Short-term Missions Research Articles

Teaching Faith Community Nursing on Short-Term Medical Missions in Nigeria.

The purpose of this study was to empower interprofessional Nigerian healthcare volunteers with knowledge and skills to promote community health. The U.S. researcher engaged in community-based participatory research in the context of a long-term partnership of annual short-term medical missions. Using a pre/posttest study design, three Nigerian nurses and the researcher co-taught Foundations of Faith Community Nursing in a 3-day class to 76 participants. The t-test analysis and informal evaluation of participants' performance at a mobile clinic demonstrated strong evidence of learning, suggesting that the teaching was an effective method to empower members of the Nigerian interprofessional team with the knowledge and skill to provide effective culturally congruent community healthcare.

Ethical Dilemmas in Global Plastic Surgery: Divergent Perspectives of Local and Visiting Surgeons.

As more of the world's resources are directed toward improving patient access to safe surgical and anesthesia care, there is a growing concern that volunteer surgeons' "desire to help" has numerous unintended consequences. The purpose of this study was to ask in-country, local surgeons and visiting volunteer plastic surgeons about the frequency of ethical dilemmas for different types of global surgery collaborations and to assess their perception of compliance with the concepts of autonomy, beneficence, nonmaleficence, and justice. A cross-sectional email survey tool was sent to a representative sample of domestic American Society of Plastic Surgeons members, all international members of the American Society of Plastic Surgeons, and international partners of the Volunteers in Plastic Surgery committee of the Plastic Surgery Foundation. The survey response rate was 7.7 percent, with 356 respondents from 65 countries. This survey data showed a statistically significant divergence of perspectives between local and visiting surgeons in regard to scope of practice, quality of patient care, impact on local health care systems, perception of the quality of care by local providers, the integrity of the informed consent process, and photography in global plastic surgery collaborations. Though the short-term mission trip model was particularly polarizing when comparing the responses of local and visiting surgeons, educational and research exchanges may also significantly interrupt local health care and incite ethical lapses. This survey provides quantitative insight into the impact of current global plastic surgery collaborations and highlights ethical areas of disagreement between local and visiting surgeons.

Guidelines for short-term medical missions: perspectives from host countries

BackgroundIn the past decade, there has been increasing guideline development for short-term medical missions (STMMs) traveling from high-income to low- and middle-income countries for the purpose of supporting health care services. The ethics of STMMs is criticized in the literature and there is frequently a lack of host country collaboration. This typically results in guidelines which are developed through the lens of the sending (high-income) countries’ staff and organizations. The aim of this paper is to evaluate an existing best practice guideline document from the perspective of host country participants with knowledge of STMMs from Honduras, Malawi, and the Philippines.MethodsThe guideline used for the evaluation consisted of nine best practice elements that were discerned based on literature and the experience of those working within the field. Semi-structured interviews were conducted in a cross-sectional study with participants (n = 118) from the host countries. Thematic analysis was conducted by two researchers and the results were assessed by working group members to confirm interpretations of the data.ResultsOverall, participants expressed a strong interest in having more structured guidance surrounding STMM practices. There was a positive response to and general acceptance of the proposed STMM guidelines, although participants found the 24-page document onerous to use; a companion checklist was developed. The key themes that emerged from the interviews included collaboration and coordination, care for hard-to-reach communities, capacity building, critical products and essential medical supplies, and opportunity and feasibility.ConclusionsHost input suggests that the guidelines provide structured regulation and coordination of the medical mission process and have the potential to improve the way STMMs are carried out. The guidelines have also proven to be a useful tool for the actual implementation of STMMs and can be a tool to strengthen links and trust between mission teams and local health staff. However, local contexts vary considerably, and guidelines must be adapted for local use. It is recommended that STMM teams work in conjunction with host partners to ensure they meet local needs, increase capacity development of local health workers, and provide continuity of care for patients into the local system.

Strategi Kepala Sekolah dalam Mengembangkan Mutu Pendidikan

This study aims to illustrate the principal's strategy in developing the quality of pre-eminent Islamic elementary school education in Integrated Islamic Elementary School Iqro Kangploso Malang. This type of research uses qualitative methods, studies. Data collected through observation, interviews and documentation. The results of this study indicate that the principal's strategy in developing the quality of Education includes 1) formulating a plan by formulating a vision, short-term mission and medium-term goals (4 years); 2) implementing strategies by increasing discipline, increasing UN results, conducting extracurricular activities, establishing cooperation with the community.

Integrated Pest Management Protocols for Space-Based Bioregenerative Life Support Systems

Human missions to the Moon and Mars will necessarily increase in both duration and complexity over the coming decades. In the past, short-term missions to low-Earth orbit (LEO) or the Moon (e.g., Apollo) utilized physiochemical life support systems for the crews. However, as the spatial and temporal durations of crewed missions to other planetary bodies increase, physiochemical life support systems become burdened with the requirement of frequent resupply missions. Bioregenerative life support systems (BLSS) have been proposed to replace much of the resupply required of physiochemical systems with modules that can regenerate water, oxygen, and food stocks with plant-based biological production systems. In order to protect the stability and productivity of BLSS modules (i.e., small scale units) or habitats (i.e., large scale systems), an integrated pest management (IPM) program is required to prevent, mitigate, and eliminate both insect pests and disease outbreaks in space-based plant-growing systems. A first-order BLSS IPM program is outlined herein that summarizes a collection of protocols that are similar to those used in field, greenhouse, and vertical-farming agricultural systems. However, the space environment offers numerous unusual stresses to plants, and thus, unique space-based IPM protocols will have to be developed. In general, successful operation of space-based BLSS units will be guided by IPM protocols that (1) should be established early in the mission design phase to be effective, (2) will be dynamic in nature changing both spatially and temporally depending on the successional processes afoot within the crewed spacecraft, plant-growing systems, and through time; and (3) can prevent insect/phytopathology outbreaks at very high levels that can approach 100% if properly implemented.

Forming a New Normal: Service Learning & Short-Term Mission Post COVID-19

Service learning and short-term missions represent one of the many habits disrupted by the COVID-19 pandemic. The disruption imposed a break from routine that may also offer opportunities to push back on habits that hinder the flourishing of our students and our host communities. This article critically analyzes the practice of these trips to reflect on what they actually do and argues we do not return to that normal. It concludes by offering both conceptual and practical suggestions for a new approach.

Quō vādis? Short-term medical missions in a globalized world and the role of pharmacy

Short-term medical missions (STMMs) have evolved in the past few decades to provide non-emergent care including routine and follow-up primary care for acute and chronic conditions, along with treatment of neglected tropical diseases. Many STMMs operate outside the local health care infrastructure and may have limited local partnerships. STMM outcomes in improving local population health are often inferred but not well documented. Concerns such as ethical conduct, provider bias, and lack of adequate training and preparation continue to be raised. When disruptions occur (e.g., the COVID-19 pandemic), STMMs need to develop and prepare for challenges such as the inability to travel and provide care. Pharmacists as health professionals play a unique role when volunteering in STMMs. However, pharmacists’ roles in STMMs need further development along with a framework to guide STMM work. Often driven by a few dynamic individuals, STMMs need to be aware of local geo-socio-political issues and develop local partnerships toward a meaningful legacy of building sustaining, long-lasting systems that will continue to serve others beyond the life of the STMMs and their founders.

GPR Investigation at the Archaeological Site of Le Cesine, Lecce, Italy

In this contribution, we present some results achieved in the archaeological site of Le Cesine, close to Lecce, in southern Italy. The investigations have been performed in a site close to the Adriatic Sea, only slightly explored up to now, and where the presence of an ancient Roman harbour is alleged on the basis of remains visible above all under the current sea level. This measurement campaign has been performed in the framework of a short-term scientific mission (STSM) performed in the framework of the European Cost Action 17131 (acronym SAGA), and has been aimed to identify possible points where future localized excavation might and hopefully will be performed in the next few years. Both a traditional elaboration and an innovative data processing based on a linear inverse scattering model have been performed on the data.

Long-Term Impact of Interprofessional Medical Mission Service Trips in Sierra Leone.

Objective: The purpose of this study was to evaluate the impact of capacity-building short-term mission service trips to Sierra Leone on local health education and perspectives.Methods: This was a prospective, mixed-methods study. During three mission trips between June 2017 and December 2019, health professional students taught multiple locally selected patient care-related topics. Local staff completed knowledge questionnaires and were surveyed or interviewed on mission service impact along with the cultural competence of missionaries. Mission team members completed the Intercultural Effectiveness Scale (IES) and surveys to determine their cultural competence.Results: After initial education, 90% passed the knowledge questionnaire with at least a 50% and the correct response rate was 57.9 vs. 66.7% after 6 months and 2.5 years, respectively (p = 0.40). Local staff ranked education/training as most valuable (84%) and highly desired (53%). Mean IES score and survey responses of both missionaries and local staff rated mission team cultural competence as average.Conclusions: Education-focused mission trips in Sierra Leone seem to have long-lasting benefits and a positive impact on local staff, though improved intercultural competence is needed.

Ghanaian views of short-term medical missions: The pros, the cons, and the possibilities for improvement

BackgroundVarious governments in Ghana have tried to improve healthcare in the country. Despite these efforts, meeting health care needs is a growing concern to government and their citizens. Short term medical missions from other countries are one of the responses to meet the challenges of healthcare delivery in Ghana. This research aimed to understand Ghanaian perceptions of short-term missions from the narratives of host country staff involved. The study from which this paper is developed used a qualitative design, which combined a case study approach and political economy analysis involving in-depth interviews with 28 participants.ResultFindings show short term medical mission programs in Ghana were largely undertaken in rural communities to address shortfalls in healthcare provision to these areas. The programs were often delivered free and were highly appreciated by communities and host institutions. While the contributions of STMM to health service provision have been noted, there were challenges associated with how they operated. The study found concerns over language and how volunteers effectively interacted with communities. Other identified challenges were the extent to which volunteers undermined local expertise, using fraudulent qualifications by some volunteers, and poor skills and lack of experience leading to wrong diagnoses sometimes. The study found a lack of awareness of rules requiring the registration of practitioners with national professional regulatory bodies, suggesting non enforcement of volunteers’ need for local certification.ConclusionShort Term Medical Missions appear to contribute to addressing some of the critical gaps in healthcare delivery. However, there is an urgent need to address the challenges of ineffective utilisation and lack of oversight of these programs to maximise their benefits.

Protocol for a systematic review of outcomes from microsurgical free-tissue transfer performed on short-term collaborative surgical trips in low-income and middle-income countries

BackgroundIn many units around the world, microsurgical free-tissue transfer represents the gold standard for reconstruction of significant soft tissue defects following cancer, trauma or infection. However, many reconstructive units in low-income and middle-income countries (LMICs) do not yet have access to the resources, infrastructure or training required to perform any microsurgical procedures. Long-term international collaborations have been formed with annual short-term reconstructive missions conducting microsurgery. In the first instance, these provide reconstructive surgery to those who need it. In the longer-term, they offer an opportunity for teaching and the development of sustainable local services.MethodsA PRISMA-compliant systematic review and meta-analysis will be performed. A comprehensive, predetermined search strategy will be applied to the MEDLINE and Embase electronic databases from inception to August 2021. All clinical studies presenting sufficient data on free-tissue transfer performed on short-term collaborative surgical trips (STCSTs) in LMICs will be eligible for inclusion. The primary outcomes are rate of free flap failure, rate of emergency return to theatre for free flap salvage and successful salvage rate. The secondary outcomes include postoperative complications, cost effectiveness, impact on training, burden of disease, legacy and any functional or patient reported outcome measures. Screening of studies, data extraction and assessments of study quality and bias will be conducted by two authors. Individual study quality will be assessed according to the Oxford Evidence-based Medicine Scales of Evidence 2, and risk of bias using either the ‘Revised Cochrane risk of bias tool for randomized trials’ (Rob2), the ‘Risk of bias in non-randomized studies of interventions’ (ROBINS-I) tool, or the National Institute for Health Quality Assessment tool for Case Series. Overall strength of evidence will be assessed according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.DiscussionTo-date the outcomes of microsurgical procedures performed on STCSTs to LMICs are largely unknown. Improved education, funding and allocation of resources are needed to support surgeons in LMICs to perform free-tissue transfer. STCSTs provide a vehicle for sustainable collaboration and training. Disseminating microsurgical skills could improve the care received by patients living with reconstructive pathology in LMICs, but this is poorly established. This study sets out a robust protocol for a systematic review designed to critically analyse outcomes.Systematic review registrationPROSPERO 225613

'We had to take a hammer to get some roots out' - experiences, motivations and challenges among volunteer dentists: a qualitative study.

Objectives To address a gap in the literature by examining the experiences, motivations and challenges among volunteer dentists engaged in short-term missions to low- and middle-income countries.Methods In-depth interviews among volunteer dentists (n = 20) who had provided voluntary dental care in low- or middle-income countries within the preceding five years. Interviews lasted on average 55 minutes and were recorded, transcribed and analysed using NVivo. Routine debriefings complemented analysis. COREQ principles guided this research.Results Motivations to volunteer included: exposure to new dental challenges (enhancing competence); discovering a new setting (tourism); and enhancing the lives of clients (humanitarianism). Volunteers enjoyed undertaking new tasks and developing new skills, but were burdened by a high patient load, challenging clinical conditions, peri- and post-operative complications, and a concern that their work was not addressing root causes of inadequate access to basic dental care. Respondents recommended that more information regarding the vision, equipment status, armamentarium and dental supplies be made available pre-departure, and that more dental schools include training on global oral health. Such measures could facilitate volunteers' abilities to provide care while also enhancing their personal and professional development. Creating an appropriate, sizable and competent capacity-building programme for local dentists was described as essential.

Update on Noma: systematic review on classification, outcomes and follow-up of patients undergoing reconstructive surgery after Noma disease

IntroductionNoma is a significant yet neglected disease which affects some of the least developed countries in the world. The long-term benefit and safety of Noma surgical reconstructive missions have recently...

A professional virtues–based ethical framework for medical missions

BACKGROUNDMore than 1.6 million physicians participate in medical missions each year. This effort is part of a long history of volunteerism and service to those in need in the form of medical missions to low-income countries. The Children's Health International Medical Project of Seattle has provided the following 7 guiding principles of sustainable short-term international medical missions: “mission, collaboration, education, service, teamwork, sustainability, and evaluation.” The role of professional virtues in grounding these principles and thus guiding medical missions is underappreciated.OBJECTIVETo provide a professional virtues–based ethical framework for medical missions, this article addressed the question, “How should physicians design and implement a medical mission in a professionally responsible way?” Reference is made to one of the authors’ experiences as a point of reference.STUDY DESIGNThe authors addressed the questions on how to design and implement a medical mission based on 5 professional virtues: compassion, integrity, humility, self-effacement, and self-sacrifice. A concise, historically based explanation of each virtue was provided, and the implications of the aforementioned principles for medical missions were identified.RESULTSCompassion motivates the mission and its team members, whereas integrity, humility, self-effacement, and self-sacrifice guide team members as they act on the professional virtue of compassion.CONCLUSIONThese 5 professional virtues can be used to provide a practical framework for the professionally responsible design and implementation of medical missions.

Short-Term Missions Contribute to Dentists’ Development

Short-Term Missions Contribute to Dentists’ Development

Predictors of Difficult Laparoscopic Cholecystectomy on Humanitarian Missions to Peru Difficult Laparoscopic Cholecystectomy in Surgical Missions

Laparoscopic cholecystectomy (LC) is the gold standard treatment of gallstone disease. On short-term surgical missions (STSMs), it is unclear what factors can predict safety of LC. This study evaluates patient risk factors of difficult LC in Northern Peru, towards optimizing outcomes. A retrospective review was performed of patients who underwent LC during short-term surgical missions to Peru from 2016-2019 under the International Surgical Health Initiative (ISHI). Difficult and routine LC groups were compared for: age, weight, gender, symptom duration, pain on presentation, history of abdominal or pelvic surgery, diabetes and hypertension. 68 of 194 patients underwent LC; 42 patients (62%) were classified as difficult with OR (operating room) time > 70 min (90%), 2 cases converted to open (5%) and 2 aborted cases (5%). Higher weight class was found to correlate with difficult LC. Increased patient weight was correlated to longer operative time during STSMs. Patients undergoing LC must be selected carefully to mitigate risks of difficult operations on STSMs.

Doing missions right: Popular development imaginaries and practices among U.S. evangelical Christians

This article explores recent evangelical Christian engagements with issues of poverty and development, focusing on prescriptive accounts about the right and wrong ways to ‘do missions’. Such accounts have proliferated amidst the phenomenal expansion of popular development activities among middle-class, white evangelicals in the U.S. As more and more white Christians purposefully confront and address poverty through short-term missions, evangelical scholars and leaders must theorize the causes poverty and how best to alleviate it. Such theorization can be situated in a long, entangled history of missions and development as fields of practice – a history that has been acknowledged but not fully appreciated. This article examines popular Christian theologies of development, typified by the bestselling title, When Helping Hurts. Drawing on in-depth qualitative research with short- and long-term missionaries, thearticle highlights three key tensions within popular evangelical development theology and practice: First, it absolves the poor of responsibility for their poverty while holding the poor responsible for their own wellbeing; second, it acknowledges poverty as a material problem, yet favors spiritual solutions to material deprivation, and third, it conceives of missions as acts of selflessness and sacrifice, yet instrumentalizes poor communities as sites of spiritual challenge and fulfilment.

A Short-Term Medical Mission in Rural Nepal: Chief Complaints, Medications Dispensed, and Unmet Health Needs.

BackgroundAlthough Nepal is striving to expand primary health services for its citizens, many remote areas have limited access to basic health care. Short-term medical missions (STMMs) are one way of supplementing human resources for health in underserved areas. This article describes the chief complaints, medications dispensed, and unmet health needs during an STMM in rural Nepal.MethodsThis study is a retrospective analysis of data collected during an STMM that occurred in October 2017. Deidentified data from clinic intake forms were entered into an Excel spreadsheet, and formatted and cleaned. Demographics, chief complaints, medications, and unmet health needs were analyzed using descriptive statistics.ResultsDuring a two-day health camp, 443 patients were seen. The most common chief complaint was dental (33.4%) followed by musculoskeletal (28.2%) and gastrointestinal (21.2%). Medications were dispensed to 94.8% of patients, primarily analgesics, antibiotics, and ophthalmologic preparations. Of the patients, 21% had unmet health needs, including specialty care and labs or imaging that were beyond the scope of the STMM. One patient was referred urgently to a hospital for treatment of dyspnea and markedly elevated blood pressure.ConclusionWhile STMMs cannot replace access to primary health services, they can provide insight into acute care needs in a system that has limited surveillance. This information describing an acute care patient population should inform future development work.

The impact of complex facial surgery provided on a short-term surgical mission

The long-term consequences of performing facial surgery on patients living in rural Ethiopia are largely unknown. A review of 36 patients who had been treated on a short-term surgical mission (STSM) in the previous 2 years was conducted to evaluate the outcomes of the surgical interventions performed. There was a significant reduction in social isolation following a surgical intervention. Improvements in postoperative self-reported changes were found for facial appearance, facial function, and quality of life. Positive outcomes can be achieved when surgical treatment is performed on a STSM.

Mete Tèt Nou Ansanm (Putting our heads together): Global health capacity building within short-term medical missions

ABSTRACT Short-term medical missions (STMMs) have the potential to increase local health care capacity in low resource settings. Few studies have examined capacity building within STMMs from the perspective of both donor and host providers. A qualitative study using a transcendental method for research with human subjects examined the experiences of 21 North American ‘donor’ and Dominican ‘host’ health care providers who participated in STMMs in the Dominican Republic. Perry and Ojemeni’s levels of capacity building for human good provided the theoretical framework, proposing a three-level approach: (1) augmenting local health care delivery capacity (2) assisting local communities to develop their own capacities and (3) transforming barriers to capacity. Findings are grouped into five themes and their subthemes: (1) making a difference (2) education and knowledge transfer, (3) acknowledging barriers, (4) host empowerment and (5) personal and interpersonal development. An overarching paradigm of ‘Mete Tèt Nou Ansanm’, or ‘putting our heads together’, emerged from the data, reflecting a dynamic process in which donor and host participants evolved their collaborative partnerships. STMMs have the potential for addressing global health capacity at all three levels. Mission compatibility with the local health system, host empowerment and repeated interactions over time are noteworthy determinants for STMMs sustainability.