By Aliza Norwood (Tuesday, Oct 5, 2010)
During my second year of medical school I joined a group of students, residents, and physicians to launch the first medical trip to Haiti from my institution (UTHSCSA Haiti). We went through Project Medishare, an established non-profit organization based out of Miami that has been providing medical care in rural Thomonde, Haiti since 1994. Given the short timeframe of our trip, just one week, we wanted to be sure that our work would contribute to sustainable health improvement and that we would in no way be a drain or danger to the community we wished to serve.
Medical student interest in global health and participation in medical trips abroad has been growing steadily for decades; in 2004, almost a quarter of US and Canadian medical students participated in an international health elective. Studies show that medical students who take international electives are more likely to express interest in working with underserved populations and to pursue a career in global health. However, due to the time constraints and the amount of resources needed to carry out these trips, many are brief and thus raise important ethical and human rights concerns. Short-term trips that disregard existing programs and local priorities can divert resources from local providers, disrupt local relationships, and undermine efforts to build sustainable, cohesive primary health systems. How can students who want to do international electives to reduce suffering and gain important experience avoid this?
Pediatrics residents at the University of Washington published a paper (http://www.ncbi.nlm.nih.gov/pubmed/17660105) that outlines a model [h1] for conducting short-term, sustainable international medical trips that I found helpful. The paper highlights 7 guiding principles: Mission, Collaboration, Education, Service, Teamwork, Sustainability, and Evaluation.
Mission. It is important to create a mission statement that you can always refer back to when starting a new project or organizing a trip. This statement will keep your group focused and ensure that you remain on target to reach your end goal.
Collaboration. In order to make your trip more than a band-aid solution for long-term problems, it is critical to collaborate with the community itself. This means working with the leaders in that community and “teaching the teachers” so that they become empowered to continue positive change in your absence. An example is creating a health committee of local community members to provide education and simple health interventions. Another would be to meet with local healthcare workers and make sure they are aware of and in agreement with your intervention(s).
Education. This means educating yourself, your peers, and the communities you serve. In order to understand the health issues of a community we must learn about the sociopolitical context of that community and how that climate affects health. This research will help you to identify the most valuable health interventions you can offer. Ask the community and its health professionals what they identify as major health issues. Each international experience should be followed by a period of group or self-reflection. If you can, try to present what you learned to your peers in the form of class presentations.
Service. Short-term volunteers need to take a critical look at available resources and infrastructure to know what to bring and which interventions will be the most beneficial, given time constraints. Collecting clinical and demographic data is necessary to understand the impact of your interventions and direct your actions for the future.
Teamwork. Be sure to understand the skill sets and limitations of your team. In Haiti, we worked closely with translators who were invaluable partners in our clinical work. If you can identify a prevalent deficiency, say, lack of fluency in a language spoken in your target community, address it by training team members prior to the trip.
Sustainability. Working in one location and sending repeat trips can help to engender trust and maximize the effectiveness of your interventions in a community. Sustainability also necessitates working within existing structures and training/teaching local leaders so that they have responsibility and control of care.
Evaluation. This is where the data comes in. Analyzing initial data, such as evidence of malnutrition or iron deficiency, can reveal which interventions will be most beneficial to the community. Long-term follow-up data can be used to demonstrate your effectiveness to your community and direct goals for future trips.
The guidelines above are just one model for a sustainable short-term trip, and the core principles can be used for medical efforts in many different settings. UTHSCSA Haiti continues to support field medical trips and evaluate the impact of those trips in Thomonde. We are also working with Project Medishare to open an Akamil fortified grain facility that should combat kwashiorkor and marasmus in children over the long-term. All short trips have potential ethical and human rights pitfalls, but by taking responsibility for good preparation and communication with the communities we aim to serve, we can hopefully play a part in improving lives and reducing suffering beyond our brief visit.