Hoping to Help: The Promises and Pitfalls of Global Health Volunteering

Volunteers and the organizations that send them for short periods to poorer countries often describe the trips as “missions” or “brigades.” Both words describe organized, purposeful ventures to accomplish a goal. “Mission” has been used in religious contexts; “brigade” is primarily a military term. In whatever use, both words denote a group with a purpose, a calling, and a common cause. What I am exploring here is the purpose of these missions and brigades and whether these hundreds of weekly arrivals really bring hope (or housing or health benefits) to Haiti or to the thousands of other poor communities around the world that receive international volunteers every year. It may seem obvious that the goal is to accomplish good for the communities visited, to “make a difference,” and often to “give back.” Whether this actually happens, and what other objectives might be involved in these volunteer trips, is rarely considered. These issues motivate this book. Do volunteers help or hurt? In what ways? Can these missions be handled more effectively

Veterans\u27 Medical Care: The Politics of an American Government Health Service

The history of veterans\u27 benefits and services in the United States is reviewed; it demonstrates their responsiveness to dominant political, economic, military and medical interests. The ideological position that social services must be deserved is also seen to be an important influence on the V.A. system. The consequent inaccessibility of V.A. medical care to most veterans and almost all non-veterans raises questions about the appropriateness of the V.A. system as a model for national health care

Applying the Brocher Declaration to short-term experiences in global health in dental education

Participating in Short-Term Experiences in Global Health (STEGHs) has become an increasingly popular way for dental students to learn about the global burden of disease and health inequalities by traveling to a low-income community. However, there is little information available in the dental education literature providing guidelines on best practices for STEGHs. Often little is known about the local dental practice laws and ethics guidelines. One useful resource is the Brocher Declaration. The Brocher Declaration, created by the Advocacy for Global Health Partnerships (AGHP), is a comprehensive document outlining best practices for developing ethical and sustainable global health partnerships. The six guiding principles are: (1) mutual partnership with bidirectional input and learning, (2) empowered host country and community-defined needs and activities, (3) sustainable programs and capacity building, (4) compliance with applicable laws, ethical standards, and code of conduct, (5) humility, cultural sensitivity, and respect for all involved, and (6) accountability for actions. The principles of the Brocher declaration can serve as a foundation for ethics and sustainability and can be easily applied to STEGHs in dental education. The authors present a set of recommendations specific to each principle to guide dental schools in offering STEGHs to their students. Participating in STEGHs represents a unique opportunity for students to learn about the global burden of oral disease, its risk factors, and the population and public health strategies to reduce oral disease in diverse populations. When done ethically, they may serve as a spark for students to become future leaders in global health

Enhancing the value of short term volunteer missions in health from host country perspectives: the Case of Uganda

Short-term medical missions (STMMs), estimated to involve 1.6 million volunteers and US$2-3 billion annually, can be very valuable, but there is a growing critique of practices. Serious concerns have arisen around possible harms to host countries and patients, including medical errors, non-alignment with local systems and priorities, cultural insensitivity, and the high cost compared to benefits. Scholars and practitioners across diverse sectors involved-faith-based, corporate, NGO, and educational-have questioned the value of STMMs and proposed strategies for improving them. Missing from this assessment are voices of host communities and research on host country efforts to control the quality of visiting programs. In this study, we investigated host perspectives on STMMs. The study was driven by the need to examine the regulatory and policy environment as well as to establish the perspectives of all country stakeholders on STMMs with the view of enhancing their value. This research is a collaborative effort between researchers at Uganda Christian University in Mukono, Uganda and Lehigh University, PA, United States of America. A qualitative methodology was adopted, with in-depth interviews as the main tool. A total of 46 interviews with policy makers, Non-Governmental Organisations and those who have engaged with volunteers in the communities were conducted in Uganda. The analysis was computer-assisted and thematic. The study revealed that the health needs of the country are many, and STMMs contribute to closing some of the gaps, although this may be limited given the scope of needs. Some of these health needs include limited infrastructure and budget support for health, low levels of staffing and inadequate resources such as equipment in the facilities. It was further revealed that the contributions made are bi-directional, with host communities claiming that they contribute towards pre-visit preparations, accommodation, local expertise on tropical diseases, and social support while volunteers contribute skills, treatment, equipment, awareness and research. Nevertheless, from the perspective of stakeholders interviewed, STMM volunteers face challenges such as cultural shock, inadequate resources to work with, manpower to support them, high expectations from the communities and delay in clearance for practice. Despite their contributions, the study established that host communities expressed concerns about the nature of STMMs involving lack of experience, hidden interests, misalignment with community needs, security risks, code of conduct and sustainability of support. A review of Ugandan laws reveals many that are related to the regulation of health services, but none that specifically mentions short-term mission trips. Most stakeholders interviewed were unaware of any regulatory oversight of visiting health teams, although some were aware of the need for clearance of visitors’ credentials. It is therefore recommended that in order to enhance the value of STMMs in Uganda, concrete actions be taken involving improving and making known the conditions for licensing and oversight, improving communication, enhancing collaboration and supporting capacity building for local experts.Uganda Christian University, Uganda and Lehigh University, US

Effective practices of international volunteering for health : perspectives from partner organizations

Abstract: The demand for international volunteer experiences to promote global health and nutrition is increasing and numerous studies have documented the experiences of the international volunteers who travel abroad; however, little is known about effective practices from the perspective of partner organizations. This study aims to understand how variables such as the skill-level of volunteers, the duration of service, cultural and language training, and other key variables affect partner organizations’ perceptions of volunteer effectiveness at promoting healthcare and nutrition..

Short-term volunteer health trips: aligning host community preferences and organizer practices

Background: Short-term medical missions (STMMs) are quite common and largely understood to be a response to health needs in low-income countries. Yet most information about STMM practices is anecdotal. Even less is known about the preferences of in-country host communities regarding STMMs. Objective: We aimed to gather enough quantitative and qualitative information from both STMM organizers and host community staff to compare dominant practices of organizers as well as preferences of host community staff. We use these data to discover differences between practices and preferences and suggest ways in which STMMs can be more responsive to the communities they serve. Methods: Researchers gathered online survey responses from 334 STMM organizers and conducted interviews to determine existing practices. Similar methods were used to collect 49 online survey responses from, and conduct 75 interviews with, host community staff. Results: Organizer practices and host community staff preferences are different in several areas. Organizers admit to minimal screening and preparation of volunteers whereas host staff have clear ideas of topics that should be covered in preparation, including culture and basic language skills. Organizers prioritize provision of clinical care during trips whereas host staff prioritize capacity building. Practices and preferences also differ in relation to the length of STMMs, the nature of the partnership itself, and the type of assessment and evaluation that is needed. Conclusions: The large amount of data gathered for this study allows us to confidently say that organizer practices are often not aligned with host community staff preferences. Several concrete changes can be made to STMMs to bring practices more in line with the desires of the communities they serve

The Role of an Online Community for People With a Rare Disease: Content Analysis of Messages Posted on a Primary Biliary Cirrhosis Mailinglist

Reviewer: Cotten, Shelia[This item is a preserved copy and is not necessarily the most recent version. To view the current item, visit http://www.jmir.org/2005/1/e10/ ] Background: This study focuses on the role of an Internet-based group for people who have an autoimmune liver disease, primary biliary cirrhosis. Primary biliary cirrhosis is a relatively rare disease, affects primarily women in their 40’s and older, and is not well understood. The PBCers Organization (PBC stands for primary biliary cirrhosis) provides electronic mailinglists (listservs) and informational resources for those with primary biliary cirrhosis. Objectives: (1) to identify the issues of greatest importance to those posting to the listserv, specifically the relative importance of biomedical, socioemotional, and organizational/systems messages; (2) to compare frequency and content of posts by people at different stages of disease; (3) to identify how people with primary biliary cirrhosis represent the psychosocial challenges and dilemmas (role and identity change, uncertainty, and stigma) identified in the social-scientific literature as key elements of the experience of chronic disease. Methods: The paper is based on content analysis of messages posted during two months to the Daily Digest listserv for people who have primary biliary cirrhosis. To analyze the posts, we developed a coding system with three major categories--biomedical, socioemotional, and systems/organizations--and 12 codes in each category. Results: A total of 275 people posted 710 messages. Of the 250 people for whom information on gender was available, 239 (95.6%) were women and 11 (4.4%) were men. Analysis of 710 messages posted to the listserv revealed a predominance of requests for and reports of biomedical information, such as health care providers (32.7%), medications (30.9%), tests and procedures (25.8%), and symptoms (25.7%), combined with very frequent expressions of emotional support. The most frequent single topics were peer support (included in 40.6% of all posts) and positive emotions (25.3%). Posters who reported fewer years since diagnosis were more likely to be seeking biomedical information than those who were further in time from their diagnosis (r= -.241, P<.001, n=313). Those in later stages posted an average of 3.87 messages, compared to an average of 2.64 for people in earlier stages (t= 1.786, P=.08, n=90), which is different from what we expected. No relation between years since diagnosis or age and number of messages was found. Contrary to our expectations, the topics reflecting issues of role change/identity (2.9%), stigma (0.7%), and thoughts about the future (3.9%), all identified in social-scientific literature as key concerns for people with chronic illness, appeared infrequently in this set of messages. Conclusions: Messages exchanged on this particular mailing list have a biomedical, rather than socioemotional or organizational, emphasis. The Internet offers a highly valued opportunity for those with rare diseases to connect with, learn from, and provide support to others having similar experiences. Research that compares those with primary biliary cirrhosis, who are involved in an Internet support group and those who are not, would be an important next step to better understanding the role of the Internet among patients with chronic liver disease and the implications of it in the course of their illness

Community social change and mortality

This paper first reviews the types of explanations that have been used in analyzing unequal distribution in coronary heart disease among different groups and changes in prevalence over time. The explanations have mostly focused on the individual: individual behaviors, personalities, stressors, or social ties. It is suggested here that a shift in focus to community-level characteristics may also aid in understanding changes in mortality. Data are presented from Roseto, PA--a town that became known in the 1960's for its strong Italian traditions and very low mortality from myocardial infarction and that subsequently experienced a sharp rise in mortality--and from the adjacent comparison town of Bangor. Data collected over several decades--in some cases as far back as 1925--on marriages, population composition, organizational memberships, voting patterns, and social class indicators suggest that important community changes that accelerated significantly in the 1960's coincided with and may help to explain Roseto's loss of protection from coronary heart disease deaths after 1965.mortality rates social change heart disease community characteristics health indicators