It is important to know the precise capabilities and available equipment and facilities at the host site. Many surgical procedures require a specific preoperative diagnostic evaluation to determine the suitability of a surgical procedure for any given patient. You might anticipate requiring precise audiometric evaluations for otologic procedures, imaging for head and neck and sinus procedures, and basic laboratory and electrocardiographic tests for surgical clearance. Failure to confirm the proper infrastructure at the host facility can result in overestimation of the types of surgical procedures that can be performed.
Explore this issue:July 2016
Mission planning should also include an emphasis on patient safety, quality care (even considering the infrastructure limitations), quality improvement over mission iterations, impact assessment of the mission on the host community, teaching opportunities of host physicians, and the importance of maintaining positive international relations. No longer can medical missions be conducted with minimal planning and maximum optimism—reality must prevail.
Scope of Practice
Medical missions to developing countries should not be undertaken just as an opportunity for training residents or medical students in surgical procedures. In fact, it may well be that the most experienced otolaryngologists should be performing the difficult portions of the surgeries to achieve the best chance for a successful outcome. After all, the American otolaryngologists will be leaving these patients after just a few weeks of postoperative care, so while teaching others is indeed a secondary mission, the primary mission is to provide the most expert care for the patients. In this scenario, the resident physicians on the mission trip were excited about getting to perform difficult cases on patients whom they would only know for a short time and in the context of quite diverse cultural differences. Of course, the residents should participate, but the senior otolaryngologists should decide just what part of the appropriately selected procedures would be amenable to resident performance.
The procedures otolaryngologists perform on a medical mission should be similar to those they routinely perform in their own practice. It is not a time to perform surgical procedures the otolaryngologist has not performed since residency. The team composition should appropriately be organized to include the range of generalists and specialists that reflects the types of procedures included in the scope of the mission planning. This same concern would apply to other specialties, as well. Patient safety and positive patient outcomes are best served by practicing well within the scope of the individual physician’s experience and expertise.
Proper selection of patients rests with the integrity, ethics, and expertise of the mission leadership. Along with scope of practice, the other important parameters for proper patient selection and patient safety include the capabilities of the surgical team, the infrastructure of the facilities, proper working condition of the equipment, a history based on adequate translation, a pertinent physical examination, an informed consent that at least includes the assent of the patient, proper diagnosis of the disorder, perioperative care that includes blood banking and nursing care as needed, and the provision of physician follow-up care. Too many blank spots in the assessment and selection of the appropriate procedure for a given patient can lead to a disaster that may not be recoverable. The availability of a crash cart for cardiac arrests must be confirmed during mission planning, as these events can occur even in the best of circumstances. Requesting photographic evidence of the equipment and facilities before embarking on the mission can greatly aid in planning. Do not be caught unaware of the limitations of the host site or facilities.