MEMBER VOICES: What is the “mission” in medical mission trips?

Tim Heintz and Larry Kravitz, MD
April 03, 2024

The world has undergone extensive globalization over the past few decades, and higher education continues to provide medical students and physicians with global health opportunities to help underserved communities. These opportunities, typically conducted in low- to middle-income countries, are commonly known as “mission trips,” and tend to be short-term in nature, and offer clear and plentiful advantages for all stakeholders who engage in this activity. Students can refine their clinical and language skills, become more familiar with novel diseases, remain sensitive to the social determinants of health, and further their desire to enter primary care.1-2 Currently, no central regulatory agency oversees short-term global health initiatives,3 and the more than 6,000 US-based annual trips might cause more unforeseen harms than benefits.4 With increased skepticism and concern regarding the ethicality of these trips, it is advised that the well-intentioned volunteer consider some of the complexities that will be discussed below before participating in a mission trip, such as questionable motives, naive assumptions of beneficence, and time requirements to accomplish useful work.

Short-term global health organizations should carefully vet volunteers — both trainees and qualified medical personnel — for morally appropriate motives before risking any measurable harm. One insidious motive would be the desire to use the initiative as a vacation. This vacation mentality may be an incentive for a lot of trainees to join, especially if the sending-organization intentionally reserves time during the stay to explore nearby regions and tourist hotspots. This mindset became apparent to host country physicians and program administrators working with the non-governmental organization Child Family Health International in Bolivia and India; it was clear that students’ intentions were to enjoy themselves, leading to the perceived notion that the students were apathetic.2 Another kind of volunteer who fits poorly with a short-term global health initiative is one whose only motive is to further their career. Ironically, short-term global health organizations capitalize on those hoping to “enhance employment prospects”5 or on those hoping to gain a competitive advantage for professional school admissions with some organizations explicitly stating that it will “enhance a student’s application materials.”5-6 Even the host supervising physicians with Child Family Health International failed to mention improved patient outcomes in their promotional materials when they reflected on the benefits of their mission trips; instead, they referred mostly to advantages such as “increased prestige” and “professional development opportunities.”2

The perpetuation of self-serving motives may be tacitly justified by false assumptions regarding the nature of volunteer work. The first false assumption — and currently the most accepted defense of mission trips in their controversial form — is that conducting any mission trip is better for the medically underserved population than to conduct no trip at all (i.e., “something is better than nothing”).7-8 However, there is evidence to the contrary. A study of medical initiatives to Honduras discovered that there were between 2,000 and 3,000 unemployed Honduran physicians looking for jobs every month.8 Even though many of those who graduate medical school find themselves in other fields such as taxi driving, Honduras continued to receive at least one overseas medical team per day. Another fallacious assumption is the idea that it is better to treat more people than to treat less people (i.e., “quantity is more important than quality”).8 Operation Smile, a well-known nonprofit medical service organization focused on cleft surgeries, has a questionable performance history. Their services in the late 1990s were tied to the deaths of multiple children from multiple countries, leading others to believe that they were putting “the number of surgeries above patient safety for publicity reasons.”8 Unfortunately, the organization’s work in China resulted in 169 children visiting their local hospitals for ongoing care and revisions from surgical complications.

Inevitable trip brevity risks the possibility of leaving patients inadequately treated. Noncommunicable diseases such as cardiovascular disease, diabetes, and cancer, are the “leading causes of mortality worldwide”4 with developing nations and low- to middle-income countries bearing a disproportionate burden of chronicity. Given that significant chronic health care improvement is very difficult to attain, health care workers taking part in short-term global health initiatives may be tasked with providing an intervention that may be unsustainable. In their study gathering demographic, socioeconomic, and clinical data from two shantytowns on the outskirts of Lima, Peru, Geen et al9 discovered that about half (48.8%) of their patients could not afford medications. Knowing that deliverance of medication in two- to four-week supplies typically serves as the primary intervention of patient illness on these trips, sending-organizations should evaluate how much their work will truly manifest long-term health benefits for their patients.9 Even treatment for communicable diseases such as HIV and tuberculosis require substantial patient compliance over a long period of time; failure in such efforts is well-documented to enhance the risk of resistant organisms.10

Organizations with the mission of furthering the development and education of the volunteer may construct a culture that deviates from the goal of uplifting underserved populations. One who wishes to volunteer on a mission trip — irrespective of their prestige and name recognition — should join a sending-organization whose actions revolve around putting the long-term welfare of the patient and their community first. As an example of good practice, medical students from the University of Texas at San Antonio treated Ethiopian patients for Tunga penetrans in the summer of 2019.11-12 Funds were raised to provide patients with appropriate shoes — as needed for adequate healing — and treatment of the environment was performed “to prevent a reinfestation of the fleas.”11 The school even incorporated electronic health records so that they could “track whether their work [was] actually improving local patients’ health.”11 Finally, medical students created a “comprehensive education program to prevent further infection.”12

Partners in Health, co-founded by the late global health pioneer Paul Farmer, is exemplary in their pursuit for a sustainable impact. According to their mission webpage, they pursue their goals by “establishing long-term relationships with sister organizations based in settings of poverty.”13 Furthermore, “99% of staff and clinicians are from the country where they work,” as stated in their 2023 annual report.14 Volunteers may further evaluate the legitimacy of global health groups with charity assessment organizations such as CharityWatch and Charity Navigator. Currently, both Partners in Health and Operation Smile receive the highest grading by CharityWatch and Charity Navigator, respectively.15-16 Partners in Health also has a misconduct reporting system through the “confidential third-party hotline” EthicsPoint.17

There may be an overwhelming number of complexities that the global health community should consider when setting the professional standard for mission trips, but the idealistic medical volunteer can wield the power to influence the culture of medical volunteerism by being selective with whom they volunteer. By remaining informed of a few mission trip complexities and spreading awareness of their cultural flaws, the individual can push the culture of global health further towards the long-term care of the patient and their community. And of equal importance, volunteering only in organizations that hold themselves to a high degree of professionalism and virtue may instill in future generations the norm of putting vulnerable populations at the forefront of our decision-making in the medical community.


References

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