Towards a more effective model: the example of Dr Nestor Salivarria

I have been encouraged to economize the length of these postings so today I hope to keep it to only a couple of paragraphs. I know you all are very busy people. 

Today we come to the halfway point in video #2 (minutes 4:10). The example of Dr Nestor Salivarrias. The producers have moved to a completely different part of Honduras from where the AIM had been working. Dr Nestor is a pediatrician who has been working in this clinic in Olancho for 22 years. He has stopped hosting STMM’s saying they are too costly and have little to no long term positive effect on the health of the people. He instead utilizes Honduran doctors and if any foreigners come to work in this area they are specialists and not primary health professionals. But a comment was made that Dr Salivarrias felt the medical “brigades” (we call them jornadas in Guatemala) were helpful at first in raising awareness and “spreading the word” about his clinic.

This is a comment that I have heard my associate (the medical director of Salud que Transforma in Guatemala) Dr Erick Estrada make several times recently. I am always concerned that he gives in to the temptation of hosting STMM’s at the cost of losing our long view approach to our community health/development initiatives. But it seems one of the most valuable aspects in his mind, and it seems in the mind of Dr Salivarrias, of STMM’s is that it can, in a helpful way, raise awareness of a locally run and administered health initiative. Can we consider this then a “BEST PRACTICE” principle for STMM’s? Short term medical mission teams can be effectively used to raise awareness of locally initiated and administered healthcare initiatives. What would this require to be successful? Does anyone have some positive examples of this working in other places around the world? What other positive aspects do we find in the model used by Dr S?

Appropriate use of medications

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Greetings once again from the Zeal With Knowledge blog, a ministry of the Best Practices in Global Health Missions group and the CenterforHIM. This posting is going to make a slight diversion from the vision360 video series and will focus on an important topic that has come up in some recent discussions stemming from a presentation by Dr Peter Yorgin at the recent National Short Term Missions conference in Tucson.In his excellent presentation Dr Yorgin builds on the  7 Standards of Excellence  as developed and promoted by the ministry of the same name. (see SOE) An important point made has to do with medications which are brought in from outside the host country and which the STMM team will be passing out to the patients they see during their stay. Most countries have laws on the books pertaining to this practice and to the best of my knowledge most require that the incoming meds be not less than one year from their date of expiration. If that is the case can we then justify bringing in medications whose date of expiration is less than what the law permits? We have had some feedback on this question already and there are points to be made from both those who think its OK and those who think we should follow the laws that govern the nations in which we are working.

Here is one comment made by a good friend of the CenterforHIM, “

For medicines… one year shelf life really isn`t realistic especially if bringing in small quantities.. I would tend to say 3-6 months would be ok if plan to use during the visit or shortly after.” I know this is consistent with the way the majority approach this question. But it is the right approach? Here is another quote from someone who is involved in frequent STMM’s, “Some items in the slides (referring to Dr Yorgin’s PowerPoint), like requiring the meds to have at least one year before expiration, do not seem reasonable to me. We only give out small supplies of meds to each person, and never take expired meds, and never take meds which have been issued to other people, but requiring meds to have at least one year before expiration means we can’t use our resources wisely to get discounted meds that are due to expire in 3-4 months. I almost always take these discounted meds on my trips. Of course, a team could always make this their own requirement if the Medical Team Leader felt strongly about it and had the resources.”An important point that needs to be made is that all such STMM’s are going to be operating within a context where there are LAWS that are supposed to govern the actions of people who not only live in that country but who come from outside the host country to work and do good things for people who are suffering and disadvantaged. And we all are aware of the high levels of corruption that exists in most of these countries. And we are quick to criticize such corruption and other breaches of the law but we don’t seem to have a problem with breaking the law when it comes to this point about expiration dates on meds. What signal  does that send to those we are going to work with and to those who are supposed to be upholding the laws of the land? As Christians are we not called to set the bar at the highest level when it comes to how we carry out our work in foreign countries? Our standards must be such that they meet or preferably exceed those which the world (in this case secular governments) has set for itself. 1 Peter 2: 13-15 says “ Therefore submit yourselves to every  ordinance of man for the Lord’s sake, whether to the king as supreme, or to governors, as to those who are sent by him for the punishment of evildoers and for the praise of those who do good. For this is the will of God, that by doing good you may put to silence the ignorance of foolish men –

One argument made is that purchasing meds in country is too risky in that we cannot always count on the quality being what we think it should be. If that is the case then shouldn’t we discuss this with our in country partners and figure out how we can help assure that in country meds are of an acceptable quality? Is it not possible that in doing so we help establish services in country that test meds and assure that acceptable standards exist and are being enforced? Wouldn’t this help elevate the level of healthcare for all in that country?

What then can be done with all the meds that are still good though they are say within 3-6 months of their expiration date? My first thought centers on pharmaceuticals produced in the US. Would it not be better that these meds be given to health clinics serving the nations poor? If this is not happening, why not? Surely there are sufficient needs in the inner cities of most every state in the US.

But let’s say we want to continue using such meds on STMM’s. Would  it not make sense to have our in country partners contact and work with the in country authorities to gain approval of the use of such meds on a short term basis? That way we would show respect for the law and for the authority of these governmental workers. What a witness we could be. And would it not be a good thing to make at least a portion of what we bring in available to those who work in very difficult situations in governmental hospitals and clinics? Again, in doing so we would be a strong and effective witness to an unbelieving world. We welcome your feedback and comments. Also check out this excellent source online: http://www.cpfi.org/assets/docs/c-and-p/cp_2011v14_1_p6-11.pdf

Find Us Some Poor People to Help

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Grettings again from the ZealWithKnowledge blog. We seek to infuse the zeal Christian’s have to meet the needs of the poor with knowledge on how most effectively to do it. We don’t claim to have all the answers and instead seek to learn together how to most effectively relieve the suffering in this world especially as it applies to the health side of the development equation. This week we will again use the award winning “Evangelical Tourism” video series to pin point an issue to highlight. We are now on video two of the series and we don’t need to go very far to reach an important topic to discuss. 

At just 48 seconds into the video we are told “Pastor Jorge Duran finds poor people for AIM (Adventures in Missions) to help.” Pastor Duran goes on to say how he is happy (or content would be a more literal translation of what he actually says) because it is a group of Christians who come to share the love of Christ and the people (those that will receive treatment during the week) need to see this. 

I don’t know if this strikes anyone else as being a bit troubling but it does give me cause for concern. It is good to hear directly from the pastor who is assisting this group but is it really the job of a pastor to be looking for poor people for this group to “help?” The pastors I know in the country in which I serve have an awful lot on their plates already, not the least of which is to help their congregants understand that his job is to equip them to do the work of spreading the good news of Christ among their family, friends and neighbors. The vast majority of pastors in Central America have little theological training and minimal knowledge when it comes to the wholeness of what the Church is called to be in this world. Enrolling pastors to be our tour guides and logistics person is a terrible misuse of the human resources He has given His Church. Admittedly the video doesn’t give us much information about the rest of the local churches involvement so I make comments from a limited understanding but my experience has been consistent with what I have critiqued above.

If we recall how Jesus and then His disciples/apostles (primarily Paul) went about spreading the good news of the coming of the kingdom we never encounter them waiting to bring in the big guns (in this case the NorthAmerican group riding in on their big white horse-or in a big yellow bus) in order to get a foot in the door to a community. This is how it has been explained to me in my own setting. Pastors like to use groups from outside the country in order to attract more people and to make it more likely they’ll get a foot in the door of a difficult community. I just don’t see how that is biblical. When I hear this explanation the first thing that comes to mind is “Why is that pastor or his church finding it so difficult to enter a particular community?” What is the history of this community and why might it be so difficult to enter in? What about the church our pastor friend is sheparding and what about the pastor himself? Is it a healthy church whose members truly demonstrate the love of Christ to all or does it have struggles that are making it a poor example thus making the unreached community more resistant? Is this pastor a true servant or have we been duped into helping someone who simply knows the right things to say to the foreigners to get them interested in a project that primarily benefits the pastor and makes him look good?  Difficult questions to be sure but believe me I don’t bring up these types of questions without some knowledge that this is exactly what happens in some instances.  But once we understand more thoroughly what is usually a very complex situation we can better help this pastor and his church strategize how to make an effective entry. How often do we approach our attempts to spread the good news by asking such probing questions? Not very often I dare say.

There is so much more that could be said but as blog entries are not chapter in books I must keep it short. For example another important question that comes to mind is what does it reinforce in the minds of the local communities when they see the local church bringing in outsiders who stay for a week, see lots of people in the clinic, and then leave? Seems to me it reinforces the common belief that little gets done right unless someone from outside comes in to help. This reinforces the fatalistic worldview that most of the worlds poor have and tragically continues the cycle of dependency that so plagues so many of our efforts at helping the poor live healthier lives.