project Helping Hands, and Clinical Educator,Salem Hospital, Salem, Ore.

For correspondence, write: Jeff Solheim, RN, CEN, 1039 ChardonnayLoop NE, Keizer, OR 97303; E-mail: jeff@solheimenterprises.com.

J Emerg Nurs 2007;33:382-7.

0099-1767/$32.00

Copyright n 2007 by the Emergency Nurses Association.

doi: 10.1016/j.jen.2007.04.019

382

driving force for drawing many persons into the

Amedical field is an innate wish to help others. For

some people, that wish may include a desire to

serve on a humanitarian medical team.

That personal need may be met in numerous ways.

One way is to research the myriad of organizations that

regularly conduct humanitarian medical missions and find

the one that most closely aligns with your background,

desires, and personal beliefs. A second option is to con-

sider planning and carrying out your own humanitarian

mission, which is a huge undertaking with equally large

personal rewards.

After organizing over 40 trips in the past 13 years, we

recommend that the ‘‘project director’’ or team members

begin preparations, at minimum, 12 months in advance of

the anticipated departure date. The obvious place to begin

arrangements includes choosing the destination for the

mission and finding a suitable on-site ‘‘host.’’

The ideal host lives in the country or area that will

be visited by the team and has intimate knowledge of

both the people and culture. He or she will speak the local

languages, understand the needs and culture of the local

people, and be able to communicate easily with the proj-

ect director, having appropriate access to communication

devices such as E-mail or telephone.

The team director, in conjunction with the host, should

consider the following factors when planning the trip:. Scope of the trip: Will this mission have a medical,

surgical, dental, public health, educational, or other

focus (Figure 1)? This focus will depend partially on

the skill of the volunteer team members who are

anticipated, the needs of the community to be

visited, and the services already available in the

JOURNAL OF EMERGENCY NURSING 33:4 August 2007

FIGURE 1

Pat Clutter, director of education for Project Helping Hands,

assists a young boy with a fractured leg.

I N T E R N A T I O N A L N U R S I N G / S o l h e i m a n d E d w a r d s

community. For example, it would not be practical

to plan a surgical mission trip if the community does

not have a facility and electricity to support such a

team; likewise, it does not seem logical to include a

dental component if the community already meets

these needs with indigenous care providers.. Available resources: The size and composition of the

team will be depend heavily on what resources are

available within the community. Factors to consider

might include the availability of transportation to

move the team and all its supplies from the airport to

the area of work and the ability to house, feed, and

logistically support a team. The size of the team or

the scope of the project cannot exceed the resources

the community can support.. Weather: The time of year can have a significant

impact on the success of a trip. Does the community

to be visited have a ‘‘rainy season,’’ making travel

difficult? Are there times of year where extremes

in temperature could impede safe transportation

and storage of medical supplies and medications or

threaten the health of team members who may have

to work in poor working conditions? Choosing the

right season based on weather can have a significant

impact on the success of a medical mission trip.

Once the scope of the mission and available local

resources have been determined, recruitment of additional

August 2007 33:4

team members should be undertaken. Careful consider-

ation of the needs of the team should guide this pro-

cess. Obviously, a surgical team will require, at minimum,

a surgeon, someone to administer anesthesia, pre-operative

screeners, intra-operative support staff, and postoperative

care providers. The same thought processes should be un-

dertaken for other types of teams (eg, dental, medical,

public health, and educational). Aside from medical per-

sonnel, the team director should consider other needs of

the team when selecting team members. If language bar-

rier is a consideration, consider recruiting team members

who can serve as translators. Alternatively, the host may

be able to hire local translators to accompany the team.

JOUR

. . .[I]t would not be practical to plan asurgical mission trip if the communitydoes not have a facility and electricity tosupport such a team; likewise, it doesnot seem logical to include a dentalcomponent if the community alreadymeets these needs with indigenouscare providers.

Establishing a budget for the trip involves consider-

ation of numerous factors:. Transportation: How will the team travel from

their homes to the locale? If airlines are to be used,

consider contacting the ‘‘group desk’’ of major air-

lines and letting them know you are undertaking a

humanitarian medical project. They may be able to

offer discounts based on the work you are doing

and the size of your team. Some airlines will pro-

vide one free seat if you purchase a preset number

of seats for your group. If this is not possible, con-

sider doing an Internet search for a company that

purchases airline tickets in bulk and may be able to

negotiate a reduced price for a group. While dealing

with the airlines or a bulk sales company, consider

the amount of luggage that will be required by your

team, both personal luggage and medical supplies

for the trip. If you anticipate that your team may ex-

ceed the allowable weight, try to negotiate a waiver

NAL OF EMERGENCY NURSING 383

FIGURE 3

Team members from a 2006 trip awaiting orientation in Miami

before departing for Bolivia. Many team members are meeting

for the first time as well as obtaining in-depth information on

the clinics and education seminar to be held.

FIGURE 2

One of 12 trucks used to transport the medical supplies and team

members throughout the country. Here we are crossing one of

the many rivers to get to another village.

I N T E R N A T I O N A L N U R S I N G / S o l h e i m a n d E d w a r d s

of the overweight fee as part of the contract you

make. You also must work closely with your host to

budget the costs of transportation at the work loca-

tion. Consider factors such as transportation from

the airport to the work site, transportation from lodg-

ing and where meals are eaten to the worksite, and

transportation for any nonmedical sightseeing trips

that may be incorporated into a trip. Do not for-

get to factor in the massive amount of luggage and

supplies that also will need to be transported with a

medical team (Figure 2).

384

Careful consideration of the needs of theteam should guide this process.

. Food: Work closely with your host to determine

how it will be best to feed the team. Will the team

prepare their own meals? Do restaurants exist that

prepare food that is safe for the team to consume?

Will the team eat with local people, and if so, who

will educate the local people on how to prepare food

that is safe for team consumption? Once these fac-

tors are established, a budget for food costs can be

set. Do not forget to incorporate costs for additional

water and other liquids for the team to consume

while working, especially in hot climates.

J

. Lodging: Again, lodging requires careful coordina-

tion with the host. Will the team sleep on the f loor

of the medical facility or in the homes of local people,

or are there hotels or something equivalent where the

team can stay? These costs must be considered.. Taxes and fees: The host as well as the United States

State Department Web site are excellent sources for

anticipating various taxes and other fees that should

be anticipated. Various countries may have departure

taxes, airport taxes, and other fees that at times can be

significant and should be factored into the budget.

OUR

Will the team eat with local people, andif so, who will educate the localpeople on how to prepare food that issafe for team consumption?

. Administrative overhead: Anticipate costs that may

arise outside of the medical mission itself as part

of the budget. Will team t-shirts or uniforms be

purchased? Is there a team orientation planned

(Figure 3)? Will some medical or surgical supplies

require purchasing? Will the team have to pay for the

services of translators or other support personnel?

NAL OF EMERGENCY NURSING 33:4 August 2007

I N T E R N A T I O N A L N U R S I N G / S o l h e i m a n d E d w a r d s

Are activities outside of medical work planned for

the team as part of the cultural experience? What

about postage and long-distance charges associated

with the planning process?. Financial cushion: It always is advisable to budget an

extra amount of money for unforeseen circumstances

that may arise as well as the purchase of additional

supplies that either were not anticipated or that ran

out before the end of the mission.

Augu

Are there any safety factors, bothpolitical and physical, that need to beconsidered as part of theplanning process?

Using these parameters, the team director can then

establish the estimated cost of the trip and determine the

best way to fund the trip. Ways to fund the trip include

dividing the costs up between the team members and ask-

ing each to fund his or her own trip, looking for appro-

priate grants to cover the costs, or raising funds for the cost

of the endeavor. If team members will be asked to self-fund

the trip, consider approaching a not-for-profit agency to

sponsor the trip to provide a tax shelter for participants.

Team directors always must consider political factors

when planning a medical mission. Does the area they are

traveling to require visas or other travel documents? Are

there specific licensing restrictions or other permissions

that need to be obtained before performing medical care

in the area? Are there any safety factors, both political

and physical, that need to be considered as part of the

planning process? A number of resources are available

to assist with these questions, including the host, the

United States State Department, and the Embassy of the

country to be visited, if the trip is to be carried out off

of American soil.

A number of Internet-based resources are available

to team directors when planning missions such as these.

The Centers for Disease Control and Prevention (CDC)

Web site contains excellent information on recommended

vaccinations by area of the world, as well as other safety

issues that should be taken into consideration before trav-

eling abroad. The United States State Department Web

site is an excellent source of information regarding travel

st 2007 33:4

abroad, including regularly updated travel advisories, cul-

tural considerations by country, and documentation rec-

ommendations or requirements per geographical locale, to

name but a few.

Determining Appropriate Medical Supplies

Once the scope of the mission has been decided, the

project director should appoint a medical/clinics director

to be the lead person in deciding what medications and

medical supplies are necessary. The medical director, in

conjunction with the project director and host, will need

to ascertain the following information:. How many villages/towns/municipalities will be vis-

ited by the various teams during the mission, and

what facilities and personnel are available? Some vil-

lages may have a small clinic on site or may have a

trained first-aid person who can assist with the clinics.. How many clinics are planned? Will you do one

clinic per day per village, or are there plans to do

a clinic in one village in the morning, travel, and

then do another clinic at a different village in the

early evening?. What are the primary medical/health conditions/

diseases that may be encountered in the area? Gain-

ing this information will help you plan what medica-

tions and supplies you should consider taking. In

many third-world countries, malnutrition will be the

number one condition that needs to be addressed.. The CDC and the World Health Organization Web

sites also are an excellent source of information in

identifying conditions that may be encountered in

the areas you are visiting. Also, search the Web for

sites that describe the country/area to which you are

traveling. Often you can tap into news sources from

the country that describe recent outbreaks and natu-

ral disasters that you may encounter.

Once you have the information about what the teams

will encounter, you will want to start to identify what

medications and supplies will be needed that will allow

you to meet the needs of the people for whom you will be

providing care. Some of the factors to consider include:. Will there be a surgical team? If so, you will want to

discuss with the surgeon that types of surgery that

will be performed. Will the surgeon bring his or her

JOURNAL OF EMERGENCY NURSING 385

FIGURE 4

In 2006, once the group arrived in Caranavi, all 35 suitcases full

of supplies were laid out at the hotel, divided into teams,

and repackaged according to each team clinic director’s method

for later use. This is a time-intensive and tiring duty.

I N T E R N A T I O N A L N U R S I N G / S o l h e i m a n d E d w a r d s

own instruments? What about drugs for anesthesia?

What drugs does the surgeon anticipate needing for

pain control? If you are considering narcotics, you

will want to check with customs (both in the United

States and the country you are visiting) to identify

the regulations. Determine needs for both preoper-

ative and postoperative care.. Are advanced practitioners part of the team? If so,

supplies for minor surgeries such as incision and drain-

age and suturing may be needed. Suture and suture sets

as well as dressing materials will need to be obtained.

Splinting materials also may need to be considered.. How many doses of over-the-counter (OTC) medi-

cations do you anticipate needing? If malnutrition

is a concern where you are going, you will want to

consider how many doses of vitamins you want

to give both adults and children. What other OTC

medicines will be needed? Some of the other OTC

preparations that might be useful include cough prep-

arations, pain relievers such as acetaminophen and

ibuprofen, fever control medications for children and

infants, antibiotic ointments, anti-itch creams, hydro-

cortisone ointments, and eye and ear drops.. What types of prescription medications will best

serve the needs of the clinics? If you are serving an

area where most of the patients have never had anti-

biotics, the basic antibiotics such as penicillin, eryth-

romycin, and amoxicillin usually are the best and

most cost-effective to take. Sometimes drug reps are

willing to provide samples of the latest antibiotics;

however, this is a double-edged sword. Providing

second- and third-generation antibiotics to persons

who have never had the basic antibiotics may not

be the best choice. Potential problems can arise from

this practice.. Should cardiac, hypertension, or diabetic medica-

tions be taken? This decision can be controversial.

One of the main concerns with giving any of these

medications is the required follow up. Consider

proximity of the patient to a center where follow-up

can occur and the understanding by the patient/

family regarding that follow-up and taking the pre-

scribed medication correctly. If the patient will not

be able to have appropriate follow up, then analysis

of benefits versus risks must be weighed.

386 J

. Are the medications out of date? Some countries

allow you to bring medications that are out of date

by 6 months as long as you have documentation

from the manufacturer. This factor is something to

explore with the in-country host.

Once you have identified medications and supplies

needed and the approximate amount, convey this list to

the team members. It is imperative that you provide this

list to team members early in the planning of the trip so

that adequate time for collection is allowed. Have team

members E-mail weekly what has been collected, and

maintain these data on a spreadsheet to help keep track

of medications/supplies available for the trip. One way to

help focus on items that are needed is to email a top 10 list

of what is needed every 1 to 2 weeks.

Packaging and packing all of the medical supplies

can be daunting, especially if you are the person who

has collected a majority of the supplies and medicines

(Figure 4). Each team member should be expected to have

2 checked bags—one for their personal belongings and one

for the medical supplies they have collected. Advise the

team members to have an itemized list of what is in the

medical supply bag, because it will be helpful with customs

at your destination. Keep in mind the weight restrictions

for the airline.

OURNAL OF EMERGENCY NURSING 33:4 August 2007

I N T E R N A T I O N A L N U R S I N G / S o l h e i m a n d E d w a r d s

As previously mentioned, medicines need to be pack-

aged in unit doses. Small plastic bags are great for this

purpose. You can purchase either the small craft or snack-

size bags. Be sure to send labels with proper translations

for the various medications so they can be placed on each

individual bag.

Once all the medicines and supplies have been pack-

aged, each team member should then divide what he or

she has collected into the number of teams that are going;

this will make it easier to divide the supplies once you are

in country.

Embarking on a medical mission can fulfill a lifelong

dream if it is well planned. It takes a great deal of work

both for the planners and the participants; however, when

you get a hug from a mom after you cared for her child or

a handshake from the village elder for coming to help his

community, you soon forget about all the blood, sweat,

and tears of the preparation. We hope this article has pro-

vided concrete information to help make your dream of

helping others a reality.

Submissions to this column are welcomed and encouraged. Sub-missions may be sent to:

Pat Clutter, RN, MEd, CEN, FAEN

9361 E Farm Road 112Strafford, MO 65757

417 736-2203 . Clutter@wildblue.net

August 2007 33:4 JOURNAL OF EMERGENCY NURSING 387