Menu Icon Search
Close Search

Medical Missions: What makes us think we’re qualified?

Created July 11, 2012 by Alison Hayward
Share


Everyone knows at least one these days: medical providers who travel to developing countries to provide medical care to communities with little access to healthcare otherwise. “Medical missions” have become commonplace for students, residents, and practicing physicians. Allied health professionals are also frequently involved, with everyone from pharmacists to alternative medicine practitioners joining these trips. Many such trips are organized on an informal basis through networking, nonprofits, or church groups, and as such, involve little to no pre-departure training on practicing medicine in resource limited tropical settings. Participants may be expected to educate themselves on an ad hoc basis, or may be provided with some limited resources for study prior to the trip.

It has become clear that just being a doctor (or a physical therapist, or a pharmacist) does not qualify a person to practice in a developing country. And yet, there are physicians traveling from industrialized nations who are retired, have lapsed specialty certification, or are no longer licensed to practice medicine even in their own country. These people are administering medical care or even performing surgery on people living in poverty. Typically, they are lauded as humanitarians instead of questioned for such practices. This is not just an ethical issue, this is a social justice issue. Caring for patients in such scenarios requires a highly specialized body of knowledge and skills that American healthcare professionals simply do not possess without global health-specific education. We need to ensure that healthcare workers are not only licensed and qualified to work in their home areas, but any areas where they travel with the intention of providing medical care.

In the United States, we require all international physicians to go through an arduous course of USMLE exams and additional years of residency to be able to practice in our country. Yet we presumptuously believe that we can parachute in to settings completely different from those we trained in and immediately start treating patients. Despite the fact that we trained with ample availability of CT scanners, a panoply of lab testing options, and ready availability of consulting services, in an environment where tropical infectious diseases are rarely, if ever seen, we believe we can quickly translate our skill set to a location with no physician, minimal lab or radiology resources, perhaps without even running water or electricity. Yes, we do it because we want to help, but well-intentioned arrogance is still arrogance.

A typical justification for this practice is that in a resource limited setting, any provision of medical care is helpful because “it’s better than nothing.” That position is difficult to defend, since substandard care can end up harming patients. Healthcare providers who arrive in a resource-limited setting without proper preparation may end up monopolizing precious resources themselves, leaving less for the local population. Also, provision of free medical care by medical missions undermines what little local health system already exists. The healthcare worker who typically services the area now has his small income cut in half for the month, because his customers all decided to go get free care from the visiting medical mission. The pharmacist who sells medications can’t pay his child’s school fees because the medical mission gave away free medication to his customers. Finally, provision of free care by visiting health workers helps to create a ‘donor culture’ or ‘culture of helplessness’. It reinforces the belief of local community members that they are dependent on external aid, and undermines local self-efficacy.

Although it will be difficult to set and maintain standards for qualification to practice medicine in resource limited, global health settings, it must be done. Standards for qualification are ethically necessary. Academic medical centers, particularly those with offices of global health, should be at the forefront of creating and enforcing institutional adherence to these standards. Global health practitioners must prioritize the publication and dissemination of such standards in such a way that physicians in all specialties across the nation will be aware of them. Such standards will go a long way towards creating a culture of professionalism and respect for the challenges of practice in the global health field.

Have you ever considered or participated in a medical mission trip? Let me ask you – how much time did you spend considering how to get licensed to practice in that country before arrival? How many of you are taken aback that I suggest you need to be licensed to practice in a developing country, even if you are going as a volunteer on a brief medical mission? Why did you think it was acceptable to practice unlicensed in that location? Was it because of the remoteness and degree of medical need? Would you consider traveling to a rural area of the USA and hanging out a shingle as a physician if you had no American medical license or DEA number?

All right, I’m almost done grilling you now. But I do want your opinions. What makes us think we are qualified?

Alison Schroth Hayward, MD, is a board certified emergency medicine physician currently on the faculty at the Mayo Clinic in Rochester, Minnesota. In 2003, she co-founded a nonprofit called Uganda Village Project, and currently serves as the Executive Director. Her expertise in global health ethics has mainly resulted from making all the mistakes already herself, and trying to learn from them.

References
Battat, R. et al. Global health competencies and approaches in medical education: a literature review. BMC Medical Education 2010, 10:94
Burdick, W., Hauswald, M, and Iserson, K. International Emergency Medicine
. Academic Emergency Medicine 2010 Jul;17(7):758-61.
Hauswald, M. Response to: International Emergency Medicine and Global Health: Training and Career Paths for Emergency Medicine Residents. Annals of Emergency Medicine 2011; 576–577.
Morton, M and Vu, A. International Emergency Medicine and Global Health: Training and Career Paths for Emergency Medicine Residents. Annals of Emergency Medicine 2011; 57:520-525.
Panosian, C. and Coates, T.J. The New Medical “Missionaries” — Grooming the Next Generation of Global Health Workers. New England Journal of Medicine 2006; 354:1771-1773.
Redwood-Campbell, L. et al. Developing a curriculum framework for global health in family medicine: emerging principles, competencies, and educational approaches. 2011, 11:46.

// Share //

// Recent Articles //

  • Immigrants, Insurance and Nonprofits: Our Generation’s Obligation

  • Posted June 28, 2017 by Matt Agritelley
  • Republished with permission from here. The future of American health care remains uncertain. It was only a few weeks ago that the Affordable Care Act (ACA) narrowly evaded the congressional guillotine a mere seven years after its installation. On March 25th, millions of Americans learned they would retain the coverage they have had since the...VIEW >
  • Jump Starting Your Job Search While In Medical School: Part 2

  • Posted June 27, 2017 by PracticeLink
  • Read  about steps 1 and 2 in Part 1 of this series  here. Right now, your number one priority is, very understandably, focusing on your medical school workload. Still, it’s never too early to start thinking about your job search. There are easy steps you can take now that will prepare you for your job...VIEW >
  • Internal Medicine: The “Classic” Physician

  • Posted June 26, 2017 by Brent Schnipke
  • If the average reader is asked to imagine a typical medical student, he or she might picture the following scene: a group of frazzled young people in short white coats, scurrying around the wards of a large academic medical center. They travel in hordes, flocking to the nearest attending, who calmly asks them asinine questions...VIEW >
  • Your Gap Year Job Doesn’t Matter

  • Posted June 23, 2017 by The Short Coat Podcast
  • Listeners ask, we answer. A flood of listener questions this week!  It’s probably due in part to medical school application season has begun, which means medical school applicants are trying to figure out if they have what it takes…on paper.  For instance, an anonymous listener (“Meldor”) called in to find out what kinds of gap...VIEW >
  • Quiz of the Week: How Would You Manage This Rancher’s Lesion?

  • Posted June 23, 2017 by Figure 1
  • A 22-year-old male presents with a one-week history of a lesion on his index finger after working at his uncle’s sheep ranch two weeks earlier. When he first noticed the lesion, it was a small firm papule and accompanied by a low grade fever. Examination now reveals a targetoid lesion on his right index finger...VIEW >
  • Medical, +1 MORE
  • Q&A with Dr. Alison Stansfield, Learning Disability Psychiatrist

  • Posted June 22, 2017 by Gloria Onwuneme
  • Alison Stansfield, MBChB, MRCPsych, MD is the clinical lead and consultant psychiatrist for the Leeds Autism Diagnostic Service (LADS). This is an adult all-IQ autism diagnostic service which also provides consultancy and training. She is a regular lecturer for the Andrew Sims Centre on topics such as autism, learning disabilities, Mental Capacity Act, deprivation of...VIEW >
  • Deprescription: In the context of palliative care

  • Posted June 21, 2017 by Ian Wee
  • “Why is Mr X on statins?” asked the palliative consultant. “He has been on statins for a long while given his poor cholesterol profile, even before he was referred to us,” the palliative registrar replied. “What is his prognosis?” the consultant continued. “Three months”. “So why is he still on statins? Does it improve his...VIEW >

// Forums //