It appears that patient records are handwritten and rarely stored for safe-keeping. Informed consent in this region of the country amounts to the verbal approval of the senior male in the family, not necessarily that of the patient.
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July 2016The resident physicians in the team are focusing their attention on the more challenging head and neck and otologic disorders and are eager to operate on these patients. They are pressing for an extensive surgical experience that will result in many patient photographs to share with others back in the States.
As you and your team meet to discuss potential surgical candidates, a number of important diagnostic and patient care inadequacies become obvious. There is a CT scanner in the hospital, but it comes with an acknowledged history of poor maintenance and frequent breakdowns—although currently it appears to be working. There are no trained audiologists at the clinic, but a Bekesy audiometer was found in a storage closet. On the positive side, the anesthesia machines are functioning properly, and there is an instrument sterilizer with intact seals.
As you lead the patient care team in an in-depth discussion of patient selection for surgical procedures, you realize that the decisions made by the team could have far-reaching social/cultural implications, as well as a tremendous impact on the safety and outcomes of each individual patient selected.
How should you proceed?
Discussion
Short-term medical missions outside the United States can be professionally and personally rewarding—and usually are. Many altruistic healthcare providers spend precious free time planning and participating in medical missions, giving needed medical and surgical care to thousands of disadvantaged persons around the globe. The secondary missions of teaching and supporting the country’s local physicians and otolaryngologists are nearly as important as direct patient care. Additionally, the good relations that are developed by caring, compassionate American physicians and nurses with individuals of other cultures represent our commitment to helping others. All in all, medical missions can be positive and altruistic when conducted appropriately. A number of major points can be emphasized in the planning and conduct of medical missions.
Mission Planning
Much of the success of a medical mission lies in proper planning.
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Much of the success of a medical mission lies in proper mission planning, as well as proper conduct of the mission according to the plans. The most important initial steps are to identify the country in need of assistance and to select the best local physicians to host the team and the mission. It may be difficult to ensure that the host physicians have the proper credentials, capabilities, integrity, altruism, and organizational skills to manage the on-site conduct of the mission, so references must be checked. The mission plan should include the following concerns and requirements: types of surgical cases to be performed, standards of care for the patients, limitations of care and selection of patients, cultural considerations, socio-political-economic issues in the host country that could affect the mission, and, of course, ethical considerations.