Taking a longer look at short-term medicine

Harvard medical student Ben White, left, stands with a medical student from Sweden during a visit to the medical mission Rotaplast in Caracas, Venzuela

HMI is helping a Harvard medical student study the broader impact of short-term medical missions in developing countries. Every year, hundreds of missions bring teams of health care workers who lend their time and expertise to care for patients in the developing world. Some of the missions provide routine medical care to rural populations, while others send surgeons into a city hospital to perform specialized procedures. These diverse organizations have a variety of goals and practices, but all involve bringing doctors from the developed world for a short stay—usually one or two weeks—to offer health care that is out of reach for the local medical community.

So many short-term interventions undoubtedly have long-term effects on the local community, but currently there is no system to evaluate their success or track the impact on their communities. Health care workers interested in doing international work might wonder how different organizations interact with the local medical community, whether they provide training or other sustainable contributions beyond medical care, and how knowledgeable they are about the logistics and challenges of providing care in another country.

Questions like these motivated Ben White, a second-year student at Harvard Medical School, to visit several missions in Latin America and begin to study them as a whole. When he was a prospective medical student, White had the opportunity to travel in Latin America and Asia, and was naturally curious about medicine in the countries he was visiting. “I noticed that the range of health care interventions into developing countries was wide and varied, and much more prevalent than I expected,” he said. Although these interventions were undoubtedly providing a great service to patients, White wondered what kind of broader impact they had on local health care. Later, as a first-year medical student at Harvard, he began to work on a plan of action to study them in detail.

In researching the phenomenon of medical missions, White discovered an incredible diversity of programs without any centralized system of oversight or evaluation. Under the mentorship of Dr. Robert Crone, CEO and president of HMI, White decided it might be useful to develop a system that would help these different missions track their progress and evaluate their success. “We came up with the idea of a developing a matrix, a spreadsheet of factors by which program directors might internally evaluate these missions and identify the key areas for refining and improvement,” he said.

With funding from HMI and the Office of Enrichment Programs at Harvard Medical School, White visited six medical missions in Guatemala, Venezuela, and Honduras. He spent time observing the physicians in action and conducted interviews with coordinators and staff at each mission to find out what their goals were, what kinds of problems they faced as an organization, and what solutions they had found to these problems. Through his interviews and observations, he began to generate a list of qualities critical to success, from cultural and language competency, to costs per patient, to measurable outcomes and sustainable improvements.

Linda Jo Stern, a sponsor of White’s project and director of PROMESA, a medical mission working in Honduras, said that short-term brigade-style missions face significant challenges. They have difficulties providing follow-up care for patients, ensuring that medication regimens are adhered to, coordinating with in-country health care workers, handling differences in medical practice, and overcoming language barriers and logistical hurdles. The matrix, she said, is “a way of identifying and measuring the issues that confront these missions and would hopefully help the organizations that run them evaluate what they are doing.” For instance, White found that some missions interact little with the local health care system, while others routinely offer training as part of their service. “There’s a balance in how much time you spend with patients and how much time you spend teaching,” said White. However, he believes that some time spent teaching and training local health care practitioners could contribute greatly toward a sustained improvement in health.

One area that White felt could be improved across all the missions is communication. “These missions tend to not communicate with one another at all,” he said. There are many cases where missions practicing in the same region or encountering the same problems could gain from pooling information. “You could also imagine a situation where they could set up a network of short-term missions that, when put together, have a better continuity of care.”
White has completed a preliminary version of the matrix and will be working to refine it over the coming months. Dr. Crone said that the project will be a first step towards trying to understand a major influence in international health care and set standards within what is a large but disparate group of organizations. “In our quest to look at solutions to difficult health problems, is this something that contributes to the health and welfare of communities and to their health care infrastructure?” he wondered. Considering that all health care programs and interventions involve resources, he believes that some kind of standardized evaluation system can help determine how that time and money is best spent. For instance, the problems of short-term interventions have led Linda Jo Stern to re-think the strategies of PROMESA. “We are going to focus more on projects that are more sustainable by the communities,” she said.