Poor people face significant difficulties in accessing good quality health care, especially in low- and middle-income countries. Effectively addressing the health-care needs of the poor is essential to improving population health.

Humanitarian medical missions constitute an integral part of reaching underserved and vulnerable populations. Health-care teams perform medical missions with the most common scenario being the delivery of direct health care from high-income countries to low- and middle-income countries. The United States, United Kingdom, Canada, and Australia are the source of most medical missions from high-income countries. Cuba is a notable example of a low-income country that has been the source of medical missions. For the most part, these missions are short term and usually defined as lasting less than one year. Most of these medical missions last one day to four weeks (approximately 74 per cent) of the total. There are a wide range of medical and surgical care that is performed with varying degrees of complexity from primary care visits to cardiac surgical/neurosurgical procedures. It is thought that the numbers of these medical missions have been increasing over time, but this remains an area that has been poorly studied not only in terms of frequency, but also in terms of quality of the care delivered and the impact on the health-care system of the receiving countries.

Benefits of medical missions for the community

One clear benefit of medical missions are the direct recipients of the medical care. Medical missions generally take place in low- and middle-income countries (both in rural and urban environments) in which a significant proportion of the population are unable to access health care. The difficultly of access may be related to several factors but poverty and low socio-economic status play a key role. The recipients of medical missions often access care that is not available to them by any other means, or which may require a prolonged wait in trying to access the local health-care system. This delay in access to care often results in disease progression and excess morbidity and mortality. In addition to the care that is delivered, medical missions will sometimes provide medications and equipment (eg, eyeglasses, canes, syringes) to these patients. Studies have shown that aside from direct medical care, these visits have other less quantifiable benefits to the community. These include the feeling that people external to the community have an interest in their well-being, that there is recognition of the circumstances of their lives and feelings of increased hopefulness for the future.

Benefits of medical missions for providers

Several studies have looked at the motivation and rewards for physicians, nurses and ancillary personnel who take part in medical missions. Not surprisingly, a common motivation is altruism. Most physicians and nurses go into the profession not primarily for financial rewards and status, but to alleviate suffering from disease and to help patients achieve healthy lifestyle. The ability to help people who are truly indigent (many times in ways that people in high-income countries cannot conceive) and who have no other access to the care that they deliver is many times its own reward. Physicians and nurses are also enamoured of a simpler practice of medicine that is free of the administrative, billing, and charting tasks which form an increasing part of clinical workload. There is also the ability to see and treat diseases that are uncommonly seen or that is advanced due to the absence of early diagnosis and treatment. This has been referred to cynically in some circles as “surgical or medical tourism”.

Benefits for local health care providers and local health care systems

Medical missions if integrated with local health-care providers and facilities can result in skills transfer to the benefit of the low/middle income country. A common example is that of a visiting surgeon who operates with and mentors a local surgeon. At the end of the medical mission, there is now an increase in human capital that would not have occurred otherwise. Often, there can be the opportunity to conduct education outreach for both practitioners and for community health organisations. Facilities will often gain scarce medical equipment or disposables that are either not available locally or only at costs that are unaffordable. There is also the opportunity for linkages to develop between local health-care personnel/facilities with organisations in the developed world. These connections can often be leveraged to the benefit of the local facility. For example, they may result in further medical missions, donations of equipment or money, telehealth opportunities and opportunities for local physicians/nurses to receive training in the developed world. For governments who lack adequate fiscal resources to provide health care, particularly that requiring newer technology or simple primary care in rural areas, medical missions can be a welcome addition to the local health care mix.

Other benefits

Medical missions have been used as a tool for diplomacy and influence by several countries. This can occur in the setting of natural disasters but often is a strategy used to develop relationships between nations. Cuba, although a low-income country, has used its surplus of physicians and nurses to form relationships with other low and middle-income countries. The United States through its military has also deployed medical missions to less developed nations. It should, however, be noted that it is suspected that most medical missions arise from the non-governmental sector and appear to be “ground up” efforts as opposed to being directed by governments. Medical education also appears to benefit from medical missions although it is unclear how wide this practice is. A study from 2002 found that 40 per cent of English medical students had gone on a medical mission during training. Another study noted that 41 per cent of orthopaedic residents training at the University of California, San Francisco had been part of a medical mission. There is the potential for medical education in low- and middle-income countries to benefit from skills transfer and exposure to a medical culture that is less affected by resource constraints and that has access to newer technology.

There are tangible benefits from medical missions particularly when integrated with local health care. There are, however, many questions about the extent of the benefit for the low- and middle-income country, particularly in the long term in the absence of sustainable local infrastructure and human capital to continue to provide quality care. As time has gone on, it has become clear that there can be significant negatives to medical missions and a current topic of much debate is how these negatives can be ameliorated and whether other avenues may be considered to improve health care access in low- and middle-income countries. We will use our article next week to explore these issues.

The Heart Institute of the Caribbean and HIC Heart Hospital will be hosting a four-day humanitarian medical mission from October 26-30 to provide care to the poor. Those interested may contact the office at 876-906-2105 to 2108 to register.

Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for the Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Send correspondence to info@caribbeanheart.com or call 876-906-2107.