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Medical Mission Team Paternalism to Health Development

In early 2004, my wife, Candi, and I joined Mercy Ships, an international hospital ship program that at that time also facilitated community-based projects while the ships are in port. We turned to using health development program models to design short-term land based global health initiatives after joining.

Re-developing the Volunteer Healthcare Teams Program  

We were asked to re-develop their volunteer healthcare teams program that for some unknown reason had disappeared. The ship staff was providing surgical and eye care. Therefore, it made sense that there should be healthcare teams providing care alongside the ships. In our naiveté, we assumed it must have been because people like us had not stepped up to the task.

Bumps Along the Road

When we approached the ship program staff about such projects, we realized why the healthcare teams had disappeared. The response from the ship development staff about bringing healthcare teams was something like, “Only over our cold, dead bodies will you bring a healthcare team near our community projects.”

I have to say that was a bit disappointing and horribly disheartening. However, they felt as most community development practitioners feel. Because of their lack of understanding, they felt healthcare teams have more potential to cause harm in the developmental context than they do to help. However, I was on a big learning curve at the time about community development and transformational development. We began to study developmental health program models and look at how global initiatives might be applied within that context. The ship’s response forced us to rethink how short-term projects should and could be done. We needed to re-create them in the context of a community health developmental model.

A Design Overhall

One thing we realized when we first started leading medical mission teams is they are amazing tools for evaluating the health of communities. We could use a medical team to screen for health problems, identify disease prevalence, as well as weigh measure and graph upwards of 1,000 children in a one week outreach. This data can be used to assess the need to start a community health program, and assess the effectiveness of ongoing programming efforts by repeating these assessments at certain intervals.  With this in mind, we began to break apart the existing community health proposals and put them back together. They focused on achieving the same goals and objectives but now we had a tool to assess our effectiveness; that tool was short-term healthcare teams. The idea was to have healthcare teams serve and support the community development projects with assessment, monitoring, and evaluation. We also hoped that the groups could build the knowledge, skills, and teaching experience of the local community health workers trained by the development staff.

Design, Monitoring, and Evaluation

It worked, and the healthcare teams came back to life as health development teams with a little added pre-field training. The big change we made was in design, monitoring, and evaluation (DME). The key point here is that all community health programs are in need of assessing their effectiveness, and a primary healthcare teams can do a lot assist in this, both in the context of a community health fair or curative care outreach. In global health work being less activity driven and more outcomes driven is essential if we seek to receive foundation funding for our work.  We need to have some understanding of DME and the health development project cycle (problem identification–>problem prioritization–>problem solution identification–>action planning (design)–> implementation–>monitoring–>evaluation) in order to engage the community in this process.

We used medical teams to add the monitoring and evaluation components for community health projects. This made them more desirable to funding agencies. Global health volunteers could assess and gather data for program monitoring, while providing basic medical and dental services.

Alternative Funding Approaches

We also found that team project fees were also an excellent method for funding long-term community-based health initiatives. These projects find difficult to find outside funding because they lacked the capacity to monitor and evaluate their effectiveness. However, after adding DME principles, we now had two sources of funding for such projects: the volunteer project fees and a project design that was congruent with requesting grant funding. This started as somewhat of an experiment, but the results were clear. We discovered it is possible to fit short-term volunteers into more meaningful long-term projects in ways that empower communities to address their own health problems.

Blog Editor: Lynley Hatcher

Photo: Shalom Clinic Benin West Africa

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