International Mission Trip Research Articles

Abstract 11: The Gender Disparity in Global Plastic Surgery Mission Participation

Background: Plastic surgery is integral to global surgery; however, not all plastic surgeons are equally represented in this effort, with women only representing 18.7% of plastic surgeons who participate in international mission trips.1 The present study aims to identify gender barriers to participating on surgical mission trips by surveying members of the American Cleft Palate Association. Methods: A validated survey methodology with neutral, fact-based questions was implemented through Google Forms. The google form link was distributed by an administrator in the American Cleft-Palate Association (ACPA). Questions included demographics, non-identifying surgeon-specific information, and potential barriers in participation. Responses were analyzed using GraphPad Prism 8.1.2. Results: One hundred-fifty-one plastic surgeons responded to the distributed survey, resulting in a 27.45% response rate. Respondents consisted of 118 (78%) males and 33 (22%) females, with 77 (51%) under the age of 55 years old. One hundred twenty-one (80.13%) were married, and 129 (85.4%) had children, with an average number of 2.5 children. All respondents were plastic surgery trained, with 6 (3.92%) having additional training in otolaryngology and 2 (1.3%) having additional training in oral surgery. One-hundred-seventeen (77.5%) of respondents were fellowship trained. One hundred-thirty-four (88.74%) respondents reported previously having been on mission trips, with 77 (51.0%) having previously been on more than 5 mission trips and 107 (70.4%) having been on a mission trip less than 5 years ago. More men reported prior experience on mission trips as compared to women (92.2% vs. 78.8%, p<0.05), with no significant difference in men vs. women reporting mission trip experience in the last 5 years (72.0% vs. 66.7%, p>0.05). Forty-three percent of respondents with prior mission experience reported no institutional support, and of those who did not receive institutional support, there were significantly more men than women with children (p<0.05). Eight women (24.24%) reported barriers surrounding pregnancy and lactation, with 4 of those participants reporting significant barriers due to Zika. Conclusion: The present study should provoke future initiatives to encourage female plastic surgeon participation through initiatives that aid female participation during reproductive years and initiatives that enhance institutional support.

The Lived Experiences of Students and Faculty of a Christian College who Participated in a Short-term International Mission Trip

Short-term international mission trips (STIMTs) are increasing in popularity. Likewise, educators and health care workers are increasingly concerned with obtaining an understanding that improves culturally competent care. The purpose of this study was to investigate the lived experiences of participants of a Christian college who travelled on a short-term international mission trip (STIMT). One openended inquiry guided the interviews: How would you describe your experience as a participant who travelled on a STIMT? An in-depth, oneon- one interview of participants occurred until data saturation was reached. Colaizzi’s strategy was used to analyze and organize the data. Leininger’s sunrise model was used to guide this study. Themes that emerged from this study included cultural adaptation, relationships, spiritual factors, and personal gain.

Recommendations for planning short-term nursing student mission trips

Cultural immersion and service learning are effective pedagogical tools to support the development of cultural competence among nursing students. An international mission trip incorporates these concepts and provides an opportunity for students to broaden their understanding and skills. A review of the literature demonstrates a significant gap surrounding the process used to successfully plan such a trip. Within the context of a small private college, data from an exemplar project help to identify protocols for planning a successful short-term international mission trip. An appropriately planned short-term cultural immersion mission trip allows nurse educators and participants to achieve their personal and educational goals for the trip, while providing much-needed healthcare aid to residents and staff in impoverished and underserved areas.

Service Learning Initiatives in Rural Populations: Fostering Cultural Awareness

This article focuses on the implementation of service learning initiatives with rural populations to foster cultural awareness within undergraduate nursing students. The results of student reflections and how they relate to increased awareness of global rural health, cultural awareness, and health disparities is presented. Objectives: (1) To describe an international service learning project conducted through a short-term medical mission to the United Republic of Tanzania for Baccalaureate nursing students; and (2) explore student observations and perceptions regarding culture and health in a rural community. Overall, we hope to gain information about the impact of student experiences regarding international service learning, rural health, and cultural perspectives and awareness. Methods: The study used the qualitative method of reflective journaling to investigate student observations and perceptions during a medical mission trip regarding culture and health in an international rural community. Journals were analyzed using content analysis and thematic identification. Results: Student reflections revealed themes of increased awareness in global cultural differences, interprofessional relationships, compassionate care, and health disparities in a variety of rural settings. Students who participated in service learning initiatives within these international medical trips stated they were more globally aware and were now more likely to provide services to rural communities in their future nursing careers. Conclusions: This SL project effectively evaluated the benefits of a short-term international mission trip. Study results showed student benefits of increased awareness of community needs, decreased stereotyping, increased confidence in working with culturally diverse populations, and increased personal and professional growth for cultural competence. We identified a need to include and develop core interprofessional education competencies in future trips. Keywords: Rural, Rural health, Service-learning, Medical mission, Cultural competence DOI: http://dx.doi.org/10.14574/ojrnhc.v18i1.506

Introduction of the American Academy of Facial Plastic and Reconstructive Surgery FACE TO FACE Database.

The American Academy of Facial Plastic and Reconstructive Surgery FACE TO FACE database was created to gather and organize patient data primarily from international humanitarian surgical mission trips, as well as local humanitarian initiatives. Similar to cloud-based Electronic Medical Records, this web-based user-generated database allows for more accurate tracking of provider and patient information and outcomes, regardless of site, and is useful when coordinating follow-up care for patients. The database is particularly useful on international mission trips as there are often different surgeons who may provide care to patients on subsequent missions, and patients who may visit more than 1 mission site. Ultimately, by pooling data across multiples sites and over time, the database has the potential to be a useful resource for population-based studies and outcome data analysis. The objective of this paper is to delineate the process involved in creating the AAFPRS FACE TO FACE database, to assess its functional utility, to draw comparisons to electronic medical records systems that are now widely implemented, and to explain the specific benefits and disadvantages of the use of the database as it was implemented on recent international surgical mission trips.

The Role of the Away Rotation in Otolaryngology Residency.

Objective To determine the availability and purpose of away rotations during otolaryngology residency. Study Design Cross-sectional survey. Setting Otolaryngology residency programs. Subjects and Methods An anonymous web-based survey was sent to 98 allopathic otolaryngology training program directors, of which 38 programs responded. Fisher exact tests and nonparametric correlations were used to determine statistically significant differences among various strata of programs. A P value of <.05 was considered statistically significant. Results Thirty-nine percent (n = 38) of queried programs responded. Mandatory away rotations and elective away rotations were both present in 6 of 38 programs (16%). Neither number of faculty ( P = .119) nor residents ( P = .88) was predictive of away rotation. Away rotations were typically >151 miles from the home institution and typically used to address deficiencies in clinical exposure (67%) or case volume (50%). Participants of mandatory away rotations were universally provided housing, with other consideration such as stipend (33%), relocation allowance (33%), or food allowance (16%) sometimes offered. In contrast to mandatory rotations, half of elective rotations were to obtain a unique international mission trip experience. Nearly one-third of surveyed program directors (29%) would consider adding an away rotation to their curriculum in the next 3 years. Conclusions Mandatory and elective away rotations play a role in a small, but not insignificant, number of training programs. The rationale for these rotations is variable. Given that nearly one-third of program directors would consider adding an away rotation in the near future, further research into components of a meaningful away rotation and how to optimize the away rotation experience is warranted.

Does Theory Translate in the Trenches of Short Term Mission Work?

Despite numerous criticisms in the literature on the ethics and sustainable outcomes of short term international mission trips, there can be positive outcomes for volunteers and for recipients of short term mission care efforts. Utilizing a theoretical framework that addresses efforts to promote sustainability can lead to a structured, productive, and satisfying experience. With effective host country partnerships and an organized model of care delivery, international mission volunteers can provide highly effective health care services that are specific to the health and cultural needs of the host community.

The Present Status of Global Mission Trips in Plastic Surgery Residency Programs.

The present status of global mission trips of all of the academic Plastic Surgery programs was surveyed. We aimed to provide information and guidelines for other interested programs on creating a global health elective in compliance with American Board of Plastic Surgery (ABPS) and Accreditation Council for Graduate Medical Education Residency Review Committee (ACGME/RRC) requirements. A free-response survey was sent to all of the Plastic Surgery Residency program directors inquiring about their present policy on international mission trips for residents and faculty. Questions included time spent in mission, cases performed, sponsoring organizations, and whether cases are being counted in their resident Plastic Surgery Operative Logs (PSOL). Thirty-one programs responded, with 23 programs presently sponsoring international mission trips. Thirteen programs support residents going on nonprogram-sponsored trips where the majority of these programs partner with outside organizations. Many programs do not count cases performed on mission trips as part of ACGME index case requirement. Application templates for international rotations to comply with ABPS and ACGME/RRC requirements were created to facilitate the participation of interested programs. Many Plastic Surgery Residency programs are sponsoring international mission trips for their residents; however, there is a lack of uniformity and administrative support in pursuing these humanitarian efforts. The creation of a dynamic centralized database will help interested programs and residents seek out the global health experience they desire and ensure standardization of the educational experience they obtain during these trips.

Resident Participation in International Surgical Missions is Predictive of Future Volunteerism in Practice.

BackgroundInterest in global health and international mission trips among medical student and resident trainees is growing rapidly. How these electives and international mission experiences affect future practice is still being elucidated. No study has identified if participation in international surgical missions during residency is a predictor of participation in international surgical missions in practice after training completion.MethodsAll trainees of our plastic surgery residency program from 1990 to 2011, during the implementation of optional annual international surgical missions, were surveyed to determine if the graduate had gone on a mission as a resident and as a plastic surgeon. Data were compared between graduates who participated in missions as residents and graduates who did not, from 1990 to 2011 and 1990 to 2007.ResultsOf Plastic Surgery graduates from 1990 to 2011 who participated in international missions as residents, 60% participated in missions when in practice, versus 5.9% of graduates participating in missions in practice but not residency (P<0.0001). When excluding last 5 years, graduates participating in international missions in practice after doing so as residents increases to 85.7%, versus 7.41% who participate in practice but not residency P<0.002.ConclusionsResults reveal plastic surgeons who participate in international surgical missions as residents participate in international surgical missions in practice at higher rates than graduates who did not participate in missions during residency. International missions have significant intrinsic value both to trainee and international communities served, and this opportunity should be readily and easily accessible to all plastic surgery residents nationwide.

Jamaican a difference: A grassroots approach by pharmacy students to develop an international service learning experience

ObjectiveTo describe the implementation process of an international mission trip led by a pharmacy student and its acceptance as an introductory pharmacy practice experience (IPPE) at the University of Rhode Island. MethodsMustard Seed Communities (MSC), a non-profit, Catholic organization, was selected as the mission sponsor by the student leader based on previous travel experience on non-medical missions. Educational needs of the specific communities were identified and included medication management, basic physical assessment, and treatment of human immunodeficiency-infected pediatric patients. A mission team established by the student leader a year prior to travel worked to develop educational resources and fundraise. Faculty created a post-mission, student survey based on Accreditation Council for Pharmacy Education (ACPE) criteria for an IPPE to assess the acceptability of the pharmacy mission as an approved international service learning experience. ResultsThree workshops were delivered to the MSC caregivers by 11 pharmacy students and a pediatric faculty member. Educational sessions and interactions with children and caregivers gave students opportunities to provide medication counseling and expand their drug knowledge. Survey outcomes demonstrated ACPE service learning and pre-Advanced Pharmacy Practice Experience (APPE) skills guidelines, including communication, counseling, and medication information, and were satisfied. ConclusionThe implementation of an international service learning experience in the curriculum was successful. Through a student-led mission, pharmacy students were able to foster IPPE practice-based skills by working with the MSC children and caregivers.

Geographic differences in perioperative opioid administration in children

To investigate whether geographic differences exist in perioperative opioid administration to children. To investigate whether perioperative fentanyl use for cleft lip and palate surgery varies between children of three different geographic regions. Differences have been found in perioperative opioid administration to children of differing ethnicity in the USA. Whether similar differences exist in perioperative opioid administration to children residing in different geographic regions is unknown. We retrospectively reviewed the medical records of ASA I children who underwent surgery under standardized general anesthesia between January 2010 and April 2011 during SMILE Network International mission trips to Africa, India and Central and South America. Perioperative administration of fentanyl was compared between these three locations. We analyzed data from 79 children who underwent surgery in Africa, 76 in India and 153 in Central and South America. Children in Central and South America were given <50% of the intraoperative amount of fentanyl (2.0 ± 1.2 mcg·kg(-1) ) administered to children in Africa (4.1 ± 2.4 mcg·kg(-1) ; P < 0.001) and children in India (4.3 ± 2.2 mcg·kg(-1) ; P < 0.001). Postoperatively, fentanyl was administered in equivalent doses to all groups. Children in Central and South America received less opioid intraoperatively than African and Indian children, under standardized anesthesia for cleft surgeries. Further research is necessary to elucidate the mechanisms underlying these group differences.

Volunteers in Plastic Surgery Guidelines for Providing Surgical Care for Children in the Less Developed World

Many international volunteer groups provide free reconstructive plastic surgery for the poor and underserved in developing countries. An essential issue in providing this care is that it meets consistent guidelines for both quality and safety-a topic that has been addressed previously. An equally important consideration is how to provide that care in an ethical manner. No literature presently addresses the various issues involved in making those decisions. With these ethical considerations in mind, the Volunteers in Plastic Surgery Committee of the American Society of Plastic Surgeons/Plastic Surgery Foundation undertook a project to create a comprehensive set of guidelines for volunteer groups planning to provide this type of reconstructive plastic surgery in developing countries. The committee worked in conjunction with the Society for Pediatric Anesthesia on this project. The Board of the American Society of Plastic Surgeons/Plastic Surgery Foundation has approved the ethical guidelines created for the delivery of care in developing countries. The guidelines address the variety of ethical decisions that may be faced by a team working in an underdeveloped country. These guidelines make it possible for a humanitarian effort to anticipate the types of ethical decisions that are often encountered and be prepared to deal with them appropriately. Any group seeking to undertake an international mission trip in plastic surgery should be able to go to one source to find a detailed discussion of the perceived needs in providing ethical humanitarian care. This document was created to satisfy that need and is a companion to our original guidelines addressing safety and quality.

Perioperative opioid requirements are decreased in hypoxic children living at altitude

To investigate the effect of altitude on perioperative opioid requirements in otherwise healthy children. To investigate whether children living and having surgery at high altitude received different doses of fentanyl than those living and having surgery at sea level. Recent studies in animals (Anesthesiology, 105, 2006 and 715) and children with obstructive sleep apnea (Anesthesiology, 105, 2006 and 665; Anesthesiology 100, 2004 and 806) suggest that analgesic effects of exogenous opioids are enhanced by hypoxia. However, the effects of hypoxia on perioperative narcotic requirements in otherwise healthy children have not been previously reported. We reviewed retrospectively the opioid requirements of pediatric patients who underwent cleft lip or palate surgery during Smile Network International mission trips to Cusco and Lima, Peru between 2007 and 2009. Patients who had surgery at high altitude were compared to those who had surgery at sea level. All patients received a standardized anesthetic with intravenous fentanyl as the only perioperative opioid. Hundred and two patients had surgery at 3399 m above sea level (masl) (Cusco) and 169 patients had surgery at 150 masl (Lima). Patients at high altitude had significantly lower baseline oxygen saturations (92 ± 4% vs 98 ± 3%; P < 0.001) and received 40% less opioid (1.2 ± 0.8 vs 2.0 ± 1.4 μg·kg(-1) per h; P < 0.001) compared to patients at sea level. Opioid administration was reduced in otherwise healthy children with altitude-induced chronic hypoxia when compared to non-hypoxic children undergoing similar operations under similar anesthetic regimens. Whether this difference is due to altitude or altitude-induced hypoxia, requires further study.

Cultural Identity and Reentry in Short-Term Student Missionaries

This study explores the relationship between cross cultural reentry and cultural identity in college student participants in short-term international mission trips. Twenty undergraduate students from a Christian college participated in focus groups discussing the question, “How did your experiences on your trip(s) influence your view of your home culture?” The discussion transcripts were coded, and analyzed according to (a) frequency, the number of times a theme was addressed; (b) extensiveness, the number of people who discussed a theme; and (c) intensity, the emotional strength of a response (Krueger, 1998). Negative reactions to home culture were the most frequent, extensive, and intense themes, followed by themes related to cultural awareness and personal growth. Other themes addressed adjustment and positive reactions to home culture. The findings imply that participants in short-term mission trips experience challenges to cultural identity, characterized by negative reactions. Recommendations for sending missions agencies are provided.