Elsevier

Ambulatory Pediatrics

Volume 7, Issue 4, July 2007, Pages 317-320
Ambulatory Pediatrics

Brief report
Bronchiolitis, asthma, sexual abuse, international education, community pediatrics
A Model for Sustainable Short-Term International Medical Trips

https://doi.org/10.1016/j.ambp.2007.04.003Get rights and content

The health status of many people in developing countries is often dismal compared with the norms in industrialized countries. Increasingly, medical practitioners in the United States and other industrialized countries have become interested in global health issues, an interest that often takes the form of short-term international medical trips. We discuss several ethical issues associated with participation in such trips and use our experiences in developing the Children’s Health International Medical Project of Seattle (CHIMPS) to outline and illustrate a set of 7 guiding principles for making these trips. CHIMPS is a resident-run, faculty-supported international medical program founded in 2002 by pediatric residents at the University of Washington in Seattle. Members of CHIMPS work with a rural community in El Salvador to support ongoing public health interventions there and provide sustainable medical care in collaboration with the community and a local nongovernmental organization. The 7 principles developed as a result of this work—mission, collaboration, education, service, teamwork, sustainability, and evaluation—can be used as a model for health practitioners as they develop or select international medical trips. The importance of partnering with the community and working within the existing medical and public health infrastructure is emphasized. Many of the challenges of doing international medical work can be overcome when efforts are guided by a few specific principles, such as those we have outlined.

Section snippets

Ethical Challenges of International Health Work

Despite its good intentions, international health work is not without significant ethical challenges. Given the cost, time, and logistics involved in working overseas, most international medical work is short term, in the form of volunteer brigades or training electives. Labeled by critics as “medical tourism”—“short-term overseas work in poor countries by clinical people from rich countries”12—these trips can be seen as:

  • Self-serving: provide value for visitors without meeting the local

Guiding Principles

The Children’s Health International Medical Project of Seattle (CHIMPS), founded in 2002 by 2 pediatrics residents at the University of Washington, consists of residents, faculty, nurses, medical students, and other health professionals. Although CHIMPS has had moral support from the residency program, no faculty or administrative time has been provided, and residents have raised all supporting funds; faculty members have consistently volunteered to give stability to the program. Growing

Mission: A Common and Specific Sense of Purpose

The mission statement is a tool to communicate the group’s collective beliefs. Our mission statement is:

“To ethically address underlying health issues and to provide sustainable public health interventions and medical assistance for underserved communities in developing countries.”

We regularly refer to our mission to keep us on course, even as the project grows and changes. It is important that the mission statement emphasizes addressing the public health needs of the community.

Collaboration: A Relationship with a Community and its Infrastructure

Partnership with an NGO, government agency, or other local organization determines the type and extent of work that can be done. Organizations that understand and work within the infrastructure of a community can facilitate the integration of medical and public health projects and assure their continuity.

The name of our partner organization, ENLACE, means “to link” in Spanish. Its mission is to collaborate with communities to develop integrated and sustainable solutions to poverty in El

Educating Ourselves

The process of educating participants in the trip about the community, its medical problems, and effective interventions for these problems should start well before each trip begins.

The first step is to understand how the sociopolitical context of a partner community affects its predominant medical problems and to identify evidence-based solutions so that resources can be focused appropriately. El Salvador, a small country in Central America, has high rates of poverty and infant mortality. Of

Service: Commitment to Doing Work the Community Needs and Wants

In a short-term international trip, service involves providing a combination of public health interventions and sustainable clinical care that address the community’s priorities. The positive effect of short-term trips can be maximized by designing interventions that target conditions for which the traveling group has adequate supplies and that use the existing infrastructure for ongoing care. To determine the needs of the population and follow individual persons, it is important to gather

Teamwork: Building on Each Team Member’s Skills and Experiences

An ethical international trip involves appropriate supervision of all junior team members in a manner consistent with policies of patient care in the United States. In addition, it is important to bring team members with diverse specialties (ie, physicians, nurses, physical therapists, dentists, health educators) so that volunteers can use their specific strengths to address the community’s prevailing needs. Upon our arrival in Los Abelines, the local physician orients the team to the common

Sustainability: Building Capacity for Ongoing Interventions

Building a sustainable project involves working in a single location so that efforts can be augmented during successive trips. This approach demonstrates a commitment to an ongoing relationship and allows for a greater effect on the community’s health. Working within existing systems of care to teach the teachers allows the group to work with the community rather than providing care to them. In our example, this shifts the responsibility for community health improvement towards the year-long

Evaluation: A Mechanism to Determine Whether Goals are Being Reached

Conducting periodic evaluation is important for measuring a project’s effects and improving its design and implementation. By use of the structure-process-outcome model, we evaluate our program regularly.23 After consultation with our institutional review board, we have developed a database of clinical and laboratory data collected during annual visits and use this information to determine the effectiveness of our interventions and the changes needed. For example, in a convenience sample of

Conclusions

International work requires intensive logistical planning, financial support, enough skilled personnel, and institutional support for practitioners. Even with the best intentions and thoughtful planning, there are patients for whom adequate care cannot be given, and well-meaning interventions can have unexpected effects. Even so, we assert that the health of people around the world and of their communities is a global responsibility, one we as physicians in the United States share. Despite the

Acknowledgments

The authors report no relevant financial relationship with the manufacturers of any commercial products and/or provider of commercial services in preparation of this report. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. We thank the members of the health committee as well as the entire community of Los Abelines, El Salvador. We thank the staff members at ENLACE and the physicians

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