Volunteer surgical teams struggle with common aid problems

Normally I wait until Sunday to post related news items, but the article titled Volunteering Overseas - Lessons from Surgical Brigades from the New England Journal of Medicine is worth posting on it's own.  Although the article focuses on issues related to surgeries, it hits upon many of the topics I've covered in this blog.

Good aid takes time
Because of all the challenges faced in working in these conditions one doctor spoke of the need for surgeons that can stay for at least a few weeks. One doctor went as far as to say "But the real impact is made by people who are able to stay in a place for years on end. In my own experience, it took a year to really understand what was going on in a cultural and social context."
(related post: Guideline #1 for volunteering overseas)

It is far more cost effective to use local staff and facilities than to ship in foreign staff and equipment
The article compares two similar missions. One aid agency flew in all of their own equipment and a 33 person team, their trips cost around $1 million dollars. Another aid agency doing the same surgery worked with local medical staff and facilities, they flew in only a 5 person team and spent only $10,000 dollars a trip. 
(related post: Where did all the money go?)

It is important to build the capacity of the local staff
"Initially, we went out and did surgery," said Dr. Robert Rubin, chief medical officer of Operation Smile. "But after a while, it became obvious that going to a country and doing 100 or 200 cases each year wasn't going to solve the problem." The organization's investment in education includes the planned involvement of local physicians in operations, depending on their interest and skills, as well as the involvement of local nurses in preoperative and postoperative care.
(related post: Guideline #2 for volunteering overseas)

Not all aid is appropriate
"I have seen professors from fancy American universities teaching endoscopy skills in Laos to internists who don't have access to an endoscope"
(related post: Five questions you should ask before shipping donated goods overseas)

Aid can do more harm than good
"Even so, a study of anesthesia care provided by Operation Smile volunteers found that although the complication rate associated with facial-cleft surgery in the field was similar to rates in developed countries, the brevity of missions may contribute to avoidable illness and death."
(related post: Beggars can't be choosers, but are they really beggars?)

It is difficult for the local government to monitor and evaluate the work of aid agencies
"But many countries do not have the necessary infrastructure for monitoring volunteers or even for enforcing their own regulations."
"Hundreds of organizations provide medical and public health services around the world;... But although many groups collaborate with one another and with host governments, there is no formal system for coordinating or evaluating the work of so many volunteers."
(related post: Common donor misconceptions)

Aid agencies may not evaluate their work
"Some organizations conduct internal evaluations" - Why isn't every agency performing surgeries evaluating their work? Evaluations are a critical part of helping aid agencies improve their practices.
(It's time to stop telling pretty stories and start really evaluating the impact of aid)

Comments

[health care attorney]

Very good information about surgery process. Hope you haven't copy pasted this from somewhere else ;). Nice post.

[Urologist London]

I think you've hit the spot on this one!