Surgical missions to developing countries: Ethical conflicts

Abstract

Each year scores of American physicians and nurses travel overseas, usually at their own expense, aiming to improve the lot of desperate patients in developing countries. Our journals are filled with images of smiling children who have benefited from these gifts of care. Still, practicing medicine, and especially surgery, in a sporadic fashion in distant lands can lead to poor outcomes. It does little to improve public health or advance medical education. We address some of the ethical dilemmas intrinsic to international surgical missions and discuss how we might redirect our resources to provide better care to more people.

Teaching quality improvement in Tanzania: a model of inter-professional partnership for global health development

“…30,31 The short duration of this program allows health care professionals to contribute to medical mission work with limited time commitment while avoiding the well-described potential unintended consequences of short term medical mission work. 32,33 By focusing on capacity building and education, rather than providing actual medical care, we have attempted to avoid the well-described risks of mission work which may actually degrade health system development.…”

The Current Status of International Partnerships for Child Surgery in Sub-Saharan Africa

“…6,7,10,11,13,14,17,19,21,[24][25][26] The weaknesses expressed by the articles were difficulties with target definition, lack of ethical considerations in areas of supervision, patient protection, proper audit, inappropriate allocation of already scarce human and financial resources, and poor follow-up of cases. [7][8][9][10][11][13][14][15][19][20][21][22][23][24][25]27,28 On the other hand, the long-term outcome may be more difficult to assess due to ill-defined duration of the missions, lack of sustainability, and the difficulty with defining measurable outcomes. 10,11,21 The ultimate long-term goal of the partnership programs or missions is to help develop and consolidate infrastructure, and to facilitate training of local people to reduce reliance on external aid programs and ensure that all children have access to and benefit from globally acceptable level of care.…”

“…As a result of these, in most cases the visitors may not be truly aware of the local burden of disease; degree of poverty; lack of facilities; and local social, economic, and political contexts that significantly impact the outcome of the programs. [7][8][9][10][14][15][16][17]21,27,36 Closely related to this is the difficulty of providing full spectrum of care, especially with respect to multidisciplinary management and arrangements for adequate follow-up of cases that tend to leave the postoperative cases stranded after the mission is concluded. 10,11,21 When these challenges are combined with the reported poor level of the governments' administrative and financial commitment-and occasional strained relationship with the local health care workers-it is not surprising that sustainability may become a problem and the overall impact might be limited.…”

“…11,21,[32][33][34][35][36] An additional aspect of the planning may include defining objectives, establishing targets, ethical considerations, funding, and putting in place feasible exit strategies. 10,[21][22][23][24][25][26][27] There may be a need to involve the host nation government in the execution of the program, provision of logistical support, commitment toward implementation of the recommendations of the visiting groups, supporting the training of local medical staff, and improvement of health care funding. 10,28 Further impetus may be obtained by developing an initiative to attract and retain local medical personnel trained overseas or locally to stem brain drain.…”

The Usefulness of a Yearly Head and Neck Surgery Trip to Rural Kenya

“…13 Agreeably, the highest impact is a lasting one, and more than once-yearly trips with devoted teaching of local surgeons will ultimately improve the quality of medical care in developing countries. 14 Logistically, such a system requires planning, management, and buy-in from all parties involved.…”