Medical Missions and the
Emergency Physician
Organizing and involving yourself in medical
work that will have a lasting impact
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
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
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