Mission Trips Research Articles

Short-term general, gynecologic, orthopedic, and pediatric surgical mission trips in Nicaragua: A cost-effectiveness analysis.

BackgroundShort-term surgical missions facilitated by non-governmental organizations (NGOs) may be a possible platform for cost-effective international global surgical efforts. The objective of this study is to determine if short-term surgical mission trips provided by the non-governmental organization (NGO) Esperança to Nicaragua from 2016 to 2020 are cost-effective.MethodsUsing a provider perspective, the costs of implementing the surgical trips were collected via Esperança’s previous trip reports. The reports and patient data were analyzed to determine disability-adjusted life years averted from each surgical procedure provided in Nicaragua from 2016-2020. Average cost-effectiveness ratios for each surgical trip specialty were calculated to determine the average cost of averting one disability-adjusted life year.ResultsEsperança’s surgical missions’ program in Nicaragua from 2016 to 2020 was found to be cost-effective, with pediatric and gynecology surgical specialties being highly cost-effective and general and orthopedic surgical specialties being moderately cost-effective. These results were echoed in both scenarios of the sensitivity analysis, except for the orthopedic specialty which was found to not be cost-effective when testing an increased discount rate.ConclusionsThe cost-effectiveness of short-term surgical missions provided by NGOs can be cost-effective, but limitations include inconsistent data from a societal perspective and lack of an appropriate counterfactual. Future studies should examine the capacity for NGOs to collect adequate data and conduct rigorous economic evaluations.

Effects of Short-Term Mission Trips on Recipients’ Self-Esteem and Readiness for Self-Directed Learning

Short-term Christian overseas volunteer trips, also known as short-term mission trips (STMs), have become increasingly prevalent (Howell & Dorr, 2007). However, research on these programs has been limited. This quasi-experimental study adds to the literature by quantitatively measuring the effects of an STM from Singapore to Thailand. STM recipients’ ( n = 44) self-esteem and readiness for self-directed learning (RSDL) were compared across timepoints – pre-test, post-test, follow-up – and with a control group ( n = 50). It was hypothesized that recipients would experience an increase in self-esteem and RSDL such that their scores would be higher than the control group post-STM. Results provide partial support for the hypotheses; while improvements among recipients were either not significant (for self-esteem) or not long-lasting (for RSDL), recipients had higher scores than the control group post-STM. This suggests that STMs have some, albeit limited, positive effects. Recommendations for promoting greater and longer-lasting effects are offered.

Foundation for International Education in Neurosurgery: The Next Half-Century of Service Through Education

The Foundation for International Education in Neurological Surgery (FIENS) was founded in 1969, decades before globalization be camea worldwide phenomenon (1–3). Initially, efforts were focused on service delivery in under-resourced areas via short mission trips byindividual neurosurgeons. The wisdom of furthering the impact by creating sustainable training programs in partnership with h ostorganizations developed over time (3). FIENS is a neurosurgeons foundation working in partnership with various organizations toincrease global access to neurosurgery missions through the principle of “service through education (3).” FIENS shifted its f ocus from aservice delivery-centered approach to an approach centered on global health systems strengthening by emphasizing local neurosurgeryresident education and residency program development (3). It has become clear that the integration of neurosurgical efforts within thelocal health system amplifies the overall impact of FIENS initiatives by promoting sustainable change through collaborative action in theservice of local health system goals. From this point forward, initiatives coordinated by FIENS incorporated local stakeholders andworkforce in addition to mechanisms for service delivery, health infrastructure, information management, governance, and funding.

Community development for improved housing, health equity, and education in rural Honduras

This paper describes an international, long-term, population health project in rural Honduras among Mayan villagers, focused on collaboration, community building, partnership formation, and improvement of their living situation. Improved housing, health checks, education for their children, and clean water were chosen by the Honduran residents as the projects they thought were most important to improve their health and living conditions. During the short mission trips, the North Americans (NAs) and the villagers worked side-by-side on house building and participated in village life. The Hondurans organized into communities that mutually decided on which families received homes and together worked on each other's homes with the NAs' assistance. Nurse-led health clinics and scholarships for students were provided by the visitors during their time in the villages. Health has improved from better housing and periodic health checks, and most significantly, sustainable community organizing occurred. Public Health Nurses can work towards health equity and population health improvement by basing efforts on what the community partners request and create outcomes through relationships with those who stand to benefit from the improvement.

Using Simulation to Prepare Students for Medical Mission Trips.

Simulation is a valuable tool in nursing education, including during preparation for students going on medical mission trips. Faculty assessed the learning and management of expectations of undergraduate nursing students who participated in a simulation prior to an international medical mission experience. Through student focus groups postsimulation and posttrip, faculty discovered three learning themes and student recommendations for future simulation use.

Preparing Children for International Travel.

1. Hiba Chehab, MD, FAAP* 2. Philip R. Fischer, MD, FAAP†,‡ 3. John C. Christenson, MD, FAAP* 1. *Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, IN 2. †Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 3. ‡Pediatrics Department, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates * Abbreviations: CDC : : Centers for Disease Control and Prevention DEET N : : N-diethyl-m-toluamide HACE : : high-altitude cerebral edema HAI : : high-altitude illness HAPE : : high-altitude pulmonary edema MenACWY : : meningococcal quadrivalent conjugate vaccine MMR : : measles-mumps-rubella PCR : : polymerase chain reaction TD : : traveler’s diarrhea 1. Pediatricians may be unfamiliar with agents that are most effective for antimalarial prophylaxis for a young infant traveler. 2. Pediatricians may not realize that measles-mumps-rubella and hepatitis A vaccines are recommended for infant travelers 6 months and older. After completing this article, readers should be able to: 1. Select the most appropriate antimalarial prophylaxis agent according to high-risk regions. 2. Use insect bite prevention strategies to prevent malaria, dengue, and other vector-borne diseases. 3. Recognize which vaccines are necessary for the young pediatric traveler. Traveling with a child can be emotionally and educationally rewarding but challenging as well. Children are traveling from North America and Europe to most parts of the world, including Sub-Saharan Africa, Asia, and Central and South America. The most common reasons to travel are for leisure and to visit friends and relatives. (1) Children also accompany their families for pilgrimages, study abroad experiences, and parental work. Older children and adolescents travel as part of educational tours and humanitarian mission trips. Similar to adults, children traveling to potentially high-risk regions of the world expose themselves to risks of acquiring malaria, dengue, and diarrheal diseases. These diseases, followed by dermatologic conditions such as cellulitis, bites, and cutaneous larva migrans, are among the most common problems observed in pediatric travelers. Travelers visiting friends and relatives are at a greater risk because most do not visit travel clinics for advice or immunizations. (2)(3) They also tend to visit more remote parts of high-risk countries and stay for longer durations. Although at-risk children may not visit a travel clinic, they may be seen by their primary care health provider. Pediatricians, through setting …

Wielding the Power of Self-Determination Theory

Liz Hathaway, Ph.D., MPH,is an assistant professor in Health and Human Performance at the University of Tennessee at Chattanooga. She teaches Health Behavior Change and Psychology of Sport and Exercise in the Exercise Science undergraduate program and Health Promotion and Communication Strategies in the Master of Public Health program. Her interests include learning how to best motivate individuals to make lasting, positive behavior change. She loves coffee, life chats, awkward encounters, and banter. Mckenzie Gregg, MPH,graduated with her Master of Public Health at the University of Tennessee at Chattanooga (UTC) in May 2020. She graduated in May 2018 with a Bachelor’s of Science in Biology. She has played soccer at multiple levels and was captain of the UTC Mocs Soccer Team. She plans to attend medical school to become a pediatric cardiologist. She is currently the head of marketing for Heat Shields Shoe Inserts. In her spare time, she enjoys going on mission trips, being with family, coaching, being a raconteur, and verbal jousting.

19. Informed Consent Practices in Global Surgery among Plastic Surgery Organizations

Body: Background: Global surgery organizations often serve vulnerable populations but there is limited knowledge on the protocols used to obtain informed consent for procedures and content sharing. Methods: The Plastic Surgery Foundation Volunteers in Plastic Surgery database was queried for plastic surgery organizations actively involved in global surgery. 79 organizations received email invitations to participate in a survey study regarding their protocols for obtaining consent and content sharing practices. Results: A total of 17 (21.5%) organizations completed the survey. All have been active for at least 10 years and 88.2% (15/17) organize at least two mission trips annually. 88.2% (15/17) obtained written consent for surgical procedures while 11.8% (2/17) obtained only verbal consent. 58.8% (10/17) reported that their staff or volunteers were primarily responsible for obtaining informed consent, while 41.2% (7/17) primarily relied on local health staff/administrators. With regards to consent for sharing content related to global surgery experiences (i.e. photographs, videos, written narratives), 18.8% (3/16) obtained verbal consent only for content sharing, 56.2% (9/16) obtained a separate written consent, 18.8% (3/16) obtained consent concurrently with the surgical informed consent, and 6.3% (1/16) did not routinely obtain any consent. Organizations shared content via their websites (93.3%, 14/15) Facebook (73.3%, 11/15), Instagram (53.3%, 8/15), blog posts (46.7%, 7/15), peer-reviewed articles (40.0%, 6/15), internal grand rounds (40.0%, 6/15), and Twitter (20.0%, 3/15). All organizations reported using interpreters to obtain informed consent. However, only 37.5% (6/16) utilized formally trained professional interpreters, with others utilizing either volunteers (31.3%, 5/16), local health care workers (18.8%, 3/16), or other community members (6.3%, 1/16). Conclusion: Practices related to obtaining informed consent for procedures and content sharing vary widely among global surgery organizations. Trained interpreters, essential for ensuring clear and accurate patient communication, are not consistently utilized. Global surgery organizations have a responsibility to safeguard patients’ rights, especially their privacy, when creating and sharing publicly viewable content. The development of standardized protocols and guidelines will ensure that global health organizations, in collaboration with their local partners, properly collect informed consent for procedures and content sharing.

Ethical dilemmas in anesthesia mission trips.

Health inequities continue to exist globally especially when it comes to surgical and anesthesia services. Due to the lack of physician anesthesiologists in low- and middle-income countries, there has been an increase in the number of medical mission trips. Although these volunteers are attempting to fulfill a need they must be mindful and remember to adhere to ethical principles as they work collaboratively with host institutions. We will review the ethical dilemmas inherent in anesthesia mission trips. Physician volunteers for medical missions may cause significant harm to patients and host communities if they do not work in tandem with host institutions. Medical missions fulfill acute medical needs and have the opportunity to make a positive contribution to host communities by fulfilling local needs and supporting educational efforts for local providers.

Underlying premises in medical mission trips for Madiha (Kulina) Indigenous people in the Brazilian Amazon

This article proposes two premises that underlie biomedical health care delivery provided through medical missions to Madiha (Kulina) Indigenous Amazonian people living in forest villages. First, that health care is implemented through a set of detached transferable goods and services. Second, that health is a condition that requires the importation of knowledge and resources. The premises were induced through qualitative research on the Brazilian government’s medical missions that provide biomedical care to Madiha (Kulina) in the southwestern Amazon as part of the national health care system. Despite policy rhetoric, delivery practices disregard embedding health and health care in local infrastructure and cultural conditions. There is little or no collaboration with Indigenous healers, capacity building of the local (Indigenous) health care system, education of resident lay health monitors, or extensive and lasting infrastructural development. The article recommends reorientation of delivery to prioritize local health care infrastructure development.

Spanish Blood

Spanish Blood Erin H. Davis (bio) A Candle for San Simón Kelly Daniels Owl Canyon Press https://www.owlcanyonpress.com/product-page/a-candle-for-san-simon 276 Pages; Print, $18.95 Kelly Daniels, in his new novel A Candle for San Simón, juxtaposes his interpretation of the enigmatic, oft tangled, and misrepresented Guatemalan gang culture with that of the darkly comedic American mega-church. The traditions of white American evangelism — under scrutiny especially in recent years — comes face to face with the realities of Guatemalan poverty and violence (imagined or not by the white burden). Daniels explores the precise moment cultures clash, the moment when Americans imagine themselves above, yet nevertheless entrenched in, gang violence. He especially delves into white confrontation of the ethnic divide between ladina/mestiza women and Mayan indigenous peoples. The novel is a constant buzz of connecting — and often confusing — social divides that are not, contrary to popular American wish, too far from our own home front reality. Characters in A Candle for San Simón must navigate the road of not quite belonging. Take, for example, Caruthers, a white American expatriate who, after running out on his family, settled in Panajachel to become a drunkard bus driver. Both he and the natives of Panajachel yearn for the return of American tourist dollars after the collapse of the entire industry due to growing media coverage of violence. However, Caruthers must come to terms with the idea that gang violence does not only affect his life financially, but — as he soon learns — firsthand. His skin color does not grant him safety; thus, he must put aside his white blindness. Daniels writes, “Eventually the tourists would return. They always did. The familiar injustice of life in Guatemala would resume.” Fast-paced and plot-driven, readers are taken through the mind and experiences of not only Caruthers, but his mission-trip son Max, gang member Vicki (recently deported from California), and Guatemalan teacher Karma. There is no lack of characters in Daniels’s novel, no desire for action left wanting. If anything, the novel could use a plot tone-down. However, the novel wouldn’t fully represent a broad character swatch if not for the constant plot progression. It is, after all, what brings all characters together, boiling their personalities and emotions until their eventual breaking point. Most fascinating is Daniels’s darkly humorous ability to show the seedy underbelly and false holiness of the classic American mission trip as it stands in relation to gang culture. As Daniels switches perspectives between his characters, readers are able to get deep into the mind of Max, Caruthers’s son, as he volunteers to build chimneys and preach to the village of Zunilito. Despite his outward benevolence, it takes Max nearly a week to arrive at his destination after questionable decisions and, despite his best intentions, a week of what’s traditionally seen as “sin.” Daniels writes, with a wink toward his readership, The girl sat on her mother’s lap, snuggled into her belly and closed her eyes. She coughed, a grave-sounding rattle. The sling, bulging like a pea pod, held an infant Max hadn’t noticed before. He shrank away instinctively, afraid of catching whatever they had, a virulent despair. Max’s intentions throughout the novel are less than holy, and readers come to learn that nothing in Daniels’s world is what it originally seems. Daniels explores other themes that stem from his globetrotting background. Growing up, the author lived in a Hawaiian commune, in the desert, in vans. He has worked in Europe, Mexico, and Central America (including Guatemala). His familiarity with Guatemalan culture lends his work authority, and he utilizes his abilities to entertain to call into question the very ideas of ethnicity, post-colonialism, and the church’s role in colonizing. Daniels’s asides are delicately woven into the greater tapestry of his work, easily mistaken for the familiar crassness of his characters. But his words beg you to stop, re-read, and re-think what you have just read. They are words of power, of anger, but they are also of deep acknowledgement that must be, in...

Social, Demographic, Spanish Language, and Experiential Factors Influencing Nursing Students' Cultural Competence.

Development of culturally competent nursing students is a core objective in nursing education. One hundred sixty nursing students completed an online survey assessing sociodemographic information, Spanish language, service-learning participation, and cultural competency. Degree of participation in the multidisciplinary farmworkers clinic (r = .374, p = .013), federally qualified health center (FQHC) (r = .387, p = .032), and short-term international medical mission trip (r = .433, p = .021) was associated with higher cultural competency. Furthermore, several demographic factors including being a native Spanish-speaker (p = .022), female (p = .004), Latino (p = .045) or a student of low socioeconomic status (p = .026) were associated with higher cultural competency. Participation in service-learning opportunities involving care for minority and disadvantaged communities, whether required or voluntary, was correlated with higher cultural competency scores, as long as the students' experiences involved direct patient care responsibilities. These findings highlight the need for identifying more diverse opportunities for service-learning and more diverse direct patient care opportunities to foster students' cultural competence. [J Nurs Educ. 2021;60(1):29-33.].

Malaria Diagnosis by U.S. Providers on Short-term Medical Mission Trips to Uganda.

Malaria is one of the top 10 leading causes of death in Uganda. Short-term medical missions (STMMs) to address unmet medical needs in lower-resource settings are increasingly common. Th is study evaluates correlations between patient and clinician variables and accurate malaria diagnosis by providers on STMMs to Uganda. We surveyed 18 U.S. providers and performed a retrospective chart review of 246 patients seen by those providers on STMMs in Uganda between 2016 to 2017. All providers recorded their clinical level of suspicion for patients who met inclusion criteria, following which a rapid diagnostic test (RDT) was performed. Fift y-four percent of the patients tested positive for malaria. Level of provider accuracy ranged widely from 30.0% to 95.5% correct. Our fi ndings reaffirm that signs and symptoms of malaria are too nonspecifi c to be used alone without diagnostic testing by STMM providers. Pre-departure STMM training on malaria diagnosis is a necessity.

777. Travel Destination, Demographics, and Underlying Medical Conditions Among Travelers Seeking Yellow Fever Vaccination at a Large Academic Medical Center in the U.S

BackgroundYellow fever (YF) vaccine has the potential to cause viscerotropic and neurotropic disease in at-risk individuals. Screening patients is necessary to prevent vaccine-related life-threatening complications. We lack data on the clinical features of patients seeking YF vaccination. We aim to describe the characteristics of a cohort of patients receiving the YF vaccine before travel.MethodsA retrospective analysis of 964 patients receiving the YF vaccine (Stamaril®) from Oct 2016 to Jul 2019 was performed at the University of Colorado Hospital in the United States. Percentages, means, and standard deviations were calculated. A multivariate logistic regression model was built to evaluate the association between receiving YF vaccination less than 10 days before departure and visiting friends and relatives (VFR).ResultsThe average age of patients was 39 ± 18 years with a range of 9 months to 83 years. Patients who were 60 years of age and older represented 17%. Women consisted of 52%, and most of the patients were Caucasians (64%). Patients reported traveling to Africa (57%) or South America (40%). The primary destination for patients overall was Kenya (19%), Uganda (11%), and Tanzania (11%) in Africa; and Peru (14%) and Brazil (13%) in South America. The most common reasons for travel included leisure (44%), VFR (18%), and mission trips (10%). Comorbidities included a history of hematologic disorders (4%), HIV infection (2%), and diabetes mellitus (3%). The average duration between vaccine administration and travel was 43 days. Those visiting friends and relatives were 2 times more likely to receive the YF vaccination less than 10 days before departure.Table 1. A cohort of patients receiving the Yellow Fever vaccine at the University of Colorado Hospital. Figure 1. Heat map of destinations among patients receiving the YF vaccine. Figure 2. Reasons for travel among patients receiving the YF vaccine (n=964). ConclusionIdentifying the type of travel, itinerary, and underlying medical conditions allows providers to administer the YF vaccine to travelers safely. There is a need to identify strategies to improve the timing of YF vaccination among travelers visiting friends and relatives.Disclosures All Authors: No reported disclosures

Pemuridan Bagi Jemaat Penyandang Disabilitas

Abstrak
 Gereja harus berperan aktif di dalam masyarakat dengan memberdayakan jemaatnya, tanpa kecuali kaum marjinal - penyandang disabilitas; yang seyogyanya mendapat hak dan kesempatan yang sama, serta perlakuan yang setara; diberdayakan dan terlibat dalam pelayanan gereja, memberi arti bagi kehidupan orang lain dan dirinya sendiri bagi kemuliaan Allah. Tidak dapat dipungkiri bahwa penyandang disabilitas mengalami diskriminasi dalam berbagai bidang kehidupan, tidak terkecuali, juga di dalam pelayanan gereja. Metode penelitian yang digunakan kualitatif; melakukan observasi, wawancara terfokus dan wawancara terpilih terhadap informan yang terpilih secara mendalam dan terbuka. Tujuan penelitian adalah untuk menemukan model pemuridan bagi jemaat penyandang disabilitas di Gereja M Malang. Temuan hasil penelitian mengemukakan bahwa model pemuridan di gereja M Malang adalah kombinasi dari pembekalan melalui pengajaran nilai-nilai Kristen, pembinaan sikap, serta pemberdayaan jemaatnya. Gembala mengutamakan pemberdayaan dengan kegiatan mission trip sebagai model pemuridan bagi jemaat penyandang disabilitas.
 

Stay Cool—Alternatives for Long-Term Storage of Large Quantities of Liquid Hydrogen on a Mars Transfer Vehicle

Improved methods for storing liquid hydrogen in larger quantities and over longer periods of time in space are becoming progressively more critical as sights are once again set on Mars. Current storage methods involve the venting of vaporized hydrogen to space, with the consequence that significant amounts of hydrogen are wasted. Extra hydrogen must be stored to account for this loss resulting in unnecessary mass penalties. Eliminating this waste can reduce overall mission mass, extend mission range, and perhaps most importantly, lower mission trip times and costs. This technical note explores alternative methods for storing liquid hydrogen with an emphasis on missions to Mars as laid out by the National Aeronautics and Space Administration’s current design reference architecture.

A skin ulcer in a returning traveler caused by Leishmania panamensis

An 18-year-old male patient presented with an ulcer over the dorsal right fourth finger. He had just returned from a three-month mission trip to Costa Rica, Ecuador and Peru, where he noticed a painless papule over the dorsal right fourth finger that progressively increased in size and eventually developed an ulcer (Figure 1). Limited debridement was performed in the office by plastic surgery. Pathology showed extensive acute and chronic inflammation, with organisms consistent with Leishmania (Figures 2 and 3).

Recommendations to Medical Mission Trip Teams: A Retrospective Study of an Annual Medical Student-Run Mission Trip to Jarabacoa, Dominican Republic.

IntroductionThere are more than 6,000 international medical mission trips that are conducted annually by United States medical teams. Successfully planning a medical mission trip relies on careful preparation. The objective of this study is to elucidate common chief concerns, diagnoses, and prescription patterns so that medical mission trip teams can effectively prepare for future medical mission trips in Jarabacoa, Dominican Republic, or similar international sites.MethodsA retrospective chart review of 940 patient charts was conducted from two University of South Florida Latino Medical Student Association medical mission trips to Jarabacoa, Dominican Republic (DR) that took place during October 2017 and 2018. A coding system was utilized to categorize the data. The most common chief concerns, diagnoses, and medications prescribed were revealed. Findings were stratified further by age (<18 vs ≥18 years old) and sex.ResultsOur study reveals that 68.6% (n=597/870) of the patients were female and 59.2% (n=161/870) of males were under 18. The most common chief concerns were “cold/flu” (33.2%,n=289/870), gastrointestinal problems (20.3%, n=177/870), headache (20.0%, n=174/870), and musculoskeletal problems (12.0%, n=104/870). The most common diagnoses were viral syndrome (25.4%, n=221/870), presumed parasitic infection (16.9%, n=147/870), hypertension (12.6%, n=110/870), headache (10.6%, n=92/870), and musculoskeletal disorder (8.5%, n=74/870). The most frequently prescribed medications were acetaminophen (18.3%, n=291/1,587), albendazole (15.2%, n=241/1,587), nonsteroidal anti-inflammatory drugs (NSAIDs) (10.5%, n=166/1,587), antihistamines (6.1%, n=97/1,587), and antibiotics (5.9%, n=93/1,587).ConclusionsOur study reveals potential areas for improvement of an annual, medical student-run medical mission trip to Jarabacoa, DR. Dedicated efforts should be made to address long-term management of chronic conditions identified or treated on medical mission trips. Community partnerships should be established to facilitate this. We hope this will encourage other medical mission trip teams to analyze their data in order to be more prepared for their trips.

Indicator Measurement and Outcome Reporting Following Short-Term Neurosurgical Mission Trips

Penuela, Maria; Jella, Tarun; Mehmood, Amber; Fuller, Anthony; Wright, Christina; Shammassian, Berje Haroutuon MD Author Information

Incorporation of Physical Medicine and Rehabilitation Residents for an Interdisciplinary Medial Mission Trip to Dominican Republic

To investigate the needs and benefits of PM&R residents to participate in medical mission work. Specifically, this focuses on incorporation of residents in a well-established interdisciplinary trip with physical therapy (PT) staff and students to the Dominican Republic.