Short-Term Medical Service Trips: A Systematic Review
Short-Term Medical Service Trips: A Systematic Review
Short-term medical service trips (MSTs) aim to address unmet health care needs of low- and middle-income countries. The lack of critically reviewed empirical evidence of activities and outcomes is a concern.
Developing evidence-based recommendations for health care delivery requires systematic research review. I focused on MST publications with empirical results. Searches in May 2013 identified 67 studies published since 1993, only 6% of the published articles on the topic in the past 20 years. Nearly 80% reported on surgical trips.
Although the MST field is growing, its medical literature lags behind, with nearly all of the scholarly publications lacking significant data collection. By incorporating data collection into service trips, groups can validate practices and provide information about areas needing improvement.
With globalization, there has been significant growth in short-term medical service trips (MSTs) from high-income countries (HICs) to low- and middle-income countries (LMICs). Although MSTs deliver significant amounts of care, relatively little attention is given in the medical and public health literature to the impact of these interventions on the populations being served. The following review offers a step forward by addressing this gap with a systematic analysis of the existing empirical work and suggestions for further study.
According to the World Health Organization, the highest proportions of the global burden of disease fall on the regions that also suffer significantly from physician shortages. A growing group from HICs aims to address both medical and surgical unmet needs in LMICs through MSTs, sometimes referred to as medical missions.
For purposes of this review, MSTs are defined as trips in which volunteer medical providers from HICs travel to LMICs to provide health care over periods ranging from 1 day to 8 weeks. Both faith-based organizations and non–faith-based organizations facilitate these trips, a feature that will be discussed in more detail later. Team composition can range from members of academic departments from a single institution to collections of individuals affiliated only by friendship, geography, or the organization facilitating the trip.
Authors of several published articles have noted that MSTs as a form of aid do not address the primary sources of the health care problems in the developing world: poverty and overstretched health care infrastructure. There are, however, significant resources, financial and human, dedicated to MSTs annually. Although there is no central monitoring group or agency for MSTs, conservative estimates that do not take into account opportunity costs for the volunteers place the annual expenditures at $250 million. With expenditures of this magnitude, questions naturally arise about the return on investment. If noteworthy returns exist and organizations are simply not measuring or reporting them, then this can be remedied. If the returns do not exist and the missions continue, an ethical dilemma may be emerging.
Over the past 20 years, publications describing MSTs have largely aimed to promote models of health care delivery in these settings. The pressure to develop practice guidelines has created some standardization in care, but the lack of critically reviewed empirical data continues to be a concern. Assumptions that the safety and acceptable risk or rates of complications from HICs are automatically transferable to MSTs are unwarranted and could be dangerous.
The lack of evidence is particularly concerning when one considers the vulnerable nature of patients living in LMICs. Under the best circumstances, MSTs address an unmet medical need with high-quality care. Under the worst circumstances, they serve, as one author states, as an opportunity for physicians to practice techniques for the treatment of conditions that are less common in the developed world. This example is extreme and is unlikely to play a role in the justification for most contemporary MSTs, but the possibility is concerning. One report in the faith-based literature (of an evangelical short-term mission trip in this case) suggested that some trips may benefit the volunteer as much as or more than the recipient of aid as well as potentially costing the hosts valuable time and resources.
Martiniuk et al. recently provided a starting point in the review of MST evidence; however, they included articles with mixed goals and did little to assess the quality of the articles presenting empirical data from MSTs or their participants. The authors described benefits associated with MSTs, including personal gains for the volunteers and an increased sense of solidarity between the recipients and volunteers. They went on to identify common criticisms of MSTs, namely questions about efficacy or impact and unintended consequences.
The present review differs in several ways. First, it specifically targets publications with empirical results based on intentional data collection regarding activities associated with MSTs. These empirical results include work discussing treatment interventions, cost-effectiveness, quality assessment and assurance, or the perspectives of MST participants and target communities. Second, it addresses the assessment of quality. Third, the final section of this article suggests a framework drawn from the existing literature and its remaining gaps for the minimum data collection requirements necessary to expand the evidence base for MSTs.
Investments in MSTs continue to grow while their impact remains largely unmeasured. This demands a critical review and illustrates the need to measure the quality and impact of MSTs. Analyzing the status of existing empirical evidence will help to establish some basic guidelines and a research agenda for future work in this area. Scholarship in the fields of social psychology and tourism also addresses aspects of MSTs; however, this review focuses solely on the medical literature.
Abstract and Introduction
Abstract
Short-term medical service trips (MSTs) aim to address unmet health care needs of low- and middle-income countries. The lack of critically reviewed empirical evidence of activities and outcomes is a concern.
Developing evidence-based recommendations for health care delivery requires systematic research review. I focused on MST publications with empirical results. Searches in May 2013 identified 67 studies published since 1993, only 6% of the published articles on the topic in the past 20 years. Nearly 80% reported on surgical trips.
Although the MST field is growing, its medical literature lags behind, with nearly all of the scholarly publications lacking significant data collection. By incorporating data collection into service trips, groups can validate practices and provide information about areas needing improvement.
Introduction
With globalization, there has been significant growth in short-term medical service trips (MSTs) from high-income countries (HICs) to low- and middle-income countries (LMICs). Although MSTs deliver significant amounts of care, relatively little attention is given in the medical and public health literature to the impact of these interventions on the populations being served. The following review offers a step forward by addressing this gap with a systematic analysis of the existing empirical work and suggestions for further study.
According to the World Health Organization, the highest proportions of the global burden of disease fall on the regions that also suffer significantly from physician shortages. A growing group from HICs aims to address both medical and surgical unmet needs in LMICs through MSTs, sometimes referred to as medical missions.
For purposes of this review, MSTs are defined as trips in which volunteer medical providers from HICs travel to LMICs to provide health care over periods ranging from 1 day to 8 weeks. Both faith-based organizations and non–faith-based organizations facilitate these trips, a feature that will be discussed in more detail later. Team composition can range from members of academic departments from a single institution to collections of individuals affiliated only by friendship, geography, or the organization facilitating the trip.
Authors of several published articles have noted that MSTs as a form of aid do not address the primary sources of the health care problems in the developing world: poverty and overstretched health care infrastructure. There are, however, significant resources, financial and human, dedicated to MSTs annually. Although there is no central monitoring group or agency for MSTs, conservative estimates that do not take into account opportunity costs for the volunteers place the annual expenditures at $250 million. With expenditures of this magnitude, questions naturally arise about the return on investment. If noteworthy returns exist and organizations are simply not measuring or reporting them, then this can be remedied. If the returns do not exist and the missions continue, an ethical dilemma may be emerging.
Over the past 20 years, publications describing MSTs have largely aimed to promote models of health care delivery in these settings. The pressure to develop practice guidelines has created some standardization in care, but the lack of critically reviewed empirical data continues to be a concern. Assumptions that the safety and acceptable risk or rates of complications from HICs are automatically transferable to MSTs are unwarranted and could be dangerous.
The lack of evidence is particularly concerning when one considers the vulnerable nature of patients living in LMICs. Under the best circumstances, MSTs address an unmet medical need with high-quality care. Under the worst circumstances, they serve, as one author states, as an opportunity for physicians to practice techniques for the treatment of conditions that are less common in the developed world. This example is extreme and is unlikely to play a role in the justification for most contemporary MSTs, but the possibility is concerning. One report in the faith-based literature (of an evangelical short-term mission trip in this case) suggested that some trips may benefit the volunteer as much as or more than the recipient of aid as well as potentially costing the hosts valuable time and resources.
Martiniuk et al. recently provided a starting point in the review of MST evidence; however, they included articles with mixed goals and did little to assess the quality of the articles presenting empirical data from MSTs or their participants. The authors described benefits associated with MSTs, including personal gains for the volunteers and an increased sense of solidarity between the recipients and volunteers. They went on to identify common criticisms of MSTs, namely questions about efficacy or impact and unintended consequences.
The present review differs in several ways. First, it specifically targets publications with empirical results based on intentional data collection regarding activities associated with MSTs. These empirical results include work discussing treatment interventions, cost-effectiveness, quality assessment and assurance, or the perspectives of MST participants and target communities. Second, it addresses the assessment of quality. Third, the final section of this article suggests a framework drawn from the existing literature and its remaining gaps for the minimum data collection requirements necessary to expand the evidence base for MSTs.
Investments in MSTs continue to grow while their impact remains largely unmeasured. This demands a critical review and illustrates the need to measure the quality and impact of MSTs. Analyzing the status of existing empirical evidence will help to establish some basic guidelines and a research agenda for future work in this area. Scholarship in the fields of social psychology and tourism also addresses aspects of MSTs; however, this review focuses solely on the medical literature.
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