Good intentions with unknown consequences: understanding short term medical missions
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Introduction: Short-term medical missions (STMMs) are international service trips of short duration and typically involve teams traveling to provide medical service to low- and middle-income countries. The phenomenon of STMMs is neither well understood nor well defined in the literature. To date, the only published reviews of STMMs focus exclusively on the academic literature. However, these reviews do not capture the characteristics of medical missions conducted by visiting medical teams (VMTs) with no impetus to publish. YouTube, a video sharing platform which launched in 2005, is a novel information source for studying health-related issues. The goal of the present study is to understand the scope of STMMs. Specifically, we aim to characterize the STMMs described in publications listed in PubMed and videos posted to YouTube. We aim to subsequently compare findings from the literature and video review. Methods: We followed PRISMA guidelines to conduct a two pronged search of PubMed-indexed articles and videos posted to YouTube. We created a data extraction form to collect information about short-term medical mission characteristics, including sending and recipient country, sending organization, size of VMT, duration of medical mission, student involvement, and links to the local health system. Additional YouTube video-specific information was extracted including number of views, perspective, quality, operating location of the team, and distribution of medicines and vitamins. The free-text observations of the videos were thematically analyzed. Results: The majority of STMMs described in both PubMed (72%) and YouTube (93%) originate from the USA. The countries receiving the highest number of STMMs identified through literature publications were Haiti, Guatemala, Ethiopia and Peru; among videos, the countries with the highest number of STMMs were Philippines, Haiti, Honduras, and the Dominican Republic. Analysis based on income grouping shows the majority of missions go to lower-middle income countries. Analysis of recipient country based on health workforce density shows that most STMMs go to countries with a health workforce shortage, but this relationship is not linear. The majority of STMMs described in the literature (46%) were organized by secular non-profit organizations whereas the majority of STMMs described in the videos (45%) were organized by faith-based organizations. Out of 49% of articles that specified size, the median was eight members. In comparison, out of 33% videos that specified size, the median was 19 members. Whereas the median size of STMM reported in the literature was 9.5 days, the median duration in videos was 7 days. Student involvement was mentioned in 39% of articles and 18% videos. The majority (87.3%) of articles described a link to the local health system, whereas only 49.8% of videos described any link to the local health system. The median number of views of the videos was 315. Almost all videos (98.6%) were taken from the perspective of the VMT, and 82.2% were of amateur quality (non-professional). Although patients’ faces were shown in 96.1% of videos, only 0.7% of these videos stated that patient consent was obtained. Among the videos that specified the operating location of the STMM, 52.2% took place in a local healthcare facility, 21.5% in a school classroom, and 20.5% in a church. Over half (59%) of the videos portrayed the distribution of medications or vitamins. Of the videos that specified the type of service provided, 80% described STMMs that delivered medical (non-surgical) services. The provision of dental (36%), surgical (29%), and optometric (18%) services was also commonly described. Themes that emerged from the videos included patient privacy issues and long wait times. Discussion/Conclusion: The identified recipient countries of STMMs, when analyzed by income grouping and health workforce density, suggest inadequate distribution of STMMs. Furthermore, the videos highlight aspects of STMMs that have not been clearly explored in the literature including patient privacy, long wait times, and the distribution of medications and vitamins. Additionally, we found considerable variation between STMMs described in the academic literature and in grey data sources, specifically with respect to recipient country, sending organization, size of VMT, duration of STMM, and student involvement. Thus, we recommend caution in using only the academic literature to characterize the scope of medical missions. Future programmatic and policy directions should include improved pre-departure VMT training, rigorous evaluation of STMMs and the creation of a global registry.