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Foundations for Best Practices in Global Health

Foundations for Best Practices in Global Health

I am often asked about what constitutes best practices in global health. The answer is actually pretty simple in theory but maybe not in practice. If you want to identify best practices in global health work, ask yourself two questions: 1) Does the work I am considering/analyzing support human dignity in responding to human need, and 2) Does it support and promote patient safety in the context of healthcare delivery?

The first question looks at how we see those we serve. Do we see them as stewards of God’s resources with God-given abilities, capable of meeting their own needs, maybe with some support? Or, do we see them as victims of circumstance trapped by material poverty? Sometimes in serving the poor we portray them as helpless victims in our communications with people in our home countries. To truly respect human dignity we must see beyond material poverty and begin to see people in developing communities as stewards of God’s resources, competent to meet their own needs. That doesn’t mean there is never a need for charity, there often is, but when responding to human need, the focus needs to be on the capacities of individuals and communities that already exist. In mature cross-cultural health missions, the model of Asset-based Community Development applies. We should always look at assets, capacities, and abilities as the starting point for partnership. Looking at needs is not a starting point that is supportive of dignity. Put another way, if I make a list of all your needs, deficiencies, and lack of resources, that can be a pretty disempowering list. However, if I make a list of all your assets, capacities, and capabilities, that can be a very empowering list, and is certainly a healthier starting point for cross-cultural partnership. It also helps us avoid viewing or portraying people as victims. This is not simply a matter perspective. Communities always have a variety of resources, but we will miss these if we assume that we are ones who bring all of the resources to the table and think that they bring nothing. That is not reality.

The second question looks at how do we follow established guidelines to support patient safety in our global health missions work. The greatest barrier to achieving better levels of patient safety in such programs is that they often lack a permanent hospital or clinic setting through which to provide care. Many short-term programs attempt to provide patient care and dispense medications in churches, schools, or community centers disconnected from any existing health services. I co-authored a paper on “The Perils and Promise of Short-Term Healthcare Missions,” which was published in the Journal of Christian Nursing back in 2010[1] that describes how this often leads to situations not conducive to safety. In this article we cited some important examples of common practices that compromise patient safety. They included: (a) non-medical church volunteers are often used to fill prescriptions, and then instructions are given through translators by a nurse or paramedic; (b) caregivers of children may be given several prescriptions, usually in Ziploc bags, and often receiving instructions in front of a crowd of people; (c) those same caregivers then take the baggies of medications home to a one-room dirt-floor house, with no safe place to store them away from children; (d) patients often hold cultural beliefs about the medicines that further cloud their understanding (e.g., big pills are for big people and little pills are for children, red pills are for blood problems and blue are for stomach problems). In studying the quality of short-term healthcare projects in the Dominican Republic, Dohn and Dohn state that as many as 36% of patients seen by a recent healthcare team had shared the medicines with one or more people, some of whom were children.[2]

In my book, When Healthcare Hurts: An evidence-based guide for best practices in global health initiatives, I delve into this topic much more deeply and break down this idea of best evidence-based medical missions or global health practices into four foundational areas:

  • Patient Safety
  • Stakeholder/ Healthcare System Integration and Collaboration
  • Facilitation of Health Development
  • Community Empowerment

The first three foundations of best practices are very much intertwined and overlap on many levels. They serve and support each other, and it is difficult to discuss one aspect to the exclusion of others. Collaboration with healthcare systems and providers makes patient safety more achievable and can improve healthcare quality on both ends of the partnership. This, in turn, can facilitate healthcare development by increasing attention to patient safety in participating medical facilities and programs around the world. Community empowerment applies to programs working at the community level: rural health outposts, community clinics, and community health engagement. This is a simplified summary, but it is a helpful starting point for studying best practices in global health.

[1] Seager, G.D, Tazellar, G., and Seager, C.D. (2010). The perils and promise of short-term healthcare

missions. Journal of Christian Nursing.

[2] Dohn, M.N., & Dohn, A.L. (2003). Quality of care on short-term medical missions: Experience with a

standardized medical record and related issues. Missiology: An International Review, 417-429.

 

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