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STMsOrganizing and involving yourself in trips that will have a lasting impact
Objectives
Identify common errors and misconceptions in STM planning
Identify the key features necessary with a non-surgical STM to make a sustainable and empowering impact
Discuss alternative STM models that have 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”
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 causes 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
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
Consider utility of the health fair model
Alternative short term options
Become involved in development
Relieve a long term medical missionary
STMs in surgical specialties
Teaching opportunities
Become involved in disaster relief
How to find out more?
Attend conferences
Inmed.us
Kansas City May 31-June 1
Louisville, KY each November
International section of specialty organizations
What is poverty
Lack of material resources
Oppressive relationships
Unjust government systems
Lack of opportunity
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