In the modern era, we are more aware of global health disparities than ever before. As such, it is natural to want to engage in helping to lessen those disparities. This is what we are seeing with short-term medical missions (STMM). Short-term medical missions are a form of unregulated medical service aid from wealthier countries to lower/middle-income countries. The number of U.S. medical physicians participating in these missions has been rising in the last few decades, especially here in Utah. While short-term medical missions (STMMs) are driven by good intentions, their success and ethical integrity hinge on meaningful collaboration with local communities and health care systems. Without this, STMMs risk doing more harm than good.

There has been debate throughout literature on the ethics of STMMs as more than 1.6 million physicians participate in missions each year. Many reasons for the ethical concerns stem from volunteer intentions, ignorance, practicing outside of volunteers’ trained capacities, and undermining local physicians and government agencies. Having worked for a Utah based nonprofit that facilitates STMMs, the group would make a conscious effort to work closely with local physicians and governments. We had the opportunity to meet with the Ugandan Ministry of Health and discuss the previous successes and tragedies of STMMs in Uganda. Historically, many foreign groups would work without local partnerships and practice outside their scope, unfortunately causing more harm than benefit. The representative from the Ministry of Health recounted various stories of groups treating small infections that weeks later resulted in complications and amputation due to the lack of proper follow-up with local physicians.

Requiring that STMMs collaborate with local communities is of utter importance to ensure the best quality of patient care for communities abroad. Without such connections, STMMs may overstep the boundaries of the local health system, leading to long-term complications for patients and the health care system. Patients may experience complications like chronic infections or fistulas, while the health care system itself may develop dependency on foreign aid. Thus, there is a strong consensus that sustainable change requires local involvement and collaboration. For example, Roche and colleagues conducted a systematic review of 92 publications of STMMs where they analyzed each medical mission’s recommendations on how they could have improved their service. By far, the leading recommendation was to include the local health care providers in their medical mission. Specifically, they advocated for reciprocal teaching and educating between native providers and the medical volunteers. Setting such standards for STMMs will result in the best possible care for patients.

To facilitate the inclusion of local communities in the work of STMMs, organizations that coordinate medical missions should understand the factors that lead to long-term success. Education is essential, and there is no shortage of sources that provide guidance. Some resources that may be utilized include The Sphere Handbook, CUGH Global Health Competency Toolkit and WHO Guidelines on Community Engagement. We recommend that all organizations that coordinate STMMs should follow the six core principles set forth by Lasker and colleagues:

1. Appropriate recruitment, preparation and supervision of volunteers.
2. A host partner that defines the program, including the needs to be addressed and the role of the host community in directing and teaching the volunteers.
3. Sustainability and continuity of programs.
4. Respect for governance and legal and ethical standards.
5. Regular evaluation of programs for impact.
6. Mutuality of learning and respect for local health professionals.

While the intentions behind STMMs are commendable, their efficacy hinges on local support and collaboration as previously outlined. The ethical concerns of STMMs emphasize the necessity of working closely with local communities, health care providers and governments. The call for sustainable change resonates throughout research, highlighting the importance of including local practitioners in the planning and execution of medical missions. By adhering to the principles above, in addition to seeking additional education and expertise, STMMs will be better able to form meaningful, long-lasting connections with the local communities they serve.

Taylor Mendenhall, Jarom Morris, Jonathan Palmer and Kole Brodowski are medical students at the University of Utah.