STMs

1. STMs Organizing and involving yourself in trips that will have a lasting impact

2. 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

3. 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

4. Why STMs Healthcare professionals want to help but for a variety of reasons they are unable/unwilling to put forth a long term commitment

5. 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?

6. 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

7. Why can’t we keep doing it this way? Harm from medications

8. 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

9. 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

10. 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

11. 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

12. 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”

13. 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

14. 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?

15. 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 developmentis needed causes harm

16. 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

17. 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

18. 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

19. 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

20. 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

21. Key areas • HIV/AIDS • Maternal mortality • Infant/pediatric mortality

22. 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

23. 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

24. Health fair BP and glucose measuring and documenting HIV testing/counseling HIV anti-stigma education Optical programs

25. 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

26. 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

30. How to find out more? • Attend conferences • Inmed.us • Kansas City May 31-June 1 • Louisville, KY each November • International section of specialty organizations

31. What is poverty Lack of material resources Oppressive relationships Unjust government systems Lack of opportunity

32. 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 CandiSeagar, 2010 Harm from Drugs in Short-Term Missions-Arnold Gorske, 2009