Health Development Fostering health system development through Short-Term medical missions Greg & Candi Seager GMHC 2008

Objective Following the example of Jesus, we lovingly present a message of hope- Serving and supporting local health systems as they endeavor to serve their communities Facilitating programs that engage local churches, local missionaries and other agencies in the process of health development at the community level

Health Development Health development is a process of empowering individuals and communities to achieve an improved state of health and well-being. In order to understand this process, it is important to view health as a continuum. Short-term programs are only one component of a larger picture. Regardless of how bad things may appear, God has already been at work in each community we serve, and will continue long after we leave.

The Rakku Story

WORKSHOP GOALS Develop medical mission strategies that come along side local churches and health providers with their efforts to alleviate suffering in their communities.

The Primary World Health Issues Millennium Development Goals: Goal 4 Reduce under 5 Child Mortality by 2/3 by 2015 Goal 5 Reduce Maternal Mortality by 3/4 by 2015 Goal 6 Halt and reduce the spread of HIV/ AIDS, TB, Malaria and other communicable diseases by 2015.

Help or Hindrance Short-Term Medical Teams will either build or diminish confidence in the local health establishment.

Questioning the solutions for Short-Term Medical Missions Whose needs are we trying to serve? Your teams or the communities? Is the provision of medical care by your team viewed as conditional upon hearing and/or responding to the Gospel message? Have you assessed whether or not your methods of conducting a medical outreach may be paternalistic/contributing to dependency?

Case Presentation # 1 A general medical team is requested by a missionary in Guatemala. The missionary’s home church in Vancouver had several doctors, nurses and non- medical volunteers that went in response to the request. The team was directed, by the missionary, to 3 communities where they held clinics in local churches. They saw 200 patients per day for seven days, in a rural area that they believed had very limited access to health care. However, on the second day, Dr. Hernandez, the primary health care provider for the area, arrived to extend his welcome to the team. His clinic was two blocks away. Later a translator, stated that Dr. Hernandez, his cousin, may have to close his clinic because he is having difficulty making ends meet. Apparently, volunteer medical teams were coming to the area every two to three months and each time they did his business dropped off significantly for the weeks to follow. In addition, his office closed during the time the teams were there - no one wants to go to a local doctor- “Everyone knows the gringo doctors are so much better”. At church on Sunday you run into Dr. Hernandez again, and learn he is board certified in Internal Medicine, and did his fellowship in public health with the Pan American Health Organization in Washington D.C.

Questions Are the skills, knowledge, and expertise of local providers being utilized and acknowledged? Are you fully aware of the government and non- government health services being provided in the area you are serving? Do volunteer medical teams adversely affect local physicians economically?

Questions Are you using the data collected from your short-term team to implement public health programming, either directly or through a partnership with another NGO or governmental health system? What types of health education is being provided by your team, and is it connected with health educators in the community? Are pregnant mothers being assessed for high-risk pregnancy and plugged into prenatal care where available?

Case Presentation # 2 A general medical team was serving a village community in Honduras. Maria a 29 y/o mother of five arrived at the clinic pharmacy to receive her medication after having her entire family seen by one of the physicians. Maria had three prescriptions for herself, and each child received prescriptions for parasite medications and vitamins. In addition, three of the children were febrile and two had been diagnosed with otitis media and one with strep pharyngitis. Each of them also received antipyretics (Tylenol), and antibiotics. Dosages were carefully explained to Maria, for the 12 y/o, 6 y/o and 6 month old children. Less than a week after the team left the country Maria’s 6 month old child was brought to the public hospital in Santa Rosa Copan in acute liver failure and died. It seems Maria mixed up the dosages of medication and had been overdosing her six month old with Tylenol for the entire week.

Questions What safeguards can be built in to limit the potential for harm? What other medical mission models could be considered ?

Case Presentation # 3 A medical team arrived in a Honduran village in response to an invitation from a local pastor who organized the church for them to use as a clinic. The team saw patients all day and had to turn some away. One of the translators, a local Peace Corps Volunteer, needed a ride home and was picked up by a friend. A young women holding a baby wrapped in a blanket was also in the truck. After getting into the pickup the volunteer asked to hold the baby. The mother replied only by asking if the PCV was working with the medical team that day. It was then that the PCV realized something was terribly wrong. The mother told her she had waited in line all day for the doctors to see her baby. She was too far back in line and did not receive care. It was then that the PCV realized the baby had died. The local public health clinic was only two blocks away from the church where the medical team was serving.

Questions Does your team know and adhere to WHO standards of practice for developing communities? Does your team adhere to acceptable pharmaceutical standards for developing communities and dispensing of unused medications and equipment? Are the weights, heights, and immunization data being recorded for all children 0 – 5 and how can that information be used to support local health systems or long term programming efforts?

Case Presentation # 4 A plastic surgery team was working in a rural hospital in a Central American country. The fourth patient of the day, a 16 year old girl, had a malignant hyperthermia reaction and died. When the public health director for the region learned of the situation he was extremely upset. The team was not even credentialed to work in the region. After discussing the issue with the local police chief a decision was make to arrest the surgeon and anesthesia provider for practicing medicine without a license in that country. What are some ways this situation could have been avoided?

Questions Are you aware of the credentialing process in the country you’re serving? If you are providing surgical care, are you working with a foreign counterpart to build their programs knowledge and expertise? How is follow up care being provided to those who you treat?

Outreach Ideas Child Weight and Nutrition Program Community Health Assessment Community Health Fair Women’s health fair Birth attendant Training Maternal classes for infant care/needs, breastfeeding Child Health Fair Child Immunization Programs IMCI training for local medical staff Surgical training for local surgeons Palliative Care training for those caring for HIV Pts. HIV Testing and Counseling HIV Anti-Stigma programs –(gospelcom)

Case Presentation # 1 A general medical team is requested by a missionary in Guatemala. The missionary’s home church in Vancouver had several doctors, nurses and non- medical volunteers that went in response to the request. The team was directed, by the missionary, to 3 communities where they held clinics in local churches. They saw 200 patients per day for seven days, in a rural area that they believed had very limited access to health care. However, on the second day, Dr. Hernandez, the primary health care provider for the area, arrived to extend his welcome to the team. His clinic was two blocks away. Later a translator, stated that Dr. Hernandez, his cousin, may have to close his clinic because he is having difficulty making ends meet. Apparently, volunteer medical teams were coming to the area every two to three months and each time they did his business dropped off significantly for the weeks to follow. In addition, his office closed during the time the teams were there - no one wants to go to a local doctor- “Everyone knows the gringo doctors are so much better”. At church on Sunday you run into Dr. Hernandez again, and learn he is board certified in Internal Medicine, and did his fellowship in public health with the Pan American Health Organization in Washington D.C.

Workshop Question What could have been done to support Dr. Hernandez in his efforts to serve his community? Can you think of a few ways a short- term medical team could help him implement health programming in the areas of child health / maternal health or HIV AIDS?

Greg & Candi Seager 8921 Fair Oaks Pkwy Fair Oaks Ranch TX Greg Candi