Medical Brigades Research Articles

Clinical guidelines for Western clinicians engaged in primary care medical service trips in Latin America and the Caribbean: an integrative literature review.

Participation in primary care-focused medical service trips (MSTs) by North American providers is increasingly common, with many of these being conducted in Latin America. The literature has yet to comprehensively explore the nature of MST practice, including the use of evidence-based clinical guidelines. This integrative review presents an analysis of guidelines employed in MSTs in Latin America. MEDLINE and LILACs were searched using the terms 'medical brigades', 'Latin America', 'primary health care' and related terms. The search was limited to articles published between 2000 and 2015 in any language. Qualitative or quantitative articles were subsequently included if they described management protocols in the context of patient care on an MST occurring in Latin America. Additional publications were identified by searching the citations of articles reviewed in full. Themes were extracted to an Excel file, and objective instruments were used to evaluate article quality (Mixed Methods Assessment Tool) and the quality of guidelines (Appraisal of Guidelines for Research & Evaluation II). Of 391 abstracts screened, eight met inclusion criteria. All described MSTs operating in rural settings in Central America. Five were qualitative descriptive, including two travel reports, an ethics thesis paper, and a description of a dermatologic MST. Four described subjective clinician experiences while describing non-evidence-based treatment suggestions or practices. Only one described evidence-supported primary care interventions. Three studies were quantitative descriptive, including two epidemiological articles, one of which used case definitions for select diagnoses. One described the application of American Family Physician guidelines to the description of UTI prevalence on a MST. Article scores in MMAT quality domains were variable, and only one article achieved a positive overall AGREE II score for guideline quality. Existing literature demonstrates minimal development or use of clinical guidelines on MSTs in Latin America. Future work must focus on the development, implementation, and evaluation of culturally sensitive, evidence-based guidelines for the management of patients receiving care from MSTs.

Medical Brigades and Global Health

Recently, recommendations have been made that global health initiatives change their focus from disease specific intervention to bolstering health systems and general health care. The aim of this is to ultimately increase access to primary care, clean water, education, hygiene, and prevent malnutrition, among other goals. While many major global health initiatives have followed this trend, so have many smaller scale programs including short term medical brigades. Despite a trending increase in the number of privately run short term medical brigades, until recently, little research has been done on the potential positive and negative effects that can arise from such programs. Now, guidelines have been initiated to create well-structured programs. When followed, these smaller scale initiatives can be successful in helping increase access to healthcare, sustainably strengthening communities in terms of general health. While recent legislation in the United States has addressed domestic policy in the Patient Protection Affordable Care Act of 2010 (ACA), the ACA should also consider some of the basic “sustainable” policies being implemented by international health care providers.

Primary Care Provision by Volunteer Medical Brigades in Honduras: A Health Record Review of More Than 2,500 Patients Over Three Years

The weak health system in Honduras contributes to poor health indicators. To improve population health, a number of volunteer medical brigades from developed countries provide health services in Honduras. To date, there is little information on the brigades' activities and impact. The primary objective of this article is to increase understanding of the type of health care provided by voluntary medical brigades by evaluating and presenting data on patients' presenting symptoms, diagnoses, and care outcomes. The article focuses on an ongoing medical brigade organized by Canadian health professionals in conjunction with Honduras' largest national non-governmental organization. This is a descriptive study of data that are routinely collected by volunteer Canadian health care professionals. Data on all patients presenting to temporary primary health care facilities across Honduras between 2006 and 2009 were analyzed. The data were used to analyze patient demographics, presenting symptoms, diagnoses, and treatments. We found that the brigades provide additional human resources to the relatively weak Honduran health care system. However, while brigades may increase solidarity between Hondurans and Canadians, concerns persist regarding cost-effectiveness and continuity of care for conditions treated by short-term brigade volunteers. Greater scrutiny is needed to increase brigades' effectiveness and ensure they are supportive of domestic health systems.

Teamwork and Program Organization in Developing Countries

Establishment of congenital heart surgery programs in developing countries is often impeded by competition among providers for scarce resources and opportunities. To avoid this problem, the authors have sought to focus program development on a domestic medical team that includes a visiting North American surgeon. A leadership group was formed consisting of a domestic cardiologist and surgeon, the visiting surgeon, and leading local benefactors. Surgery was initiated beginning with closed cases, and the volume and complexity were gradually increased. The team was mentored by the visiting surgeon, and full medical brigades visited periodically. All members of the leadership group interacted with local health care providers, missionary groups, and visiting medical teams from international organizations, aiming to develop a single congenital heart surgery center. Over a period of 3 years, 185 children have been operated on and the team has progressed to do more complex open and closed cases. Overall mortality is 6.5%. Actively working with the program are 3 of the 5 local pediatric cardiologists, 2 of 4 pediatric intensivists, the only pediatric perfusionist, and the only active pediatric heart surgeon. Three additional international organizations currently participate in program development. Fundraising by the domestic nonprofit organization has increased approximately 20-fold in 5 years, and the program has been evaluated and approved by the government-based health insurance program. Focusing program development around a domestic leadership team allows coordination of patient referrals and resources, which contributes to excellent patient care and program sustainability.

THE RESULTS OF EXAMINATION OF MEDICAL CARE QUALITY FOR ASSOCIATED VERTEBRO-SPINAL-CORD INJURY

Medical care quality assessment for patients with vertebro-spinal-cord injury at different stages in St.-Petersburg during year was performed. The first aid in the most cases (74,8%) was rendered by emergency service. A vertebro-spinal-cord injuries were not diagnosed by a staff of line and special medical aid brigades in 31,6-51,9%. The causes of incorrect diagnostics at hospital stage: insufficient and delayed patient examination, underestimation of injury severity in consequence of delayed use of neuro-imaging methods. Surgical operations for vertebro-spinal-cord injuries were performed in 59 (8%) cases. 43 (73%) patients needed in vertebral fixation.

Cuban Medical Internationalism and the Development of the Latin American School of Medicine

In response to Hurricane Mitch (1998) in Central America, which claimed over 30,000 lives, Cuba sent medical brigades to the affected region and constructed the Latin American School of Medicine just outside Havana. This medical school offers a free six-year medical education to students from rural and marginalized communities in Latin America, Africa, Asia, and the United States. This establishment is a logical continuation of a long-standing tradition of Cuban medical internationalism that emphasizes investment in human capital. This is a progressive movement not just in foreign policy but also in community medicine that has an important place in dialogues about capacity building and human security strategies for the twenty-first century.

Systemic approach to the integration of motorway networks into European emergency number 112

In recent years, the world has focused on the protection of critical infrastructures, especially in the field of transportation, which is particularly critical considering traffic accidents. This paper presents the procedure for categorisation of the efficiency level of an existing motorway emergency system, as well as presenting the most important basis for the design of a new emergency management system based on Information and Communication Technology (ICT) tools, geographic information systems and systems for operative procedures. The whole motorway emergency management system should be improved with eCall technology. Using the systemic approach and taking into account the available emergency services, such as police, medical emergency services and fire brigades, a procedure for making the optimal schedule is proposed. For each emergency service, the fastest-route principle is defined, taking into account available road networks, traffic intensity, road closures caused by accident, etc.

Limits on Student Participation in Patient Care in Foreign Medical Brigades

Case Phil is a third-year medical student at a northeastern university. During the summer between his second and third year, he was selected to go to El Salvador with a team of surgeons who staff a rural clinic for two weeks twice a year.

Use of volunteer medical brigades to assess growth in Honduras.

We endeavored to determine whether a visiting volunteer medical group could effectively measure growth status among children in a developing country, identify predictors of poor growth, and thus participate in nutritional surveillance. Cross-sectional measurements of growth and diagnosis of current clinical conditions were made. A sample of 3284 Honduran children aged 2-11 years who sought care from volunteer medical brigades between January 2000 and May 2001 were included in the study. Main outcome measures were height-, weight- and body mass index-for-age z scores. Compared with standard reference data, 10 per cent of children were moderately underweight and 3.3 per cent severely underweight, while 13.7 per cent were moderately stunted and 6.4 per cent were severely stunted. After simultaneous adjustment for demographics, clinical conditions, and village characteristics, nutritional complaints were associated with lower body mass index- and weight-for-age, while children seen in villages with clean water and higher levels of development had higher body mass index- and weight-for-age. Older children had poorer growth for all parameters. It was concluded that Honduran children seeking care from a volunteer medical brigade were underweight and stunted compared with a reference population. This study demonstrates that a visiting volunteer group can collect quality growth data that may assist in nutritional surveillance, identify predictors of poor growth, and provide information useful for local public health initiatives.