Short-term Missions Research Articles

Evaluating Medication Habits in Medical Mission Patients: A Cross-Sectional Study.

BackgroundShort-term medical missions (STMMs) are a highly debated and largely understudied form of international volunteer work. With growing dedication to health care abroad, research evaluating their impact is crucial to ensure continued interventions are effective in improving medical care. STMM care varies in length, frequency, size, location, services offered, and country of origin and destination. This makes systematic evaluation of STMMs difficult. In addition, the transient nature of patient visits makes trending STMM’s impact on long-term health outcomes complex.Despite intermittent availability, primary care missions offering pharmaceutical supplies have the unique opportunity to provide continued care to the community via free prescription supplies each visit. Given the challenges with measuring long-term outcomes in this population, it is unknown if these donated medications have any impact on patient health outcomes. As medication noncompliance is known to hinder health outcomes, our study chose to evaluate patient medication habits to see if these prescription supplies were being utilized appropriately. To our knowledge, no study has surveyed medical mission patients to explore their access and utilization of medication.MethodsA cross-sectional study was conducted using a patient survey to identify risks and/or factors associated with medication noncompliance in patients visiting the medical mission, Waves of Health (WOH). For over 10 years, WOH has organized biannual seven-day trips to the Dominican Republic. The multi-question survey was translated into the native language, Spanish with Dominican dialect. Noncompliance was defined through the survey question “Did you run out of your prescription medication at all during the past year?” Spanish speaking participants, of both sexes and age ≥18 years old, who visited the mission clinic in November 2019 met inclusion for this study. Patients from Haiti or age <18 years old were excluded. Participation was voluntary.Survey items were dichotomized for univariate analysis to identify factors associated with running out of medication. To explore predictors of running out of medicine, we performed multivariate logistic regression analysis by ENTER method. ResultsOf 127 patients, over half (58.3% [74]) reported running out of medication. Inadequate access to healthcare, daily medication use, and rationing personal medications were all significantly associated with running out of medicine. Frequency of WOH visits was not associated with running out of medication. Multivariate regression showed that being on daily medication and rationing personal medications were statistically significant predictors of running out of medicines. Access to healthcare, frequency of WOH visits, and WOH medication supply were not predictors of running out of medication.Conclusion Mission interventions to improve medication practices should be explored due to the high number of patients who reported improper utilization of medication. In order to improve health outcomes in primary care settings, patients must play an active role in their care and understand the importance of taking their medication as prescribed for optimal disease management. Primary care STMMs may relieve short-term health concerns, but without proper utilization of chronic disease medications, it is unclear if STMMs role is impactful in long-term health outcomes.

3. Global Spine Outreach (GSO): how to safely establish a sustainable short-term spine deformity outreach program

BACKGROUND CONTEXT Many nonprofit organizations exist with the purpose of providing medical care to patients in low and middle-income countries and the most common way to approach this is through short-term surgical mission trips (STSM). Within this matter, surgical voluntarism has become an increasingly popular means to exercise generosity, share knowledge and bridge cultural gaps. Global Spine Outreach (GSO) was created to provide a mechanism to safely execute an STSM. The critical elements to develop an STSM include a local surgeon, hospital partner, local nonprofit and an industry partner for implant support. There are presently no published reports that unify the safe delivery of pediatric spine care in low and middle-income countries. PURPOSE The aim of this study is to present a model that can be used by other organizations who desire to initiate, maintain and grow an STSM. We hypothesize that outlining a standardized and reproducible protocol can lead to other organizations who desire to initiate, maintain and grow an STSM. STUDY DESIGN/SETTING We retrospectively reviewed 30 consecutive STSM trips between 2013 and 2019. Our current STSM model is presented. OUTCOME MEASURES GSO evaluation was based on the reproducibility and sustainability of the STSM and re-engagement of our volunteers, local and US surgeons. METHODS We retrospectively reviewed 30 consecutive STSMs from 2013 to 2019. The protocol includes pre-work and data gathering prior to site visitation, initial site visitation prior to selection, pre-STSM clinic, initial STSM and recurring STSM. RESULTS The protocol was implemented in three countries to initiate five STSMs: Cali, Colombia; Chihuahua and Monterrey in Mexico; Poznan and Otwock in Poland. A total of 1,479 patients were screened, with 346 surgeries performed; GSO engaged 17 local surgeons, all serving on >1 STSM. One hundred and two different volunteers have served at least in one STSM, 32 in at least 2 trips and 17 in >2 trips. Five different industry partners have generously donated implants for the STSMs and four have partnered with GSO on ≥2 trips. One site was aborted and moved (including its patients) from Chihuahua to Monterrey as there was no local surgeon to maintain the site. In Colombia, at the time of site initiation, local surgeons had not performed pediatric deformity surgery independently. In 2018, the same local surgeon team performed 187 complex spine cases without GSO being present. CONCLUSIONS The demand for STSMs focused on pediatric deformity in low and middle income countries is high. GSO has developed a protocol that can be used to safely initiate and maintain a spine deformity STSM and have a lasting impact. Perhaps sharing this methodology will result in surgeons having a resource to safely pursue their philanthropic passions. By following this standardized and reproducible model, any organization who desire can initiate, maintain and grow a safe and sustainable short-term surgical mission trip in an outreach setting. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Fostering methodological advances and technical capacity building

Abstract Countries all over the world, and especially in Europe, are increasingly using the burden of disease approach to assess the health status of populations and to identify the main drivers of ill health. Thus, there is an increasing need for equitable capacity building on the one hand (including an improved understanding of the complex methods behind global and national burden estimates), and harmonization of methods on the other hand to keep the results comparable. Furthermore, involved researchers also strive for a platform to exchange experiences and foster collaboration. To address the current challenges in burden of disease research, our COST Action CA18218-European Burden of Disease Network will build strongly on the COST mechanisms, such as short-term scientific missions and training schools to foster and increase capacity building activities across Europe. Our Action will also serve as a technical platform where knowledge and expertise can be shared among experienced and less experienced researchers. Collaboratively, the technical platform will provide unique opportunities for developing a joint research agenda in the domain of burden of disease, for fostering methodological developments, and for developing new collaborative research. With this presentation, we aim to show how the COST Action is fostering methodological advances and technical capacity building, focusing on 1) the role and aim of short-term scientific missions including real case examples; 2) the concept and structure of the Action's training schools; and 3) examples of specific methodological activities underway as part of the Action. The session will conclude with an interaction with the audience during which the needs and expectations of the attendees will be elicited.

Occupational Therapy in Haiti: A Pilot Study to Identify Intervention Methods Used during Short-Term Medical Missions.

Due to the shortage of occupational therapists (OTs) in Haiti and over 800,000 individuals with disabilities, most occupational therapy assessments and interventions are provided by OTs on short-term medical missions (STMMs). Learning which methods OT use to provide assessments and interventions during these STMMs is the first step to understanding how to facilitate follow-up and carry-over for clients and ensure longevity for STMMs in Haiti. This study used a cross-sectional, descriptive design to gather data on methods used by OTs. Thirty-three OTs, who travelled to Haiti on STMMs, completed a 16-question, online survey. The most common method provided by OTs was education to patients, caregivers, and local providers. Training of Haitian rehabilitation technicians was also prevalent. There was an association between the years of the OTs' clinical experience and the effort of OTs to train local providers, but this result was not statistically significant. Further research should be implemented on specific methods that can be used in the absence or shortage of Haitian OTs to ensure follow-up for Haitian clients. The sharing of data regarding OT methods on STMMs will promote evidence-based, client-centered, and cost-effective therapy to enhance effective client outcomes.

Effectiveness of Short-term Medical Missions on Chronic Disease in Underserved Communities.

A retrospective chart review study was conducted to evaluate health outcomes after a nurse-led short-term medical mission group provided free health care in four communities in Kingston, Jamaica over a four-year period. Participants were adult patients who had visited short-term medical mission clinics at least twice and were diagnosed with hypertension and/or diabetes. Blood pressure (BP) and blood sugar (BS) results along with factors including adherence and control per guidelines were analyzed using descriptive, t-tests and chi-square analysis. The data revealed that overall BP and BS measurements trended down, and there was a significant decrease in BP in patients with uncontrolled hypertension at the first visit. Medication adherence between the visits and gender had a statistically significant impact on BP and BS control. Outcomes suggest short-term medical missions are an effective model to address hypertension and diabetes in developing countries when using a sustainable approach.

The Efficacy and Safety of Transversus Abdominis Plane Blocks After Open Cholecystectomy in Low- and Middle-Income Countries

BackgroundPostoperative pain management is challenging in low- and middle-income countries (LMICs). This study assesses the safety and efficacy of transversus abdominis plane (TAP) blocks as an adjunct for postoperative pain control after an open cholecystectomy in LMICs during short-term surgical missions (STSMs). TAP block is a regional anesthesia technique that has been shown to be effective in providing supplementary analgesia to the anterolateral wall post abdominal surgery. MethodsA retrospective chart review of patients undergoing open cholecystectomy during STSMs was performed. STSMs took place in Guatemala, the Philippines, and Peru from 2009 to 2019. Measured outcomes including pain scores, presence of postoperative nausea or vomiting, and opioid consumption were compared between TAP block and non-TAP block groups. ResultsOf the 48 patients analyzed, 28 underwent TAP block (58%). Non-TAP block patients received, on average, 8 mg of oral morphine equivalents more than the TAP patients (P = 0.035). No significant difference was noted in pain scores, which were taken immediately after surgery, 2 h after surgery, and at multiple times between these time points to calculate an average. Of the patients who received a TAP block, 11% reported nausea or vomiting compared with 45% in the standard group (P < 0.01). There were no reported procedure-related complications. ConclusionsTAP blocks are safe and effective adjuncts for postoperative pain management on STSMs to LMICs. Additional studies are needed to investigate the potential advantages and disadvantages of more widespread use of TAP blocks in LMICs.

Contributions, challenges, and emerging patterns of short-term missions

It was not until the last decade that missiologists placed the short-term missions (STM) movement at the center of their research. As the initial wave of STM scholarship surfaced, research centered on measuring the impact of STM on participants. Later, attention shifted to unraveling the impact upon the host community. More recently, with the exponential growth of partnerships between congregations in the Global North and the South, researchers have focused on analyzing the prevalent dynamics and patterns of relationships that involve STM teams. This article unravels the impact of STM in terms of its contributions and challenges to the global missionary enterprise and describes emerging patterns, such as reverse STM and multicultural STM teams.

Demonstration of a Longitudinal Medical Education Model (LMEM) Model to Teach Point-of-Care Ultrasound in Resource-Limited Settings.

Background: Short-term medical missions prevail as the most common form of international medical volunteerism, but they are ill-suited for medical education and training local providers in resource-limited settings. Objective: The purpose of this study is to evaluate the effectiveness of a longitudinal educational program in training clinicians how to perform point-of-care ultrasound (POCUS) in resource-limited clinics. Design: A retrospective study of a four-month POCUS training program was conducted with clinicians from a rural hospital in Haiti. The model included one-on-one, in-person POCUS teaching sessions by volunteer instructors from the United States and Europe. The Haitian trainees were assessed at the start of the program and at its conclusion by a direct objective structured clinical examination (OSCE), administered by the visiting instructors, with similar pre- and post- program ultrasound competency assessments. Results: Post-intervention, a significant improvement in POCUS competency was observed across six different fundamental areas of ultrasound (p < 0.0001). According to our objective structured clinical examination (OSCE), the mean assessment score increased from 0.47 to 1.68 out of a maximum score of 2 points, and each trainee showed significant overall improvement in POCUS competency independent of the initial competency pre-training (p < 0.005). There was a statistically significant improvement in POCUS application for five of the six medically relevant assessment categories tested. Conclusion: Our results provide a proof-of-concept for the longitudinal education-centered healthcare delivery framework in a resource-limited setting. Our longitudinal model provides local healthcare providers the skills to detect and diagnose significant pathologies, thereby reducing avoidable morbidity and mortality at little or no addition cost or risk to the patient. Furthermore, training local physicians obviates the need for frequent volunteering trips, saving costs in healthcare training and delivery.

Short-Term Surgical Missions: Role of Pharmacist Volunteers

Health care professionals often participate in short-term surgical missions in underserved areas of the world. Surgical missions often rely on the use of medications to provide health care to these underserved areas in patients with multiple comorbid conditions. The direct role a pharmacist may have in surgical missions is not well described in the literature; however, numerous opportunities exist for pharmacist involvement to improve patient care and operational processes throughout medication planning and delivery of surgical missions. Pharmacists have specialized knowledge in medication acquisition, preparation, and distribution that result in a unique position to contribute positively to the mission’s clinical and operational dynamics. Pharmacists may assist in various activities such as medication ordering, accrual, purchasing and preparing during the surgical mission. Pharmacists may also provide clinical support and offer alternative medications in the setting of drug intolerance or allergies. In 2008, Operation Walk Boston, a short-term surgical mission was established to provide hip and knee joint replacements to patients in the Dominican Republic. Pharmacists and pharmacy residents play a crucial role as members of this surgical mission. Based on our experience, this article aims to describe the evolving role of pharmacists as a member of a surgical mission.

Short Term Mission and Formation – A Norwegian Perspective

Abstract The following article focuses the attention on how participants in Short Term Mission (STM) from Norway understand the practice they have been part of. In the first part the article investigates what motivates participation in STM, and how STM is understood to be influential in life-choices. The second part of the article introduces “formation” as a theoretical lens. In this part the article investigates the working hypothesis suggesting that STM from Norway is best understood as a formative trip. The material is constructed from a survey with 153 respondents.

Improving standard of pediatric surgical care in a low resource setting: the key role of academic partnership

BackgroundAn epidemiological transition is interesting Sub-Saharan Africa increasing the burden of non-communicable diseases most of which are of surgical interest. Local resources are far from meeting needs and, considering that 50% of the population is less than 14 years of age, Pediatric surgical coverage is specially affected. Efforts are made to improve standards of care and to increase the number of Pediatric surgeons through short-term specialist surgical Missions, facilities supported by humanitarian organization, academic Partnership, training abroad of local surgeons. This study is a half term report about three-years Partnership between the University of Chieti- Pescara, Italy and the University of Gezira, Sudan to upgrade standard of care at the Gezira National Centre for Pediatric Surgery (GNCPS) of Wad Medani. Four surgical Teams per year visited GNCPS. The Program was financed by the Italian Agency for Development Cooperation.MethodsThe state of local infrastructure, current standard of care, analysis of caseload, surgical activity and results are reported. Methods utilized to assess local needs and to develop Partnership activities are described.ResultsMain surgical task of the visiting Team were advancements in Colorectal procedures, Epispadias/Exstrophy Complex management and Hypospadias surgery (20% of major surgical procedures at the GNCPS). Intensive care facilities and staff to assist more complex cases (i.e. neonates) are still defective. Proctoring, training on the job of junior surgeons, anaesthetists and nurses, collaboration in educational programs, advisorship in hospital management, clinical governance, maintenance of infrastructure together with training opportunities in Italy were included by the Program. Despite on-going efforts, actions have not yet been followed by the expected results. More investments are needed on Healthcare infrastructures to increase health workers motivation and prevent brain drain.ConclusionsThe key role that an Academic Partnership can play, acting through expatriated Teams working in the same constrained contest with the local workforce, must be emphasized. Besides clinical objectives, these types of Global Health Initiatives address improvement in management and clinical governance. The main obstacles to upgrade standard of care and level of surgery met by the Visiting Team are scarce investments on health infrastructure and a weak staff retention policy, reflecting in poor motivation and low performance.

Identification of current best practices for short-term medical mission trips and adherence to current common principles and guidelines

Background: Recent reviews of published guidelines for conducting short-term medical missions (STMM) identify significant concerns about the lack of adherence and of formal regulations concurrent with the increasing number of individuals and organizations participating in STMM. Method: A descriptive survey methodology was used. A 44-item survey that identifies current practices utilized by healthcare providers (HCP) who have participated in STMM was used based on the literature and prior research, and distributed electronically to HCP participating in STMM to identify current best practices and compare findings with the most recent recommendations for short-term global health activities. A focus on current operational practices was surveyed and analyzed to develop operational recommendations for the ethical and safe care provided during STMM. Results:M Eighty-seven surveys were included in the final analysis with 33% (N=29) serving as coordinators for the trip. The majority of the respondents were female (67%), and the primary roles represented were: MD (N=17; 20%), nurse practitioner (N=20; 23%), and registered nurse (N=18; 21%). A majority (N=48; 67%) traveled to South America or Latin America with 38% (N=33) having participated in four or more STMM. Language proficiency was reported as deficient (N=35; 40%) along with little or no knowledge of the basic culture (N=39; 45%). Additional data were collected on trip preparation, clinic operations, and outcomes follow up. Conclusions: Using a convenience sample, the results of the survey provide information on the current practices utilized by HCP who have participated in STMM and compare the findings to assess for adherence with the most recent recommendations for short-term global health activities. There was variation in the degree to which HCPs were knowledgeable about specific aspects related to knowledge of local culture, language proficiency, and adherence to recommended practices for STMM. Additional research on STMM is needed, along with further exploration of how evidence-based practices for STMM can be implemented to improve access and safety to the care provided while in the host country.

Barriers to Obtaining Informed Consent on Shortterm Surgical Missions.

Background:Short-term surgical missions (STSMs) enable visiting surgeons to help address inequalities in the provision of surgical care in resource-limited settings. One criticism of STSMs is a failure to obtain informed consent from patients before major surgical interventions. We aim to use collective evidence to establish the barriers to obtaining informed consent on STSMs and in resource-limited settings and suggest practical solutions to overcome them.Methods:A systematic review was performed using PubMed and Web of Science databases and following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. In addition to the data synthesized from the systematic review, we also include pertinent data from a recent long-term follow-up study in Ethiopia.Results:Of the 72 records screened, 11 studies were included in our review. The most common barrier to obtaining informed consent was a paternalistic approach to medicine and patient education. Other common barriers were a lack of ethics education among surgeons in low-income and middle-income countries, cultural beliefs toward healthcare, and language barriers between the surgeons and patients. Our experience of a decade of reconstructive surgery missions in Ethiopia corroborates this. In a long-term follow-up study of our head-and-neck patients, informed consent was obtained for 85% (n = 68) of patients over a 14-year period.Conclusions:This study highlights the main barriers to obtaining informed consent on STSMs and in the resource-limited setting. We propose a checklist that incorporates practical solutions to the most common barriers surgeons will experience, aimed to improve the process of informed consent on STSMs.

Short-term surgical trips: local collaboration and its effects on complications and patient satisfaction.

Short-term surgical missions can provide communities in need with desired expertise; however, it is uncertain who will manage the complications after visiting experts leave. Poor outcomes, decreased patient satisfaction, and tension on the healthcare system develop when local providers, often excluded from the initial patient care, are unable to cope with subsequent morbidity. Two-year retrospective review of pediatric general, plastic, and reconstructive surgery, and urology cases performed by a relief organization in the developing world. Case complexity and postoperative complications were analyzed. Phone interviews conducted with patients/families to quantify postoperative outcomes and satisfaction. 474 surgeries were performed on pediatric patients with 60% response rate. Respondents stratified into three levels of complexity: 159 simple, 72 intermediate, and 54 advanced surgeries. Six (2.1%) high-level complications occurred. No association between the complexity of the surgery and the occurrence of a complications. 83.5% were satisfied with outcomes and > 92% were happy with the provided support. Facilitating visiting and local surgeons performing cases together increases the expertise of local providers, strengthens infrastructure, and establishes clear follow-up. Despite complications, patients and families continued to recommend care to family and friends by the relief organization and were happy with support from local providers. Engaging local providers is the gold-standard for short-term trips.

Abstract 16: Characterizing the Global Need for Plastic Surgery Service

Background: Nearly 5 billion people worldwide do not have access to surgical care. Access to plastic surgery for trauma-related injuries, congenital anomalies, and malignancies is equally limited. The current global surgery model relies heavily on short-term international surgical mission trips, yet little information is available to guide their development. Methods: To assess global plastic surgery service needs, a 16-item survey was designed and electronically distributed to 4550 members of the International Society for Aesthetic Plastic Surgeons (ISAPS). Members are required to maintain active membership in their respective national society of plastic surgery. Three rounds of surveys were distributed. Countries with fewer than 3 responses were excluded from individual analysis. Results: A total of 906 responses (20%) were obtained. 91% of respondents practice in an urban setting, and the majority are in private practice. More than 80% of respondents from Bangladesh (n=12), China (n=3), Colombia (n=20), Ecuador (n=10), Iraq (n=5), Panama (n=10), Philippines (n=11), Saudi Arabia (n=7) and Vietnam (n=5) indicated a need for volunteer plastic surgeons. 80% of respondents in Southeast Asia (n=40) and 79% of respondents in Central America (n=29) indicated a need for volunteers. Respondents from India (n=26) and Bangladesh (n=12) indicated a particular need for burn and trauma reconstruction, while craniofacial anomaly repair is needed globally. “Operating together with local surgeons” and “offering educational opportunities to local surgeons” were rated as the “most helpful” service modalities overall. A majority of respondents in each country indicated that plastic surgeons, operating room staff, anesthesia, physical therapists, and speech therapists are at least “somewhat accessible” in their local community. Conclusion: To maximize the impact of global plastic surgery outreach, organizers should know which service modalities are most needed and where. Our study suggests partnering with local surgeons may provide the greatest local impact, and that much of the global need for plastic surgeons is concentrated in Southeast Asia and Central America.

Facial human bites. Vision on STMMs in Africa.

&lt;b&gt;Objectives:&lt;/b&gt; Human bites of the face are a frequent and serious health issue as they often compromise patients function and aesthetics as well as lead to further complications. The aim of the study is to review human bites of the face referred to our team during 112 short-term medical missions (STMMs) in Sub-Saharan Africa over the past 20 years and to discuss the epidemiology, appearance, management and outcome, including the most common complications. &lt;br&gt;&lt;b&gt;Methods:&lt;/b&gt; A retrospective medical documentation review was carried out examining all human bites of the face operated by our team during 112 STMMs from 2000 to 2019 in different countries of Sub-Saharan Africa. &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; Out of about 5500 patients medical charts 51 patients were selected due to history of human bite. Patients' age range was 15-65 years, female to male ratio was 1, 55:1, the most often involved parts were: lips, ear and nose. Various surgical procedures were carried out including local flaps and free grafts. Infection and graft necrosis were the most common reported complication (n = 4; 9.3%). &lt;br&gt;&lt;b&gt;Conclusion:&lt;/b&gt; Human bites injuries are a serious health problem in some African populations because of their frequency and possible severity. The treatment is particularly challenging due to their potential to cause local infections, the risk they pose for transmission of systemic diseases as well as their demanding surgical management.

A partnership to develop disaster simulations for nursing students in response to climate change: description of a programme in Bluefields, Nicaragua, and Virginia, USA

BackgroundA common practice in global nursing education is short-term missions where US-based students spend a brief time in a host country with hands-on experiences with patients, but maintain a US-centric perspective. Subsequently, an exchange becomes extractive, where one group benefits. Capacity-building models are needed in global health nursing education. In 2007, Bluefields Indian and Caribbean University (BICU), Nicaragua, and the University of Virginia (UVA), USA, began a collaborative partnership. In 2018, nursing faculties in these institutions developed simulations for nursing students at both sites, focused on disaster response in the context of climate change. Bluefields, located on the Caribbean Coast of Nicaragua, is vulnerable to extreme weather events and, increasingly, communities across Virginia are also experiencing such weather events. Here, we describe the joint programme and report student responses to the pilot simulations. MethodsIn 2019, three pilot simulations were conducted with groups of BICU and UVA students in Bluefields; subsequently, simulation-based training events centred on disaster preparedness responses to climate change were integrated into curricula at both institutions. In July, 2019, faculty partnered to run the simulation with 46 UVA graduate (pre-licensure) second year students, and 36 undergraduate students at BICU. Only faculty travelled between both institutions in 2019, although student groups in both locations participated in the same simulated disaster scenarios to promote preparedness. All participants completed a pre-event and post-event survey about the simulation experience and their preparedness for a disaster scenario and also participated in group debriefing. FindingsStudents at UVA reported increased confidence related to their ability to: respond in the event of a disaster (96%); their ability to describe three important considerations for disaster response in low-resource settings (97%); and their ability to describe considerations or activities for public health nurses to support disaster preparedness before a disaster (97%). Similarly, increased confidence was reported students at BICU in these categories of 97%, 99%, and 98%, respectively. InterpretationStudents and faculty at both institutions were open to, and interested in, the focus area of disaster preparedness, and the process of learning about extreme weather events related to climate change. A focus on the simulation on the acute disaster response and the subsequent debriefing on proactive pre-disaster prevention was important for learning. This work exemplifies a process for developing best practice models in global nursing education, underpinned by nursing education research in global health and capacity building. FundingThe Jefferson Trust, an initiative of the Alumni Association of the University of Virginia.

Ethical considerations in global surgery: a scoping review

IntroductionAn unmet burden of surgical disease exists worldwide and is disproportionately shouldered by low-income and middle-income countries (LMICs). As the field of global surgery grows to meet this need, ethical...

The dark side of doing good: a qualitative study to explore perceptions of local healthcare providers regarding short-term surgical missions in Port-au-Prince, Haiti

Background In response to the increasing global burden of surgical diseases, medical providers from high-income countries are increasingly volunteering in underserved regions. Short-term surgical missions are growing in number but lack appropriate oversight. Many studies on volunteers’ perspectives have been published, but few have examined the perspectives of local healthcare providers. Aim To explore perceptions of Haitian healthcare providers regarding short-term volunteer missions in order to identify positive and negative perceptions. Methods A qualitative approach utilizing interpretivist epistemology and a social constructivist perspective captured perceptions of participants in their social setting. Interpretivism recognizes that perceptions are subjective and socially constructed. After purposive sampling, 17 participants were recruited. In-depth recorded interviews with assistance from local interpreters explored participants’ perceptions. Using thematic content analysis, unexpected themes emerged. Results Four themes emerged: general perceptions, perceived effect on healthcare system, perceived effect on healthcare workers, and future recommendations. In general, local healthcare workers appreciate the skills and knowledge that teams impart and the improved access to surgical services for the poor. However, volunteers working independent of local teams create negative perceptions, stress local healthcare providers, and strain hospital resources. Future teams should utilize local perceptions to measure impact and effectiveness of their efforts. Conclusions Perceived impact of short-term surgical missions is dependent on participant perspective. This study addresses negative perceptions and offers recommendations for before, during, and after a mission. Surgical missions that emphasize training local staff and forming long-term relationships have a greater impact on surgical capacity than do missions that focus primarily on surgical volume. Further research on local perceptions is essential to ensure that local voices continue to be heard and that altruistic efforts of volunteers do not inadvertently cause negative effects.

Reliability of the Service Trip Audit Tool to assess the quality of short-term medical missions.

BackgroundWe aimed to assess the adherence of short-term medical missions (STMMs) operating in Latin America and the Caribbean (LAC) to key best practices using the Service Trip Audit Tool (STAT) and to calculate the inter-rater reliability of the data points. This tool was based on a previously published inventory of 18 STMM best practices.MethodsProgramme administrators and recent volunteers from 335 North American organizations offering STMMs in LAC were invited to complete the STAT anonymously online. Adherence to each of 18 best practices was reported as either ‘yes’, ‘no’ or ‘not sure’. Fleiss’ κ was used to assess inter-rater agreement of the responses.ResultsA total of 194 individuals from 102 organizations completed the STAT (response rate 30.4%; 102/335 organizations) between 12 July and 7 August 2017. Reported adherence was >80% for 9 of 18 best practices. For 37 non-governmental organizations (NGOs) with multiple raters, inter-rater agreement was moderate to substantial (κ>0.4) for 12 of 18 best practices.ConclusionsThis is the first study to evaluate adherence to STMM best practices. Such an objective evaluation will be valuable to governments, volunteers and NGO donors who have an interest in identifying high-quality partners. Assessment and monitoring of STMMs through self-audit may be foundational steps towards quality improvement.