Short-Term Medical Trips: Practical, Cultural, and Ethical Considerations

Introduction And History

Over the past few decades, humanitarian aid expanded due, in part, to increased globalization, media exposure to global needs in the era of the 24-hour news cycle, and awareness of global health interconnectedness. The transnational enterprise of humanitarian aid goes largely unregulated as it is primarily governed by organizational self-policing. Humanitarian aid is far from simple and confined. Rather, it is a complex network of government organizations, non-governmental organizations (NGOs), and international global organizations like the United Nations and the World Health Organization. One common form of aid is medical service trips (MSTs) from high-income countries (HICs) to low and middle-income countries (LMICs). Some LMICs have adequately trained healthcare workforces, but the resources are poorly distributed and therefore inadequate to offset the ratio of a high burden of disease relative to the limited healthcare infrastructure (Scheffler, 2008).

MSTs originated from private, predominantly faith-based organizations from the 19^th century through the early 20^th century. Current efforts also include secular organizations with a volunteer workforce. The history of global health has centered on rapid, emergency aid or disease eradication, frequently conflicting with the local communities’ culture and at the expense their healthcare infrastructure by failing to recognize social determinants of health. However, recent conversations have shifted towards emphasizing partnerships with host organizations and incorporating education to improve sustainability(Conway et al., 2017). These long-term relationships are seen in both the academic setting and with non-profit organizations such as Health Volunteers Overseas, Partners in Health, and Operation Smile (Amado et al., 2017). These organizations, and many others, have developed short-term medical service trips in the framework of long-term commitments to strengthen the capacity of the host country’s healthcare system. In addition, the importance and benefits of international medical service trips to safely provide humanitarian aid has been discussed even amidst a pandemic (Al Abyad et al., 2021; Talsania et al., 2021) Upon analysis, the motivation for volunteers ranges from personal service and professional development, to emotional benefits and diplomacy. For the majority, the complex nature of these motivations is likely to be dualistic and include self-focused and selfless attitudes within the same individual.

For the purposes of this discussion, short-term MSTs encompass trips that are 4 weeks or less and originated to address needs of medically underserved populations. There are a limited number of studies that analyze the outcomes of these trips, and some critics state MSTs do not address underlying issues of poverty and poor health infrastructure in LMICs (Dupuis, 2004).

MSTs are sometimes overlooked in global health discussions; however, the magnitude of investments in these activities warrants their inclusion. A 2008 publication by Maki et al. was one of the first to estimate expenditures on these activities at 250 million USD per year based on the average number of trips per year per organization according to survey results (Maki et al., 2008). Upon further analysis, based on a survey of participating physicians, the estimated annual expenditure rose to 3.7 billion USD annually, the equivalent of 5,800 full-time physicians (Caldron et al., 2016). Others estimate international surgical MSTs alone spend a total of 3.1 billion USD per year (Gutnik et al., 2016). Regardless of the actual size of the investment, when these expenses come by way of tax-deductible philanthropic giving in the United States, they translate to federal support of unregulated unproven healthcare activities (Caldron et al., 2016). Finally, with a documented growth in interest among medical students and trainees in global health, it seems these annual expenditures are likely to increase (Melby et al., 2016).