Bajkiewicz, C. (2009). Evaluating short-term missioons: how can we improve. The Journal of Christian Nursing, 110-114.
The article is directed toward an audience of registered nurses but its implications and insights is applicable to any healthcare professional who engages in short term missions. This article does a great job of outlining the paradigm shift in healthcare mission service from long term to short term. The author demonstrates by reviewing the available research that the widely held belief that short term missions lead do more long term missionaries is a misconception. The article also explores the history and effectiveness of the short term mission movement specifically healthcare missions. The author does an excellent job of reviewing the relevant literature and outlines many of the problems that have been associated with short term missions (STM). The article also poses some practical strategies to improve short term mission service. The article also touches on the difference between culturally congruent and incongruent care and the associated outcomes. Based on the literature reviewed in the article, it is strongly supportive of the idea that STM benefit only the short term volunteer not the receiving community.
Bishop, R. A., & Litch, J. A. (2000). Medical tourism can do harm. Brittish Medical Journal, 1017.
This was a short expert opinion piece written by the co-directors of Kunde Hospital in the Mount Everest region of Nepal. The Hospital oversees a significant community health program. The authors describe the vast numbers of volunteer doctors that come and hold ad hoc clinics without any thought of connecting with the local health system. They also describe how these misdirected good intentions are undermining their community health projects. They explain how may teams set up and hand out medications for chronic disease and antibiotics completely oblivious to the fact that most of the patients are under their care at the local health system. They also describe the danger of worsening MDR TB because of the extremely high number of TB patients in the Kunde TB treatment program. After going to the ad hoc clinics patients think they should take the new medicine not the one from the hospital. The authours support the importance of these volunteers needing to be connected with and ideally directed by local health systems so not to undermine their work.
Crump, J. A., & Sugarman, J. (2008). Ethical considerations for short term experiences by trainees in global health. Journal of the Americal Medical Association, 1456-58.
This article defines some of the ethical considerations of sending students into developing countries to learn about global health. It is not comprehensive but is does provide a general overview of some important considerations in global health education.
Crump, J. A., & Sugarman, J. and the working group on global health training (2010). Global health training: ethics and best guidelines for training experiences in global health. Journal of The Americal Society of Tropical Medicine and Hygene, 1178-1182.
This is a much more extensive article than Crump & Sugarman’s 2008 article. It outlines some specific guideline for global health training experiences. It is a four page article that specifically addresses and outlines guidelines for sending agency, host agency and trainees. It is a significant work addressing the core issues involved with students serving in global health learning roles.
DeCamp, M. (2007). Scrutinizing global short-term medical outreach. Hastings Center Report , 21-23.
This article forces the reader to ask questions regarding the validity of short term healthcare outreach models and advocates the need for ethical guidance of Healthcare STM. It discusses research and compares its ethical framework to STM outreach.
DeCamp, M. (2011). Ethical review of global short term medical volunteerism. Health Ethics Comittee Forum , 91-103.
Mathew DeCamp is affiliated with the Johns Hopkins Berman Institute of Bioethics. In this article he outlines the need for an ethical framework for short term healthcare missions. In this article he creates a parallel between the models of research ethical oversight/ accountability and that which should be in place for STM. In this article DeCamp proposes the first ethical framework for short term healthcare missions which will likely be a road map for further work.
Dohn, A., & Dohn, M. (2006). Short term medical teams what they do well… and not so well.Evanjelical Missions Quarterly, 42(2), 216-224.
This is a thought provoking article focused on some of the major problems with STM. It does point out the areas of medical teams do well. It points out that the need for volunteer healthcare teams to focus on maximizing quality of services provided. The article also questions the idea of cross cultural health teaching can be effective and labels it as one of the things teams do not so well.
Dohn, M. N., & Dohn , A. L. (2003). Quality of care on short term medical missions: experience with a standardized medical record and related issues. Missiology: An International Review , 417-429.
This article overviews some of the medication safety and quality issues related to STM. It looks at the result of a small scale quality study of five STM healthcare groups in the Dominican Republic. It offers valuable insights into the levels of quality STM healthcare groups can or cannot provide.
Fanning, D. (2009, January 1). Short term missions: a trend that is growing. Retrieved September 12, 2011, from Liberty University Digital Commons : http://digitalcommons.liberty.edu/cgi/viewcontent.cgi?article=1003&context=cgm_missions&sei-redir=1#search=%22Short%20term%20missions%3A%20tren%20growing%22
This article offers a significant look into the scope and size of the overall STM movement; not only healthcare STM. It provides a comprehensive overview of the available relevant literature in the STM movement. It poses hard questions as to the cost, effectiveness and looks at many of the problems associated with STM. It also affirms that the research to this point has been directed toward studying the subjective experiences of the volunteers. It also affirms that very little community impact research has been done and that which has been has been less than favorable toward STM.
Garbern, S. C. (2010). Medical relief trips…whats missing? Eploring the ethical issues and the physicain-patient relationship. Einstein Journal of Biology and Medicine, 38-40.
This article won first prize in the 2009 essay contest of the Shoshanah Trachtenberg Frackman Program in Biomedical Ethics on the topic of physician patient relationship. The article clearly describes the ethical dilemma of choosing between substandard or sometimes potentially harmful care, and no care at all. It describes many of the short comings of short term healthcare missions from the lack of guidelines to ensure informed consent of medical treatment to the use of expired medications and some of the cultural barriers to providing quality healthcare in the short term cross cultural context. The article also addresses how most STM emphasize quantity of patient seen over quality of care provided.
Gorske, A. (2009, January). csthmbestpractices/ Harm from drugs in short term setting .Retrieved March 29, 2010, from The Center for the study of health in missions : http://csthmbestpractices.org/resources/Harm+from+Drugs+in+the+STM+Setting+Jan09.pdf
This paper outlines a comprehensive literature review describing why dispensing medications in the STM setting has a significant potential for harming the recipients of care in developing countries. It explains in great detail why the prescribing and dispensing of medications as part of STM teams is in itself a significant risk to patient safety. There is also a comprehensive bullet point list of why and how medications threaten patient safety in the STM setting.
Gorske, A. (2011, August ). Evidence based community health screening and education guidelines.Retrieved September 22, 2011, from http://hepfdc.info/: http://hepfdc.info/files/CHSEGuide.pdf
This document oulines the evidence base for healthfair model STM and defines some important practice guidelines for for STM groups working in community based care programs. It overview the literature that supports such models as a viable alternative to pharmacy driven STM which often violate international patient safety standards.
Grundman, C. H. (2008). Mission and healing in historical perspective. International Bulletin of Missionary Research, 185-188.
This paper which looks at the history of healthcare and medical missions. It gives some insight at to the ongoing evolution of healthcare missions.
Howell, B. M. (2009). Mission to nowhere: putting short term missions into context. International Bulletin of Missionary Research, 206-211.
This article attempts to put STM in context, tourism rather than a “Mission”. The other discusses this idea in a positive light and gives real validity to the idea that STM should be less about painting a building and more about cross-cultural learning. The article directs the reader to the idea that building cross-cultural relationships is, and should be the real mission.
Källander, K., Hildenwall, H., Waiswa, P., Galiwango, E., Peterson, S., & Pariyo, G. (2008). Delayed care seeking for fatal pneumonia in children aged under five years in Uganda: a case-series study.Geneva: World Health Organization.
This quantitative research project outlines the importance of care seeking behaviors in the fight against child mortality. It outlines some core precepts for those working in community based care in developing countries. It is the primary basis to support the need for all healthcare providers to counsel caregivers of children 0-5 about when and why to seek care for their young children.
Langowski, M. K. (2011). Global health needs and the short term medical volunteer: ethical considerations. Health Ethics Comittee Forum, 71-78.
This is another Health Ethics Committee article that highlights the need for ethical review of STM practices. It discusses in detail the increased interest of these program from both licensed practitioners and students. The authors divide healthcare STM ethical issues into two broad categories 1) those that emerge from patient and family encounters with volunteers and those that emerge from the overall affect of volunteer groups on their host communities. The article describes how over 600 agencies responded to the aftermath of the 2010 Haiti earthquake but few had any experience or relevant surgical capacity to provide needed care and follow up. The list cited reports of patients overwhelming local infrastructure with follow up care needs for amputations and other post op care needs. The article is a strong argument for ethical guidelines and regulation of Healthcare STM.
Luis, H. R. (2008). How much does quality of care vary between health workers with different levels of training? An observational multicountry study. The Lancet, 910-916.
The researchers studied IMCI implementation by health providers of multiple levels of training and found similar improvements in quality in all categories. This included IMCI trained community health workers with minimal formal education. Their recommendations were that strategies for scaling up IMCI might include providing IMCI training to health workers with much shorter training durations. The study investigated the use and adherence of Integrated Management of Childhood Illness protocols at different levels of healthcare training. Interestingly, the study seemed to show that village health workers seem to have greater adherence to IMCI protocols than did health care professionals.
Maki, J., Qualls, M., White, B., Kleefiled, S., & Crone , R. (2008). Health impact assessment and short-term medical missions. BMC Health Service Research, 1-8.
This was a health impact study directed at short term healthcare missions. It is the first real attempt to create measurable metrics by which the quality of care in healthcare STM can be evaluated. It looks seriously at STM through the lens of: cost, efficiency, impact, preparedness, education, and sustainability. It reports the findings of a study that assessed these metrics at the provider, host, organizer, and patient levels which makes it the most comprehensive published study of its kind to date.
Montgomery, L. M. (1993). Short term missions: enhancing or eroding health? . Missiology , 333-331.
This paper analyzes two healthcare STM projects in Latin America from the long term missionary perspective. The author concludes that when STM projects are assessed from the community impact perspective they have little if any positive impact, but significant potential for negative consequences. The author goes makes some suggestions to improve practice of healthcare STM. This is one of the first articles published the potential dangers and patient safety concerns of healthcare STM.
Montgomery , L. M. (2007). Reinventing short-term medical missions to Latin America. Journal of Latin American Theology, 84-103.
This is an exceptional article identifying the high risk nature and short comings of healthcare STM. The author discusses relevant characteristics of the primary healthcare in the Americas as set forth by the Pan American Health organizations in comparison to healthcare STM projects. Issues of lack of quality, sustainability or community direction were discussed. The article cites cases of medical care without documentation, and how patients in Honduras often wait for the next group coming to offer free care; instead of paying for care locally. The article also describes how healthcare STM often duplicate services already available in the community, and often treating patients that are already under the care of a local physician. Another citation in this article described how 36 % of patients interviewed one month out described sharing their medications with at least one other person including an infant.
Myers, B. L. (1999). Walking with the poor. Maryknoll, New Yourk: Orbis Books.
This book outlines the concepts central to transformational development. It has become a primary text for those studying and practicing Christian community development.
O’Neill, Daniel W., MD. 2008. Short-term medical missions: A practitioner’s perspective on effective strategies. In Effective Engagement in Short-Term Missions: Doing it Right! pp. 285-307.
This article offers some valid support for healthcare STM teams as a mission methodology, both from a theological and medical perspective. It does recognize many of the problems of STM. There is reference to older literature that supports STM increasing the number of long term missionaries and mission giving which is not supported in more recent studies. It addresses the idea of quality from the perspective of pre-trip training. As such, it offers some good suggestions to short term volunteers as to where to find training programs.
Parminder, S., Ahrens, K., Click, E., Macklin, L., Evangelista, D., & Graham, E. (2007). A model for sustainable short-term international medical trips . Journal of Ambulatory Pediatrics , 317-320.
This 2007 article appeared in the Journal of Ambulatory Pediatrics and it outlines the ethical challenges of STM projects. It describes them as often: self-serving providing value to the visitors not the community, ineffective because of the short term approach that is often culturally irrelevant, a burden to local hosts, and inappropriate because they fail to follow current standards of healthcare delivery. However, the article goes on to describe seven guiding principles used by the Children’s International Health Medical Project of Seattle to mitigate potential harm and maintain a strong ethical frame work for service.
Preist , R. J., Wilson , D., & Johnson, A. (2010). U.S. megachurches and new patterns of global missions . International Bulletin of Missionary Research , 97-104.
This article explore the shifting hub of Christianity from the global north to the global south and what impact the northern mega churches are having in that area. It cites a study that explored the sending patterns of both long term missionaries and short term volunteers and possible influences it has had on the global church.
Preist, R., & Ver Beek, K. (2005, July 5th ). Are short term missions good stewardship? . Retrieved September 13th , 2011, from Christianity Today : http://www.christianitytoday.com/ct/2005/julyweb-only/22.0.html
This discussion between Robert Priest and Kurt Ver Beek describe scope and depth of the STM movement and they probe the question of the significant cost of STM in relation to the long term impact. It also discusses some of the studies that have been done as to the change or lack thereof on participating volunteers. Much more has been published in the way of scholarly material on STM since the time of this discussion in 2005 but there remains a paucity of research specifically in the area of community impact assessments. These published discussions have significant relevance to the STM movement.
Radecke, M. W. (2010, July 13). Misguided missions. The Christian Century , pp. 43-44.
In this article the author discusses experiences of dealing with hosting mission teams that came with their own agenda. It describes the issues of guiding groups from the host perspective. It does not discuss the larger issues of dependency and paternalism.
Schneider, W. J., Politis, G. D., Gosain, A. K., Migliori, M. R., Cullington, J. R., Peterson, E. L., et al. (2011). Volunteers in palstic surgery guidelines for providing surgical care of children in the less developed world. Journal of Plastic and Reconstructive Surgery, 2477-2486.
This article outlines the patient safety guidelines for pediatric plastic surgery for surgical volunteers in developing countries. The guidelines have been reviewed and approved by: The American Association of Plastic Surgeons, The Plastic Surgery Education Foundations and the Society for Pediatric Anesthesia. The standards outline pre-trip, during and post-trip requirements, clinical practice standards and infrastructure requirements for volunteer work in plastic surgery.
Seager, G. D., & Seager, C. D. (2010, January). Sustainable short term health mission/ Operating responsible healthcare missions . Retrieved September 21, 2011, from Best Practices in Short Term Healthcare Missions : http://csthmbestpractices.org/resources/Sustainable+STHM+29Jun10c.pdf
Operating Responsible Short Term Missions is booklet written to provide some basic understanding of the potential harm and problems associated with healthcare STM. It offers real case studies of three children that died as a result of duffle bag medicine STM. It asks hard questions about methodologies/practice in areas such as medications dispensing practices, clinical standards, credentialing and much more. It attempts to point STM volunteers to established clinical standards such as IMCI.
Seager, G. D., Tazellar, G., & Seager, C. D. (2010). The perils and promise of short term healthcare missions . Journal of Christian Nursing , 262-266.
This article discusses a couple case presentations of harm related to provision of healthcare short term mission teams. It discusses the use of pharmaceuticals in the STM setting and includes evidence based list of why medications have a greater potential for harm in developed countries developed by A. Gorske in 2009. It also references some of the cultural issues affecting medication safety. It describes some basic guidelines that should be followed by STM teams in the dispensing of pharmaceuticals, and strongly advocates a health fair approach for healthcare teams seeking to engage in community based care. It also describes to promise and potential STM may hold to improve the health of communities if well done.
Soderling, M., & Butler, P. (2010). Best Practices Concensus Documents . Retrieved September 10, 2011, from Best Practices in Global Health Missions : http://www.csthmbestpractices.org/resources/Partnership.pdf
This paper reviews some of the complexities involved with establishing healthy cross cultural partnerships. The Author a long term missionary in Guatemala and OB/GYN outlines some significant adverse events he has experienced as a result of healthcare STM. He proposes a solution to many of the problems with STM with more effective and healthier partnerships. The article describes what cross cultural partnerships can and should look like, from a shared goal and vision to the building of trust.
Tavrow, P., Rukyalekere, A., Maganda, A., Ndeezi, G., Sebina-Zziwa, A., & Knebel, E. (2002). A comparison of computer based and standard training in the Integrated Management of Childhood Illness in Uganda. Washington D.C.: USDAID and University Reseach Quality Assurance Project.
The researchers studied 120 clinicians and nurses who provided child health care and desired IMCI training volunteered for the study. “Stratification was done by type (clinician, registered nurse, enrolled nurse), and they were randomly assigned to either the standard or CBT (computer based training) group.” The study demonstrated computer-based training of IMCI was as effective as standard training, but costs significantly less. Both the standard curriculum and the CBT training had equivalent effects on trainees. The clinical practice and knowledge retention after 3-4 months were equivalent. The CBT course was shorter, cost less, and did not require the use of as many facilitators.
Tazelaar, G. (2011). Challenges and trends in global healthcare missions . Journal of Christian Nursing , 152 – 157.
This article was directed toward a nursing audience in the Journal of Christian nursing however it has wide reaching implications across all healthcare mission fields. It discusses some important challenges in healthcare STM and four primary trends in healthcare STM. It describes the trend moving away from curative care toward community based care models, and moving away from practicing to teaching. The third trend the author describes is moving away from leading to following and last, moving away from long term to short term.
The US Consumer Product Safety Comission. (2005). Poison Prevention Packaging:A Guide For Healthcare Professionals. Washington D.C. : The US Consumer Produce Safety Comission.
This is an important document that describes important legislation dating back to the 1970’s requiring dispensing of potentially toxic medication in child resistant containers. It is relevant because STM to date have resisted this basic safety measure to improve child safety in the communities they serve. This piece of literature is used to support the need for this practice in developing counties as well as our own. I also supports the ethical question of why STM groups often feel it is OK to provide care that is less safe to the children in developing countries than is legally required in their home country.
Van Engen, J. (2000, January & February). The cost of short term missions . The Other Side , pp. 20 – 23.
In this article the author outlines a solid argument questioning the financial cost of all STM. It explains the now billions of dollars per year could be used much more efficiently and with a lasting community impact unattainable by STM teams.
Ver Beek, K., & Preist, R. (2005, July 6th ). Christianity Today . Retrieved September 13th , 2011, from Do short term teams change anyone? : http://www.christianitytoday.com/ct/2005/julyweb-only/32.0.html
This discussion between Robert Priest and Kurt Ver Beek describes scope and depth of the STM movement and how despite its enormity is has largely escaped the study of academic scholars. It also discusses some of the studies that have been done as to the change or lack thereof on participating volunteers. Much more has been published in the way of scholarly material on STM since the time of this discussion in 2005 but there remains a paucity of research specifically in the area of community impact assessments. These published discussions have significant relevance to the STM movement.
Wall, L. L. (2011). Ethical considerations by volunteer surgeons on vulnerable patient groups: the case of women with obstetrical fistulas. Health Ethics Forum, 115-127.
This article reviews the ethical considerations of STM volunteerism; it strongly advocates the application of research ethics standards for STM. The article proposes the idea that STM volunteerism is only good if conducted within the context of stringent ethical framework. It describes how the populations served by STM programs are frequently the poor and marginalized who are unable to advocate for themselves. As such the same research ethical guidelines that apply to research also apply to healthcare STM. This article presents one specific population served by STM volunteerism, women with obstetrical fistulas, however it has application for all of STM.
Warner, D. (1993). International peoples health council. The life and death of primary health care; the Mcdonaldization of Alma Ata (pp. 1 – 10). Dworp, Belgium : International Peoples Health Coucil, Northern Region.
This is a transcription id a talk given by David Warner the author of “Where There is No Doctor”. It was given in 1993 when a great deal focus was on the Alma Ata declaration of Health for All by 2000.