Neurology mission(s) impossible.

Abstract

Neurologists have become increasingly engaged in global health.1 Historically, infectious disease specialists were among the first global health practitioners due to associations with tropical medicine and the prevalence of infectious diseases in resource-limited settings. This led to programs focused on individual diseases (e.g., malaria, polio, HIV, tuberculosis), often called vertical programs.2 Horizontal programs subsequently emerged, seeking to augment primary care infrastructure for the world's poorest patients and improve the conditions of poverty intimately intertwined with their diseases.2 Superimposed upon these systemic programs have been medical missions: isolated efforts in particular places for discrete time periods. While medical missions can provide beneficial contributions, they have been criticized as unsustainable, or worse, undermining local infrastructure and causing more harm than good.3–9 Such critiques note that missions may actually reinforce the health disparities and cycles of poverty they intend to ameliorate, as inadequately trained volunteers may provide ineffective, culturally irrelevant, or disparaging care that is below recognized public health standards and burdensome to local health facilities.3,4,10 The author thanks Sophia Kostelanetz, Dr. James Hudspeth, and Dr. Allan H. Ropper for comments on earlier versions of this manuscript.