Ethical and Legal Guidelines for Short-Term Medical Missions Post Natural Disaster
Although medical missions were originally developed by religious organizations to provide basic healthcare to needy global populations while working to improve the community, an increasing number of organizations now arrange short-term medical missions (STMMs) to developing nations and populations suffering in the aftermaths of man-made and/or natural disasters, such as the massive hurricanes of 2017: Harvey, Jose, Irma, Maria, and Nate. Generally, volunteers are motivated by a sense of charity, compassion, and altruism toward those who belong to the more vulnerable and disadvantaged groups in society (Malay, 2017). Increasingly, however, there has been a growing body of literature criticizing the ethics and sustainable outcomes of STMMs (Elgafi, 2014; Hawkins, 2013; Hensley, 2016; Lal & Spence, 2016; Malay, 2017; Martiniuk, Manouchehrian, Negin, & Zwi, 2012; Stuart & Grippon, 2016; Umapathi, Choon Yong, Lan Yong, & Teik Lee, 2015). Common criticisms of STMMs noted in the literature include, but are not limited to: unsafe practices; lack of consideration for cultural differences; lack of coordination with the host country; lack of flexibility on the part of the practitioner; lack of documentation and data for analysis and follow-up care; inadequate knowledge; unfamiliarity with the native language and customs; inadequate resources; limited accountability; unavailability of or inadequate health records, health histories, laboratory testing, emergency services, examination facilities, and referral services for follow-up; and that the self-satisfaction felt by providers on STMMs does not justify the cost of the ventures (Elgafi, 2014; Hassler, 2017; Hawkins, 2013; Hensley, 2016; Malay, 2017). Improving the outcomes of STMMs requires increased organizational and practice guidelines and an awareness of the potential pitfalls. With awareness and planning, the positive impact of STMMs in providing needed services to resource-limited countries can exceed the potential negative impact (Hawkins, 2013). Guidelines and forms for STMMs created by the New York State Nurses Association (NYSNA) are included in this article.
Evidenced-Based Qualitative Descriptive Approach On January 21, 2018, a multidisciplinary team of professionals consisting of one MD, one DNP, one clinical sociologist, and six registered professional nurses from New York embarked on a STMM to Puerto Rico in the aftermath of hurricanes Maria and Irma. The team was also comprised of two New York Transport Worker Union (TWU) drivers who transported the professionals to various sites post-hurricane (Centro Comunal Los Naranjos in Vega Baja, Ramon Torres Elementary School in Morovis, Manuel A. Perez Housing in San Juan, Guayaba Dulce at Adjuntas, Concepcion Perez Elementary School in Ciales, Margarita Janer Palacios High School in Guaynabo, Escuela Segunda Unidad Nueva in Loiza, and the Jesús T. Piñero Intermediate Escuela in Manati). Four of the RNs, the drivers, the DNP, and the MD spoke fluent Spanish. Furthermore, three of the RNs and the two drivers were of Puerto Rican heritage. The ages of the volunteers ranged from 30 to 70 years old, and the volunteers had a combined total of two years of service on previous humanitarian missions. Their personal clinical areas of concentration included school health, maternal and child health, public health, critical care, pediatrics, and mental/behavioral health. Each of the two drivers had military experience as well.
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Improving the outcomes of STMMs requires increased organizational and practice guidelines, and an awareness of the potential pitfalls.
The team provided ‘responsive’ care to 348 patients, or responded to a wide range of medical conditions from primary care to responding to injuries and severe mental trauma (PTSD, depression, anxiety, suicide ideation), maternal and child care, vaccine distribution, wound care, and infectious disease management. Care was dispensed on site at temporary clinics, in women’s clinics already established within Puerto Rico, in homes, and in makeshift Red Cross settings. Key medical conditions addressed by this team included skin infections, hypertension, diabetes, gynecological care, rashes, asthma, PTSD, depression, anxiety, suicide ideation, coordinating dental care, prescription refill requests, anxiety, and skin ulcers. A qualitative descriptive approach was used in this study. Volunteers were involved in a 4-hour, semi-structured, in-depth interview one month following the completion of their STMM. Interviews were tape-recorded, transcribed, described, and interpreted using Morse and Field’s (1996) approach so that the social situations and human experiences of the volunteer healthcare professionals could be captured and better understood. Analysis of the emergent themes informed the guidelines for evidencedbased practices on STMMs.
Interpretive Analysis In attempting to describe and understand life experience, a phenomenological, philosophical, and methodological evidenced-based practice approach was used. Phenomenological research can be understood as the study of lived experience (Morse & Richards, 2002). Phenomenology attempts to uncover the essential structures and meanings of a particular lived experience as it is experienced by a particular group, thus clarifying and illuminating a deeper understanding of that lived experience (Laverty, 2003; Rich, Graham, Taket, & Shelly, 2013; Van Manen, 1997). Phenomenology, through a process of description, reflection, and communication assists us in identifying meanings of a lived experience (Morse & Richards, 2002; Rich et al., 2013).
Medical Missions To Puerto Rico: What Healthcare Professionals Need To Know Ethical Considerations Motivations for engaging in STMMs are many and varied. Sometimes there is an overwhelming health need present, which can easily be addressed by a healthcare professional on a short-term program. Sometimes there is an overwhelming need and desire on the part of the practitioner to help those who are less fortunate. Sometimes there is an invitation from a host
Journal of the New York State Nurses Association, Volume 46, Number 1
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