Practical Considerations of Caring for Patients Abroad During Short-Term Medical Trips
Am Fam Physician. 2018 Dec 1;98(11):673-675.
A 65-year-old woman presented on the second day of my week-long volunteer medical brigade to a migrant camp in Mexico. The patient had a blood pressure of 180/110 mm Hg and a heart rate of 78 beats per minute. Her presenting symptoms were itchy eyes and sneezing, which she reported were worse when she worked outside harvesting produce. She was otherwise asymptomatic.
I was primarily concerned about her blood pressure (she seemed unaware that it was elevated); however, the only antihypertensive available in our brigade was lisinopril. I did not want to prescribe it without checking the patient's renal function, but the clinic did not have a laboratory. I would not be in the area long enough to follow up with my patient. The nearest local clinic was more than an hour away, and the patient did not have transportation. Should I have prescribed the medication? How do volunteer physicians on short-term medical trips (STMTs) best manage for local health care needs?
This case identifies several common problems that can arise from participation in STMTs. Global health has gained popularity in North America as a means of providing learning experiences during medical school and enabling practicing physicians to volunteer in low- and middle-income countries. Approximately 26% of undergraduate students1 and more than 40% of graduate medical students2 have reported participating in STMTs during their training, and approximately 30% of U.S. physicians have engaged in similar trips, many more than once.3,4 STMTs generally range in duration from one day to two months5 and involve travel to a location outside the learner's or physician's home country. Pretravel preparation varies for each trip; volunteers may focus on one location or may move between several communities, and they often spend full days seeing hundreds of patients. Despite the volunteers' goodwill, these trips may introduce risks to the patients, including diagnostic mistakes, cultural miscommunication, and unreliable treatment, principally through not ensuring adequate continuity of care for the patients.6–9 As a result, some within the medical community have challenged the value of such trips for the patients who are meant to be served.7–11 To address these concerns, several groups have developed STMT guidelines.6,7,10 With proper preparation and engagement in the local community, STMT participants can provide meaningful patient care. Based on these guidelines, the following principles should be considered for conscientious involvement in STMTs (Table 16,7,10,12–14).
Practical Approaches to Address Potential Pitfalls of Short-Term Medical Trips
|Responsibilities of health care professionals||Before departure duties||While in host country||After returning|
Identify in-country contacts; discuss community needs
Confirm and implement stated goals of local host collaborators and community
Continue discussions with local contacts12 and confirm that collaborations are mutual; avoid promotion of an overreliance on outside resources
Ensure level of care
Ensure that volunteers have current medical licensing, sufficient training, or supervision to practice in country
Oversee all volunteer physicians and learners to ensure that they are working within appropriate scopes of practice
Identify quality improvement projects focused on local needs and assessing the results of clinics
Prepare and educate
Research local disease manifestations and treatments Learn about the culture and language
Employ local standards-of-care and treatment guidelines Function within local clinical constraints Ensure that a postdeparture plan is in place for follow-up
Promote continued medical education for volunteers and local physician counterparts
When possible, connect and work with local physicians; buy and use medications sold in the host country
Verify that the patient understands intended treatment, how to take medications, and which local physician to follow up with
Develop infrastructure where follow-up clinics are reliable; build reliance on local health care professionals10
Ensure that volunteer physicians and learners are aware of ethical challenges to volunteering and learn about local culture7
Train learners to implement the same model Instill appropriate expectations for level of engagement in short-term medical trips7
Ensure that adequate clinical translation and local physician oversight are available
Commit to future investment in the local area; return to the same community sites
Practical Approaches to Address Potential Pitfalls of Short-Term Medical Trips
|Responsibilities of health care|
Referencesshow all references
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13. World Health Organization. Essential medicines and health products: guidelines for medicine donations, revised 2010. http://www.who.int/medicines/publications/med_donationsguide2011/en/. Accessed July 2, 2017.
14. Unite for Sight. Module 8: the significant harm of worst practices. http://www.uniteforsight.org/global-health-course/module8. Accessed June 25, 2017.
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