La Agencia de los Estados Unidos para el Desarrollo Internacional (USAID) como arma contra la colaboración médica internacional de Cuba / United States Agency for International Development (USAID) as a weapon against Cuba's international medical collaboration

El artículo analiza la labor subversiva asignada por la administración de Biden a la Agencia de los Estados Unidos para el Desarrollo Internacional, para atacar a las brigadas médicas cubanas en el exterior. Especialmente, analiza el nuevo programa denominado Combatir el trabajo forzoso en las misiones médicas cubanas, y paralelamente, corrobora la existencia de una estrategia de boicot a la cooperación médica y a la exportación de servicios de salud, sobre todo dirigida a esta última modalidad, con el fin de cortar los ingresos económicos. El antecedente de este nuevo programa es uno similar financiado por el gobierno de Trump, en 2019, aunque este cuenta con 1 millón de dólares adicionales. Como la principal línea de mensaje que se emplea contra los convenios médicos cubanos internacionales, es que violan los derechos humanos al promover el trabajo esclavo, priorizan la búsqueda de testimonios para sustentar dicha campaña. El programa cuenta con elementos propios de acciones encubiertas y exige que los elegidos incidan dentro de Cuba y en países de América Latina. Esto último es consecuente con la estrategia sanitaria que Biden implementa para retomar su influencia en la región, además de restar protagonismo a Cuba. Finalmente, se demuestra que, aunque Biden le impone su impronta a la estrategia, es un continuador de Donald Trump(AU)

The article analyzes the subversive work assigned by the Biden administration to the United States Agency for International Development, to attack Cuban medical brigades abroad. Specifically, it analyzes the new program called Combating forced labor in Cuban medical missions, and at the same time, corroborates the existence of a strategy to boycott medical cooperation and the export of health services, especially aimed at the latter modality, with the in order to cut off economic income. The background to this new program is a similar one funded by the Trump government in 2019, although it has an additional one million dollars. Since the main line of message used against international Cuban medical agreements is that they violate human rights by promoting slave labor, they prioritize the search for testimonies to support said campaign. The program has elements of covert actions and requires those elected to carry out actions within Cuba and in Latin American countries. The latter is consistent with the health strategy that Biden implements to regain his influence in the region, in addition to reducing Cuba's prominence. Finally, it is shown that, although Biden imposes his imprint on the strategy, he is a follower of Donald Trump(AU)

Las misiones médicas al Policlínico PAMS en Chincha: evolución del modelo de misión / The medical missions to the PAMS Polyclinic in Chincha: evolution of the mission's model

RESUMEN Presentamos la experiencia del Policlínico de la Peruvian American Medical Society (PAMS) en Chincha, en la ejecución de misiones médico-educativas en la región Chincha. El Policlínico PAMS presta atención médica general y especializada a la población de la zona, seis días a la semana. Además, recibe misiones médicas que vienen generalmente de los EE. UU. Desde 2011, se han recibido 43 misiones médicas. La composición y la naturaleza de las misiones han cambiado con el tiempo. Los primeros años se atraía a especialistas con el énfasis de traer equipos e insumos para mejorar la infraestructura del Policlínico. Ahora estamos limitados por la renuencia de voluntarios de venir al Perú en parte debido a que el gobierno americano considera que viajes al Perú son de alto riesgo. Esta limitación nos ha brindado la oportunidad de hacer misiones médicas juntamente con dos excelentes universidades peruanas. La experiencia ha sido positiva.

ABSTRACT We present the experience of the Polyclinic of the Peruvian American Medical Society (PAMS) in Chincha, in the execution of medical educational missions in the Chincha region. The PAMS Polyclinic provides general and specialized medical care to the population of the area, six days a week. In addition, the Polyclinic receives medical missions generally coming from the EE.UU. Since 2011, we have received 43 medical missions. The composition and nature of the missions have changed over time. The first years attracted specialists with the emphasis on bringing equipment and supplies to improve the infrastructure of the Polyclinic. We are now limited by the reluctance of volunteers to come to Peru in part because the U.S. government considers travel to Peru to be high-risk. This limitation has given us the opportunity to do medical missions together with two excellent Peruvian universities. This experience has been positive.

Sustainable surgical resource initiative for Haiti: the SSRI-Haiti project.

In response to the 2010 earthquake and subsequent cholera epidemic, St Luke's Medical Center was established in Port-au-Prince, Haiti. Here, we describe its inception and evolution to include an intensive care unit and two operating rooms, as well as the staffing, training and experiential learning activities, which helped St Luke's become a sustainable surgical resource. We describe a three-phase model for establishing a sustainable surgical centre in Haiti (build facility and acquire equipment; train staff and perform surgeries; provide continued education and expansion including regular specialist trips) and we report a progressive increase in the number and complexity of cases performed by all-Haitian staff from 2012 to 2022. The results are generalised in the context of the 'delay framework' to global health along with a discussion of the application of this three-phase model to resource-limited environments. We conclude with a brief description of the formation of a remote surgical centre in Port-Salut, an unforeseen benefit of local competence and independence. Establishing sustainable and collaborative surgery centres operated by local staff accelerates the ability of resource-limited countries to meet high surgical burdens.

Incorporating hearing screening to an otolaryngology surgical mission in the rural Dominican Republic.

INTRODUCTION: Hearing loss disproportionately affects low- and middle-income countries. Children with undiagnosed hearing loss may have difficulty with learning, language development, and behavior. The aim of this study was to understand the extent of hearing loss and common otologic disorders among school-age children in the rural western region of the Dominican Republic and to chronical the early stages of a limited-resource, locally-sustained hearing screening program in tandem with a bi-annual surgical mission. METHODS: Hearing screenings were performed for 528 school-age children (1056 ears, age 5-17 years old) over 5 days in a village hospital in Peralta, DR. Testing initially included otoscopy and screening audiometry. Children who referred or could not be conditioned underwent distortion product otoacoustic emissions (OAEs), and tympanometry. Children who referred following both screening audiometry and OAEs were considered to have hearing loss. Those with normal tympanograms were considered potential hearing aid candidates. RESULTS: Abnormal ear examination/otoscopic results were present in 43 children (8.1%) and included: microtia/atresia, impacted cerumen, ear canal foreign body, serous otitis media, otitis externa, and tympanosclerosis. 55 of 528 school-age children referred following screening audiometry and 7 were unable to condition. Of these 62 children, 56 tolerated OAEs and 20 referred following OAEs (3.8%). Fourteen children had type B or C tympanogram and 6 school-age children who were determined to have chronic otitis media with effusion (COME) underwent myringotomy and pressure equalization tube placement. Ten of 528 children (1.9%) had normal tympanometry and otoscopy, and referred following screening audiometry and OAEs suggesting the patients may be potential hearing aid candidates. CONCLUSIONS: The prevalence of hearing loss in this cohort of children in the rural, western Dominican Republic was high at roughly 4% with roughly 2% of children being potential hearing aid candidates. Nearly 10% of children screened had an abnormal otologic examination; sometimes easily remedied by otolaryngologic intervention. With the support of local leadership, it is feasible to incorporate hearing services into otolaryngology outreach and build locally sustainable programs.

Dr. Aníbal Zambrano: un médico peruano con corazón de oro / Aníbal Zambrano, M.D: a Peruvian physician with a heart of gold

RESUMEN El objetivo del artículo es describir y analizar la trayectoria de vida y las contribuciones humanitarias del Dr. Zambrano, médico egresado de la Escuela de Medicina de San Fernando, quién fue presidente del Centro de Estudiantes de Medicina en una época políticamente álgida en la educación universitaria pública. Emigró a los Estados Unidos en 1970, bajo el contexto de crisis sociopolítica económica en el Perú y en el mundo, donde se convirtió en un renombrado médico internista y cardiólogo del St. Luke's Hospital. A pesar de su lejanía, mantuvo un lazo estrecho con el Perú organizando múltiples misiones médicas para el beneficio de poblaciones vulnerables, capacitación al personal médico e implementación tecnológica del Hospital Regional de Cajamarca. En 2011 se inauguró el Centro Médico Educativo en Chincha, siendo Zambrano uno de los líderes para su construcción. A pesar de padecer una enfermedad invalidante dedicó hasta los últimos días de su vida a brindar ayuda a los más necesitados. Su trayectoria de vida nos muestra un ejemplo de compromiso con el Perú y de un ejercicio de la medicina comprometida con la solidaridad y el desarrollo de la medicina en su país de origen.

ABSTRACT The objective of the article is to describe and analyze the life trajectory and the humanitarian contributions of Dr. Zambrano, a physician who graduated from San Fernando Medical school, and was president of the Center for Medical Students at a politically critical time in public university education. He emigrated to the United States in 1970, in the context of sociopolitical crisis in Peru and the world, where he became a renowned internist and cardiologist at St. Luke's Hospital. Despite the distance, he maintained a close relationship with Peru, organizing multiple medical missions for underserved populations, training medical personnel, and providing technological implementation to Cajamarca Regional Hospital. In 2011, the Educational Medical Center was inaugurated in Chincha, with Zambrano being one of the leaders for its construction. Despite suffering from a disabling illness, he dedicated until the last days of his life, providing help for those most in need. His life trajectory shows us an example of commitment to Peru and practice of Medicine committed to solidarity and the development of Medicine in his country of origin.

The humanitarian aid of neurosurgical missions in Peru: A chronicle and future perspectives.

Background: The unmet neurosurgical need has remained patent in developing countries, including Peru. However, continuous efforts to overcome the lack of affordable care have been achieved, being neurosurgical missions one of the main strategies. We chronicle the humanitarian labor of organizations from high-income countries during their visit to Peru, the contributions to local trainees' education, and the treatment of underserved patients. Furthermore, we discuss the embedded challenges from these missions and the future perspective on long-term partnerships and sustainability. Methods: This is a narrative review. We searched the literature in PubMed and Google Scholar about neurosurgical missions conducted in Peru. Results: Since 1962, twelve organizations from high-income countries have delivered humanitarian help in Peru by training local neurosurgeons, treating low-income patients, and providing surgical instrumentation. Out of the three main regions of Peru, cities on the coast and highlands have hosted most of these missions, with no reported outreach in the amazon area. About 75% of the organizations are headquartered in the United States, followed by Canada, Luxembourg, and Spain. In addition, 50% of the organizations have an active partnership. The predominant focus of these missions has been pediatrics, neuro-oncology, and spine surgery. Conclusion: Neurosurgical missions have represented a strategy to close the disparity in education and treatment in Peru. However, additional efforts must be conducted to improve long-term partnership and sustainability, such as adopting standardized indicators for progress tracking, incorporating remote technologies for continuous training and communication, and expanding partnerships in less attended areas.

Mete Tèt Nou Ansanm (Putting our heads together): Global health capacity building within short-term medical missions.

Short-term medical missions (STMMs) have the potential to increase local health care capacity in low resource settings. Few studies have examined capacity building within STMMs from the perspective of both donor and host providers. A qualitative study using a transcendental method for research with human subjects examined the experiences of 21 North American 'donor' and Dominican 'host' health care providers who participated in STMMs in the Dominican Republic. Perry and Ojemeni's levels of capacity building for human good provided the theoretical framework, proposing a three-level approach: (1) augmenting local health care delivery capacity (2) assisting local communities to develop their own capacities and (3) transforming barriers to capacity. Findings are grouped into five themes and their subthemes: (1) making a difference (2) education and knowledge transfer, (3) acknowledging barriers, (4) host empowerment and (5) personal and interpersonal development. An overarching paradigm of 'Mete Tèt Nou Ansanm', or 'putting our heads together', emerged from the data, reflecting a dynamic process in which donor and host participants evolved their collaborative partnerships. STMMs have the potential for addressing global health capacity at all three levels. Mission compatibility with the local health system, host empowerment and repeated interactions over time are noteworthy determinants for STMMs sustainability.

Short-term medical service trips: what is the cost of patient care and student training?

BACKGROUND: Evaluations of the costs and effects of medical service trips (MSTs) are increasingly necessary. Estimates of costs can inform decision making to determine if participation is likely to be a wise use of resources. METHODS: This study estimates the costs and effects of a 1-week MST for 20 health professions students and seven providers to the Dominican Republic. Costs were defined as direct costs for students and providers and opportunity costs for providers. Effects were defined as the cost to treat one patient and the cost to train one student. Students were surveyed about their costs before and after the MST. Most provider costs were assumed to be the same as those of the students. RESULTS: The mean direct cost per student was US${\$}$1764 and US${\$}$2066 for providers. Total opportunity costs for seven providers was US${\$}$19 869. The total cost for the trip was US${\$}$69 612 to treat 464 patients. With and without provider opportunity costs, the cost to treat one patient was US${\$}$150 and US${\$}$107, and the cost to train one student was US${\$}$3481 and US${\$}$2487, respectively. CONCLUSIONS: Short-term MSTs may be more expensive than previously thought. The cost to treat one patient was similar to a medical office visit in the USA.

A prospective observational study of postoperative follow-ups and outcomes at a nonprofit, internationally supported pediatric surgery center in Guatemala.

BACKGROUND: Global surgical access is unequally distributed, with the greatest surgical burden in low- and middle-income countries, where surgical care is often supplemented by nongovernmental organizations. Quality data from organizations providing this care are rarely collected or reported. The Moore Pediatric Surgery Center in Guatemala City, Guatemala, is unique in that it offers a permanently staffed, freestanding pediatric surgical center. Visiting surgical teams supplement the local permanent staff by providing a broad range of pediatric subspecialty surgical and anesthesia care. AIM: The aim of this study was to collect and report the incidence of completed postoperative follow-up visits and outcome measures at this nonprofit, internationally supported surgery center. METHODS: De-identified demographic and postoperative outcome data were collected from each routinely scheduled, one-week pediatric surgical mission trip and incorporated into an electronic data collection system. Emphasis was placed on identification of completed postoperative visits and associated perioperative complications. After 27 months of data collection, results were analyzed to identify and quantify trends in patient follow-ups and postoperative outcomes. RESULTS: Over 27 months, 1639 pediatric surgical procedures were performed and included in data analysis. The percentage of completed postoperative day-1 follow-up visits was 99.1%, and seven complications were identified out of these 1624 cases (postoperative complication rate of 0.4%). The percentage of completed first postoperative visits after discharge was 93.3%, and 67 complications were identified out of these 1530 cases (postoperative complication rate of 4.4%). CONCLUSION: Our data show a high rate of postoperative follow-up visits completed and low perioperative complication rates similar to those of high-income countries. Our data suggest that The Moore Surgery Center model of care offers an alternative to the short-term visiting surgical model by incorporating the local system and allows for improved follow-up, outcomes analysis, and high quality of care.

Nicaraguan Homeowner Showing Gratitude for Concrete Flooring as Part of a Public Health Mission Trip.

Description I'm Bree Kinnison, a fourth-year medical student and aspiring psychiatrist. When I'm not studying, I enjoy painting using acrylics. This painting depicts a very fond memory of mine. After completing the medical portion of our mission trip in Nicaragua, we began our public health portion. Along with fellow students, I laid concrete flooring in this woman's house. For all 76 years of her life, she had never experienced anything other than a dirt floor in her home. Traditional dirt flooring in Nicaraguan homes is responsible for many preventable illnesses. When shown the final product, she reached out and hugged the first person she could get ahold of. She began crying and thanking God for placing us in her life. We were equally grateful for this life-changing experience.

Freedom of choice, expressions of gratitude: Patient experiences of short-term surgical missions in Guatemala.

Lack of surgical care has been highlighted as a critical global health problem, and short-term medical missions (STMMs) have become a de facto measure to address this shortfall. Participation in STMMs is an increasingly popular activity for foreign medical professionals to undertake in low- and middle-income countries (LMICs) where their clinical skills may be in short supply. While there is emerging literature on the STMM phenomenon, patient experiences of surgical missions are underrepresented. This research addresses this gap through thirty-seven in-depth interviews with patients or caregivers who received care from a short-term surgical mission within the three years prior to the four-week data collection period in July and August 2013. Interviews were conducted in Antigua, Guatemala and nearby communities, and participants came from 9 different departments of the country. These first-hand accounts of health-seeking through a surgical mission provide important insights into the benefits and challenges of STMMs that patients encounter, including waiting time, ancillary costs, and access to care. Patient agency in care-seeking is considered within the pluralistic, privatized health care context in Guatemala in which foreign participants deliver STMM care.

Elevated blood pressure in the developing world: a role for clinical pharmacists.

OBJECTIVE: The objective of this study was to evaluate the prevalence and patient knowledge of elevated blood pressure amongst a cross-section of patients in underserved communities in three selected low-income countries worldwide: El Salvador, India and Kenya. METHODS: Mobile medical clinics were established as part of medical mission trips in El Salvador, India and Kenya. Willing male and female patients, at least 25 years of age, who presented at each clinic were screened for elevated blood pressure, including 332 patients in El Salvador, 847 patients in India and 160 patients in Kenya. Patients were classified into Stage I or II elevated blood pressure based on modified JNCVII guidelines. A questionnaire was completed regarding their knowledge about the existence and management of their disease state. KEY FINDINGS: Of the 1339 patients screened, 368 presented with elevated blood pressure (27%). Of these patients, 147 had been previously informed of hypertension or an elevated blood pressure (39.9%), 28 reported receiving antihypertensive medication (7.6%) and 24 reported awareness of non-pharmaceutical treatment options (6.5%). In Kenya, 81 patients were screened in a rural setting and 79 in an urban setting. Patients demonstrating controlled blood pressure were 63 (78%) and 38 (48%), respectively, demonstrating a significant difference between the rural versus urban settings (P = 0.00359). CONCLUSIONS: All regions demonstrated similar trends in the prevalence of elevated blood pressure, highlighting the need for increased disease state education in these regions.

Looking good but doing harm? Perceptions of short-term medical missions in Nicaragua.

In this paper, we present findings from a qualitative study that gathered Nicaraguans' perceptions of short-term foreign medical missions, towards deepening the understanding of what Nicaraguans value or find limited in the work of such foreign missions operating in their country. Fifty-two interviews were conducted with patients, relatives of patients, Nicaraguan physicians and nurses who partnered with or observed missions at work, 'beneficiary' community leaders, and individuals who were unable or unwilling to access mission-provided healthcare. Factors underlying participants' positive and more critical accounts of foreign primary and surgical missions are described and analysed. Empirical investigation on how, whether or not, or on what bases short-term medical missions (STMs) have been perceived as beneficial, harmful, or otherwise by those on the receiving end of these efforts is limited. This study aims to contribute to the evidence base for reflecting on the ethical performance of trans-national STMs.

Effects of short-term medical mission trips to Chiapas, Mexico, on the religiosity of the missionaries.

This study evaluates the effects that short-term, foreign, Catholic medical mission trips had on the religiosity of the United States-based participants. The subjects of this study participated in Catholic medical missions to Chiapas State, Mexico, in 2014 and 2015. Twenty-two of forty-two participants responded to a survey to assess for any changes in their religiosity and associated attitudes and behaviors. The results revealed that participation in the medical mission was associated with a significant increase in non-organizational religious activity, intrinsic religiosity, concern for health disparities and the burden of illness in the developing world, the promotion of further missions, the provision of service and/or monetary aid to the poor in the missionary's local community, and an increased likelihood to discuss the Christian faith in conversations with others. There was no statistically significant association with organizational religious activity or local participation in evangelization activities. SUMMARY: This article reports on the changes seen in the religious attitudes and charitable works performed following participation in a short-term medical mission. After serving on a mission trip to Mexico, we found that United States-based missionaries had an increase in their private religious activities, felt closer to God, were more likely to help the poor in their own neighborhoods, and were more likely to discuss their Christian faith than prior to the mission trip. We discuss possible reasons for these changes.

Caracterización de niños operados por labio y paladar hendido en la orinoquía colombiana entre 2008 y 2014

La patología congénita de niños con labio y paladar hendido es frecuente en la región, pero no ha sido caracterizada en la Orinoquía. El objetivo de este estudio fue describir las características de los niños intervenidos en un programa quirúrgico de labio y paladar hendido en Villavicencio. Tipo de estudio: Corte transversal descriptivo. Criterios de inclusión: menores de 18 años operados por labio y paladar hendido. Escenario: Hospital Departamental de Villavicencio, Colombia. Temporalidad: enero de 2008 a junio de 2014. Se realizó una evaluación descriptiva de la distribución de las variables, análisis bivariado y un mapa de georreferenciación del sitio de procedencia de los pacientes. Resultados: Se encontraron 340 registros de niños intervenidos quirúrgicamente por labio y paladar hendido, mayormente de sexo masculino. La mayoría de los casos fueron procedentes de Villavicencio, pero también de otros municipios y departamentos circundantes. El 49% de los procedimientos fueron primarios y las niñas fueron intervenidas más tempranamente. Conclusión: El estudio permite caracterizar el número considerable de pacientes intervenidos, la mayoría de ellos de forma temprana, especialmente en los casos cercanos de Villavicencio y el Meta, aunque puede mejorarse la oportunidad a los primeros meses de vida.

Cleft lip and palate is the most frequent congenital pathology but it has not been characterized in the Colombian Orinoquia. The aim was to describe the characteristics of children that had surgery in a program for cleft lip and palate in Villavicencio. Design: cross-sectional descriptive trial. Children under 18 years old that had cleft lip and palate surgery at Hospital Departamental de Villavicencio from January 2008 to June 2014 were included. Distribution evaluation of the variables was performed, as well as a map with the housing location of patients Results: Three hundreds and forty records of cleft lip and palate surgeries were reviewed, mainly male children. Most of the cases were from Villavicencio, but also from other towns and states around. Fortynine percent were primary surgeries and female children had interventions earlier. Conclusions: the study established the considerable number of patients surgically operated, most of them in an early way, especially when they were close to Villavicencio and Meta, but opportunity can be improved to early months of life.

A patologia congénita em crianças com fenda labial e palatina é frequente na região, mas no tem sido caracterizada na Orinoquia colombiana. Objetivo: Descrever as características das crianças intervindos num programa cirúrgico de fenda labial e palatina na cidade de Villavicencio. Tipo de estudo: descritivo-transversal. Critérios de inclusão: pessoas menores de 18 anos operados por fenda labial e palatina. Lugar: Hospital Departamental de Villavicencio, Colômbia. Tempo: janeiro do 2018 até junho do 2014. Realizou-se uma avaliação descritiva da distribuição das variáveis, análise bivariada e mapa de georreferenciamento no ponto de procedência dos pacientes. Resultados: Encontrou-se 340 registros de crianças intervindos cirurgicamente pela fenda labial e palatina, sendo maior os processos no sexo masculino. A maioria dos casos foram feitos em Villavicencio, além de outras cidades menores. O 49% dos procedimentos foram primários e as meninas foram intervindas cedo. Conclusões: O estudo permite caracterizar o número de casos, pacientes intervindos, na maioria deles tiveram a cirurgia cedo, especialmente nos casos perto da cidade de Villavicencio e no estado do Meta, embora podem melhorar-se a oportunidade nos primeiros meses de vida.

Cooperación internacional ¿en qué estamos y hacia dónde vamos? / International cooperation. Where are we, and where are we heading to?

Unmet needs in global health are important issues, not yet solved by the international community. A variety of individuals, non-governmental organizations (NGO) and government institutions have tried to address this situation, developing multiple types of international cooperation (IC), such as humanitarian aid (HA), cooperation for development (CD) and medical missions (MM). In the last decades, we have witnessed an exponential growth in the creation and participation of these projects. Moreover, in the last 20 years, Chile has experimented a real paradigm switch, from a receiver to a provider of IC. Due to the recent surge in interest and relevance of the topic, we performed a narrative revision of the literature related with IC. In the present article, we characterize the different types of IC, with emphasis in MM: we address the risks, controversies and ethical problems associated with these activities. We finally propose some guidelines for the future development and promotion of MM.

Motivations, barriers and ethical understandings of healthcare student volunteers on a medical service trip: a mixed methods study.

BACKGROUND: The motivation to volunteer on a medical service trip (MST) may involve more than a simple desire for philanthropy. Some volunteers may be motivated by an intrinsic interest in volunteering in which the context of the volunteer activity is less important. Others may volunteer because the context of their volunteering is more important than their intrinsic interest in volunteering. Furthermore, MSTs may pose a variety of ethical problems that volunteers should consider prior to engaging in a trip. This study evaluated the motivations and barriers for graduate health care students volunteering for an MST to either the Dominican Republic or Mississippi. Volunteers' understanding of some of the ethical issues associated with MSTs was also assessed. METHODS: Thirty-five graduate health professions students who volunteered on an MST were asked to complete an online survey. Students' motivations and barriers for volunteering were assessed using a 5-point Likert scale and Fisher's exact test. Ethical understanding of issues in volunteering was assessed using thematic analysis. RESULTS: Students' motivations for volunteering appeared to be related to the medical context of their service more than an inherent desire for volunteer work. Significant differences were seen in motivations and barriers for some student groups, especially those whose volunteer work had less opportunity for clinical service. Thematic analysis revealed two major themes and suggested that students had an empirical understanding that volunteer work could have both positive and negative effects. CONCLUSIONS: An understanding of students' motivations for volunteering on an MST may allow faculty to design trips with activities that effectively address student motivations. Although students had a basic understanding of some of the ethical issues involved, they had not considered the impact of a service group on the in-country partners they work with.

Clinical guidelines for Western clinicians engaged in primary care medical service trips in Latin America and the Caribbean: an integrative literature review.

OBJECTIVE: Participation in primary care-focused medical service trips (MSTs) by North American providers is increasingly common, with many of these being conducted in Latin America. The literature has yet to comprehensively explore the nature of MST practice, including the use of evidence-based clinical guidelines. This integrative review presents an analysis of guidelines employed in MSTs in Latin America. METHODS: MEDLINE and LILACs were searched using the terms 'medical brigades', 'Latin America', 'primary health care' and related terms. The search was limited to articles published between 2000 and 2015 in any language. Qualitative or quantitative articles were subsequently included if they described management protocols in the context of patient care on an MST occurring in Latin America. Additional publications were identified by searching the citations of articles reviewed in full. Themes were extracted to an Excel file, and objective instruments were used to evaluate article quality (Mixed Methods Assessment Tool) and the quality of guidelines (Appraisal of Guidelines for Research & Evaluation II). RESULTS: Of 391 abstracts screened, eight met inclusion criteria. All described MSTs operating in rural settings in Central America. Five were qualitative descriptive, including two travel reports, an ethics thesis paper, and a description of a dermatologic MST. Four described subjective clinician experiences while describing non-evidence-based treatment suggestions or practices. Only one described evidence-supported primary care interventions. Three studies were quantitative descriptive, including two epidemiological articles, one of which used case definitions for select diagnoses. One described the application of American Family Physician guidelines to the description of UTI prevalence on a MST. Article scores in MMAT quality domains were variable, and only one article achieved a positive overall AGREE II score for guideline quality. CONCLUSIONS: Existing literature demonstrates minimal development or use of clinical guidelines on MSTs in Latin America. Future work must focus on the development, implementation, and evaluation of culturally sensitive, evidence-based guidelines for the management of patients receiving care from MSTs.

Conflicto armado en Colombia y misión médica: narrativas médicas como memorias de supervivencia / Armed conflict in Colombia and medical mission: medical narratives as survival memories

Antecedentes. Elaborar memorias que permitan afrontar la violencia ejercida contra la misión médica en el contexto del conflicto armado facilita la creación de estrategias de diálogo en busca de la reparación y el perdón en el marco del proceso de paz que se realiza en la actualidad. Objetivo. A través de las narrativas de los médicos colombianos entrevistados, identificar los casos que tipificaban una violación a los protocolos, tratados y normas del Derecho Internacional Humanitario (DIH) en relación con la misión médica. Materiales y métodos. Se realizó un estudio con enfoque cualitativo hermenéutico adoptando los presupuestos teóricos de la función narrativa ricoeuriana, y analizando la trama del relato de la experiencia, las circunstancias, el tiempo y el sentido de la narración. Resultados. Se identificaron las siguientes tipologías de infracciones contra la misión médica: normas en el papel, violación a la neutralidad, actividades sanitarias o territorio de guerra, soledad del médico, victimas en busca de un refugio: la población civil y el médico, y la crudeza de la guerra. Entre las infracciones que se evidenciaron están la violencia que se ejerce contra las instalaciones de salud, los heridos y enfermos, el personal de salud y los medios de transporte sanitarios. Conclusiones. En el conflicto armado colombiano se han presentado violaciones que atentan contra la misión médica por parte de actores estatales y no estatales. Prevalece una falta de información y conocimiento del DIH y la misión médica. A pesar de esta circunstancia, los médicos que compartieron sus narrativas lograron solventar situaciones relacionadas con crímenes de guerra en la mayoría de los casos.

Background. Developing memorials to face violence against medical missions in the context of armed conflict facilitates the creation of dialogue strategies to seek for reparation and forgiveness within the ongoing peace process. Objective. Through the personal narratives of interviewed Colombian doctors, to identify the typical cases of violation of protocols, treaties and rules of the International Humanitarian Law (IHL) in relation to medical missions. Materials and methods. A study was conducted with a qualitative hermeneutic approach by adopting the theoretical assumptions of the Ricoeurian narrative function, and analyzing the story plot of the experience, circumstances, time and sense of narrative. Results. The following types of offenses against the medical mission were identified: rules on paper, violation of neutrality, health activities or battlefield, the physician's loneliness, victims seeking refuge: civilians and the physician, and the harshness of war. Among the evidenced violations are the violence perpetrated against health facilities, the wounded and the sick, health staff and medical transportation. Conclusions. In the Colombian armed conflict, state and non-state actors have carried out violations that threaten medical missions. The lack of information and knowledge of the IHL and medical missions is prevailing. Despite this fact, in most cases doctors who shared their narratives were able to solve situations related to war crimes.

Making surgical missions a joint operation: NGO experiences of visiting surgical teams and the formal health care system in Guatemala.

Each year, thousands of Guatemalans receive non-emergent surgical care from short-term medical missions (STMMs) hosted by local non-governmental organizations (NGOs) and staffed by foreign visiting medical teams (VMTs). The purpose of this study was to explore the perspectives of individuals based in NGOs involved in the coordination of surgical missions to better understand how these missions articulate with the larger Guatemalan health care system. During the summers of 2011 and 2013, in-depth interviews were conducted with 25 representatives from 11 different Guatemalan NGOs with experience with surgical missions. Transcripts were analysed for major themes using an inductive qualitative data analysis process. NGOs made use of the formal health care system but were limited by several factors, including cost, issues of trust and current ministry of health policy. Participants viewed the government health care system as a potential resource and expressed a desire for more collaboration. The current practices of STMMs are not conducive to health system strengthening. The role of STMMs must be defined and widely understood by all stakeholders in order to improve patient safety and effectively utilise health resources. Priority should be placed on aligning the work of VMTs with that of the larger health care system.