During three years as a community health educator with the Peace Corps in Cambodia, I saw health promotion projects succeed and fail. In one, I partnered with nurses and midwives to establish cooking sessions for new mothers in making weaning porridge. While the women were happy their infants liked the porridge, the project failed to gain traction: among other reasons, some mothers felt embarrassed to purchase the cheaper vegetables used for the porridge because they were considered "poor people's food." I also worked alongside a non-governmental organization (NGO) to promote long-term contraceptive use. The project became successful because of local interest and stable funding. In both cases, I befriended the community, learned of its perceived needs, and attempted to address them. I also discovered how much I still needed to learn at the end of three years.
Every year, the number of short-term medical missions (STMMs) in low- and middle-income countries increases. The stated purpose of such missions is for participants to gain experience in health care within a global context while giving back to the communities in which they volunteer. However, there's little quality research on these missions, which typically last less than one month. A literature review by Martiniuk and colleagues (BMC Health Services Research, 2012) found that the majority of articles on this topic were descriptive and lacked analysis of the ethical, theoretical, or contextual frameworks or of project outcomes. In the absence of clearly articulated intentions and approaches, how can we be sure that STMMs won't have unintended long- or short-term consequences?
Aside from my own projects in Cambodia, I had a chance to observe other STMMs that provided direct health care solutions for acute problems in ways that could be more or less beneficial and sustainable. In one successful model, Operation Smile, oral surgeons and other providers would come for a couple of months to perform cleft palate surgeries.
Other STMMs provided direct care in ways that were less sustainable. One group brought various antibiotics that were meant for short-term treatment, but there was no comprehensive plan for patients to follow once the mission ended. This can be problematic in cases of therapeutic failure or antibiotic resistance. Poorly designed missions like this one may inflate the moral rectitude and resumes of young health professionals at the expense of communities.
Some would argue that on the whole STMMs are achieving a net good. But too many are characterized by inadequate consideration of their long-term impact on communities. Should we cease and desist in our mission as health professionals to care for the citizens of our globe? Of course not. However, we shouldn't engage in a project simply because it feels right. Keeping in mind the following two observations might help:
* STMMs can be problematic when there is no existing structure in place (such as an established clinic or NGO) and students/providers implement care measures (particularly involving medications) that community members have no way of continuing to receive after students/providers leave the area.
* STMMs can be particularly useful when there is already an existing structure in place to enable sustainability, in which case the experiences of students and providers may be analogous to doing clinical rotations or volunteer care hours, respectively.
I would argue for fewer STMMs and more long-term options with sustainable results. This requires a systematic approach in planning, implementation, and evaluation. In addition, programs should identify local individuals who may already have the skills necessary to sustain interventions as well as ongoing communication. If we desire to take our skills abroad, we must commit to the communities in which we serve.