Short term medical missions questioned

The effectiveness and sustainability of well-meaning but ad-hoc assistance organised by small institutions has come under scrutiny in new research. Flynn Murphy reports.

Australian nurses and medics are among the top three in the world for providing short-term aid and assistance in developing countries, yet new research has called into question the long-term effectiveness of these “medical missions”.

Along with the US and Canada, Australia provides the most overseas missions, which are typically a week or two in duration and generally provide specialist surgeries for cataracts and cleft lips, as well as basic care. The most popular destination for Australian healthcare workers is Papua New Guinea and the Solomon Islands. However a new analysis of 230 accounts of medical missions over a 25-year period (from 1985 to 2009) has questioned the suitability and effectiveness of the model in meeting local needs over the long-term.

The study excluded emergency medical aid, such as that delivered in the aftermath of natural disasters and the work of established aid organisations, and instead focused on ad-hoc medical visits organised by small groups.

The University of Sydney research team says their findings raise concerns about the sustainability, financial transparency and ethical standards of the missions. While the missions do provide help to people who otherwise would not have access to it, and the volunteer health professionals gain a great deal personally, a number of negative aspects were also identified.

The study’s lead author, Dr Alexandra Martiniuk from the Faculty of Global Public Health, called for greater consideration of what developing countries want and need. Martiniuk, who has also previously worked with AusAID and Médecins Sans Frontières, said that if the missions were sustainable and transferred skill to the local area, then there was value. “But often it is curious people and curious students who are trying to get a bit of experience and they go once to a country and never return. That’s not sustainable,” she told Nursing Review.

“We need to think more carefully about what developing countries want and need. With short-term medical missions, are we really asking them, ‘does this suit your needs best?’” She said the key to effective short-term aid was communication and co-ordination. “If eight surgeons from Sydney show up in the one little hospital in the Solomon Islands, and maybe there are nine people from Melbourne who are there already, there’s no space left for anyone. We need lists of who is involved so there isn’t an overlap and we can look at where the gaps are, and not overwhelm our partners who live and work in very fragile health systems.”

Martiniuk referred to a long-running relationship between the Solomon Islands and Sydney’s St Vincent’s Hospital as a positive and sustainable model.

Generally though, the reality on the ground was different and the results were mixed, she said.

“A lot of local doctors have different experiences. Sometimes [they] and the local ministry of health thought these projects were really sustainable. Then on the other side, you’d have people coming from another country completely unannounced, barge in not knowing the language or what was going on, and not know much about developing countries at all.”

A major concern was the quality and effectiveness of the medical care provided by foreign doctors unfamiliar with local health needs, local culture and the strengths and limitations of the healthcare system in which they must leave their patients for follow up care, she said.

Such experiences can be further undermined by an absence of follow-up data and ongoing good relationships with the local health services. Medical missions may also not be the best use of limited financial and human resources.

Martiniuk said she wanted her research to start a conversation in medical circles and in the media about how to best co-ordinate and deliver short-term medical aid.

“A medical team of a few doctors, nurses and dentists might spend $25,000 just on their flights, visas and hotels. People need to ask what it would look like if that money was used in a different way. That’s an enormous amount of money when you transfer it into East Timorese dollars. Would that have paid for five local doctors’ salaries, and prevented them emigrating to the UK?”

Nurses were sometimes a special case, said Martiniuk. “Sometimes the skills of nurses are even more aligned to capacity development. Some of our developing country partners, and some of my friends who are born and raised in developing countries and are doctors, actually prefer nurses. So when nurses and midwives come from Australia they are sometimes more aligned with the health system in the local country, and have the skills to teach and fill the gap.”

Martiniuk recommended that nurses and nursing students who are considering a short-term medical mission go under the umbrella of an established aid organisation that is committed to sustainability.

The review, published in the BMC Health Services Research journal, was co-authored by Joel Negin from Sydney university’s School of Public Health, along with researchers from Canada and the University of NSW.

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