Saturday, September 20, 2014

Three Reasons Doctors Do Not Join Medical Missions

It is becoming difficult for organizers to get doctors to join them in their medical missions. I am not an advocate of medical missions. Before I give you the reasons why, let me clarify that what we mean of medical missions are the trend today of one-time events of medicals consults and surgeries with giving of medicines to patients as a tool for achieving something else. Med missions are sometimes beneficial especially during emergencies but other than that, it is an ineffective practice.


Here are three reasons why:

1. Medical missions do not address the health problem.

The medical management does not address the cause of the problem. A patient may come in with Tuberculosis due to the poor sanitation of the area, or poor nutrition, or poor hygiene habits. The current trend in medical management today is holistic approach wherein the doctor not only intervenes at the medical condition of the patient but also considers the other factors surrounding the patient. These factors include the mental, social and spiritual factors. Medical management also includes patient education on how the patient can improve her living condition, environment, lifestyle and other things more than just taking the prescribed medicines. This may not be possible as time is not a luxury during med missions. Also, some cases like TB needs further patient care which leads us to the second reason.

When Jesus healed the lepers, he restored their relationship with society. Remember, patient care is more than just treating the disease.


2. Medical missions do not provide continuing patient care.

Proper medical care is continuous and personalized. When medical missions are one time event, it does not allow for patient to follow-up with their health care provider for continuing care. Imagine the popular summer medical mission providing free circumcision to young boys. If complications happen to the wound, how will the boy get follow-up care from the healthcare giver? But a better example is chronic diseases like hypertension and diabetes. Continuous care is needed. Even if complications do not happen, the healthcare worker are ethically bound to continue care to the patient until they are well. This will not happen in one-time medical missions. Because of time constraints, personalized care are seldom given to patients.

When Jesus touched the sick, he touched their lives and they became his friends. Remember, the doctor-patient relationship is a contract of trust for care not for a one time meeting.


3. The ultimate goal is not patient well-being.

While medical missions looks into the health condition of the patients, the intent of the mission is not always the person's health. It is an open secret that politicians sponsor medical missions with the real intent of campaigning for people support. Churches sponsor medical missions as an evangelistic tool to persuade people to become Christians. Organizations sponsor medical missions as an outreach activity to gain prestige and recognition. There are other reasons individuals and groups sponsor medical mission but few are intent in addressing the health needs of the people. If the intent is to help people achieve good health, then they know that a one-time medical mission is not enough.

When Jesus came to heal the sick, his purpose was to heal the sick. In this context, health means a full life. Remember, health is an end not a means.

It is unethical for doctors to violate the principles of medicine. So, like most of my colleagues, I may decline invites in your one-time big time medical missions.

There maybe some benefits to the med missions but we can do better. I can name 5 health ministries churches can do. It is high time we level-up what we can do to improve the health of the community.



17 comments:

marcus panguros said...

sayang nasa labas ka pala ng bansa. pero pwedeng makuha ang opinyon mo sa Pagsasapribado ng mga Public Hospitals sa Pinas like Orthopedic Center? May bible-in-context reflection ka ba tungkol dito? salamat

Rod Reyes Jr said...

Three reason why you are dead wrong:

1. Medical missions do not address the health problem.

Wrong. Medical missions may seem a "one-time big-time" affair, but if one really takes a deeper look at how the medical mission was conducted, one would see a deeper essence and meaning of the word COLLABORATION.

Rod Reyes Jr said...

Collaboration meetings takes place between the medical team and other key groups like the NGO organizer, the Local/Rural Health Unit, the Local Government Unit and the sponsors (individuals, groups, pharmaceutical companies etc.). These happens before a 1-day, 2-day, 3-day and even a 5-day medical/surgical/dental mission materializes. In these meetings, they identify which type of doctors' specialties are available for the target event versus no. of beneficiaries versus the no. of other medical personnel (anesthesiologist, nurses, etc.) versus the number of medical supplies (medicines, O.R. supplies etc).

Rod Reyes Jr said...

This is called the Preparatory phase of the medical mission.

Now, since it has been made clear that medical missions are really a team COLLABORATION effort what are the functions of each member of the team?

The Local/Rural Health Unit. They detect a particular health problem but with inadequate resources (proper manpower, supplies, budget) they need external help. They ask for assistance from an NGO. They would be the ones who would "initially" screen the patients as to the parameters that would be set by the team, because in principle, they are the ones who personally know their patients' medical history and social background.

In short they are the ones who would identify the Target Beneficiaries and asks the question, "Can you help us?".

Rod Reyes Jr said...

NGO. The NGO weighs the request for assistance versus their group's mandate, versus their ability to support the "project", versus the sponsors/stakeholders they can ask for support. In short, they are the ones who answer "We will/We can't help you.".

Sponsors. They are the individuals/groups that provide the financial backbone of the mission. They are the pharmaceutical companies who provide the medicines. They are the medical supply companies who provide the medical/O.R. supplies to be used.

Medical Team: They are the team of doctors, nurses and other medical professionals who rose up to the challenge to answer the call for help. They would execute the purpose of the medical mission. To treat the target beneficiaries.

Rod Reyes Jr said...

Local Government Unit. They would provide assistance on the ground. Transportation, food, lodging, etc. They would also maintain the peace and orderliness of the event.

After each patient is seen/treated by the doctors of the medical mission team, he/she is then given post-op meds, or maintenance meds and is then referred to the local/rural health unit, who is also given medicines for post-op and complications management. An open line is established between the doctors of the Local/Rural Health Unit and the doctors of the medical mission after said "one-time big-time" event for any concerns.

So concerns regarding tuberculosis, other pre-existing medical, personal, social, spiritual "chorva" conditions that would endanger or unclassify a particular patient from the medical/surgical/dental mission, would be unclassified first by the local/rural health unit weeks or even months before the medical mission event takes place, because of the simple fact that these doctors from the L/RHUs are the initial screeners. C'mon, they are also doctors, they know what's acceptable to the medical mission or not.

Rod Reyes Jr said...

Jesus was widely accepted during his time, not only because he treated the sick, but because he showed to the people that everything can be done right, if they only believe.

2. Medical missions do not provide continuing patient care.

Wrong. It has been mentioned in No.1 that follow-up care would be managed by the L/RHUs. Part of the endorsement to them are the care given to their patients. Also included in the endorsement are the medicines and supplies needed for their follow-up care should the medicines/supplies given to these patients by the medical mission team turned insufficient.

Unless we accuse the doctors and nurses of the L/RHUs to be incompetent to carry out their work of post-op management, then we have the issue on complications covered.

When Jesus touched the sick, he touched their lives and they became his friends AND for most of them, his FOLLOWERS. Most patients that Jesus treated were a one-time affair. He made the blind man see and after talking to him that's it. He made a dead man rise back to life again, and after talking to him and his family, that's it. Jesus wont have time to cure, save from sin, preach to others if he remained in one area to maintain friendships. What is important (and i believe Jesus knows this, is that he created believers from the people he helped and cured)

Rod Reyes Jr said...

3. The ultimate goal is not patient well-being.

Wrong. Medical/Surgical/Dental mission's ultimate goal is to alleviate suffering and cure illness. It is the prime reason why the medical mission was planned, and executed in the first place. Whatever the intent of the persons, groups who organized/funded/supported the said event, the deciding factor whether the event was a success or not in relation to their individual intentions is that if they were able to help their targeted beneficiaries health problems.

No person in their right mind, whatever his intentions are would conduct a medical mission where a target medical condition does not exist. Mapapahiya sa tao ang organizer, whether NGO or pulitiko man yan.

Rod Reyes Jr said...

With regard to intentions, yes its true, politicians have their own intentions, and not only doctors knows what they are, but also the people. They might be poor, but they are not dumb. Churches have their own evangelistic, divine or sinister (depends on your religion) intentions, and the people both Christians and non-Christians knows this, yet we see a blend of religions and ethnic groups in medical missions, and they go home treated or with maintenance meds without pressure to alter their beliefs or donate more to the church. Both churches and people are mature enough to know that. Organizations sponsor medical missions as an outreach activity to gain prestige and recognition that they exist and this is what they do, true, no need to expound on that.

When Jesus came to heal the sick, his purpose was to heal the sick AND spread the good news. Jesus was not one thing. He was everything. He arrived not just to heal the sick, but to save us all from damnation. He knows his time is limited here, so that's why he did not just stop and heal all the sickness that he comes by, he made sure he gets to accomplish his higher task here, which is to teach what needs to be taught to the people.

This developing country of ours have an existing Public Healthcare System, and all of us know that it is inadequate in delivering health services to the poorest of the poor which comprises 80% of the populace. (Yep, those who read this, and those who use the internet comprise only a mere 20% or less)

Rod Reyes Jr said...

We are still a developing country. Budget for healthcare is not that sufficient to hire more personnel, buy sophisticated equipment for all public hospitals, buy medicines and supplies for all these patients.

This is why medical missions, if planned and executed well are a much needed relief for the less fortunate Filipino folk.

Time and time again, trial after trial, tragedy after tragedy, the Filipino has survived not because he is rich in wealth, resources or intellect. We survived and still survives because of our Bayanihan spirit.

Bayanihan, back in the days is the helping hand of one stranger in lifting another person's nipa hut, helping the family unknown to him in lifting their house to another location.

Nowadays, it is the sharing, and collaboration of intellectuals, of resources, of skill to lift this nation... together.

Intentions?

All of us have intentions. Back when we were still students, our intentions are to graduate no matter what the strategy is, so that we could begin working to heal the sick.

Rod Reyes Jr said...

As we grow older, our intentions change, we share our intentions with our new family. To provide for them shelter, education and clothing.

When the kids have left the house, our intentions again, change, that we want to leave this earth with a purpose.

When would this purpose begin? When your hands shake badly that you cant draw a single line with your scalpel?

There are many others that wont wait for that time to come.

There are many others, who are not afraid to go out there and talk to the real Filipinos.

Coz the real Filipinos are not the ones strolling around in Rockwell, Greenbelt etc. The real Filipinos are the ones whose families are in the dark tonight, for they have no electricity. They are the ones with noisy kids, crying, fighting, bcoz they are all hungry.

These real Filipinos are the men and women who comprise the families of our so called farmers, carpenters, jeepney drivers, cashiers, fastfood workers, gasoline boys, janitors, garbage collectors etc.

Rod Reyes Jr said...

These are the men and women who shape up our country. Its not you and me.

We should not be afraid to mingle with them, share a story and maybe a laugh or two with them.

Lets end the days that our world only revolved around our neighbors, classmates and friends.

Its time to widen our horizon. The Philippines is a big country. Medicine is a profession with a nuclear potential to change things in this country.

It is unethical for doctors to violate the principles of medicine?

C'mon, we all know thats just crap. Tinatamad lang tayo maarawan at mangamoy araw.

In military lingo, thats called "malingering" (making excuses not to complete the physical exercises).

If we have been victimized in the past by poorly planned medical missions, this is not the right reason to stop.

There are many groups out there, whose forte is organizing these kind of activities.

Or if not, why not plan one with your friends and organize a team of your own. Go to a poor location, identify which sickness is prevalent and needs your prior attention. Choose a location where you can both serve, and relax at the same time.

Its not a crime to serve and enjoy at the same time.

Good luck to all!


P.S.
I wont have time to review and edit this. My apologies for any typos you might encounter. Ciao!

didaskalos said...

http://en.m.wikipedia.org/wiki/Catholic_Church_and_health_care#Antiquity

theomed said...

Thank you for the comments. Rod Reyes articulated very well what I mentioned as the "proper way" to do medical missions. But again, we are talking about the one-time big-time missions that excludes the current health system. Pinoys are so used to the idea, "mabuti na ang nakatulong kaysa wala." OK na ang magpalimos ng tirang ulam kaysa wala. Can we not teach them to fish rather than give fish? The point is, if we want to help improve health, do it well. There are of course benefits to the med missions, but it is high time we level-up our involvement in improving the community's health instead of this one-and-done solutions. What are some other ways? Watch out for my next post.

Randy Cenon said...

Greetings in Christ, first of all congratulations on your theo med blog. Someone pointed me to your blog regarding your post on medical missions. And I do agree that some people and some doctors do really think of medical missions this way. But here are my answer to your points coming from a Missionary Doctor.
 
Let me take your point number
1. Medical Missions do not address the health problem.
 
If your medical mission does not address the health problems then what do they address? The primary goal of medical missions is to go to the community and identify and treat medical problems that are currently present in the population.
 
We are taught in medicine that 80-90 percent of the diagnosis come from history and physical examination thus when we do medical missions we can diagnose and identify patients who really need medical attention. This is when we slow down and give them immediate medical attention that we have. We then give them recommendations, referrals work ups that needed to be done (be it partner churches, rhu or lgu’s), and we are making them aware that there is really something wrong with them. This system will make them seek further doctor consultations. Tuberculosis as an example would be unfair because of the prolonged treatment of the disease, but for Pneumonia, AGE with dehydration, ATP, UTI, URTI, Hypertensive Urgency and the likes are readily addressed at the mission and it already made a big difference.

Randy Cenon said...

As for the holistic approach It's like you are saying that we will avoid or refuse one patient who have the money just for “one time big time” consultation because there will be no continuity of care? If one doctor is burdened as such then the doctor need to have a 2nd, 3rd, 4th, 5th medical mission on that community and apply the holistic approach.
 
You stated that there are other factors including mental, social and spiritual factors I totally agree but then how can you understand these factors if you don't exposed yourself to the patient's environment? How can you understand how they think, if you are not in their shoes? How can you assess in their spirituality if you are not exposed to the daily struggles that they are facing? You cannot assess these factors first hand, that you are enumerating, in the confines of your air conditioned clinics.
 
Remember Jesus as he was evangelizing, he was moving from one place to another and He was healing the sick.
 
2. Medical missions do not provide continuing patient care.
 
It was already stated also on number 1) would you turn down one patient who will seek and afford just for one consultation? Again what you can do on such situations is partner with churches, lgu, rhu or do another medical mission on the site to provide continuing care. It would not harm the patient if you can give referrals to other institution.

Randy Cenon said...

3. The ultimate goal is not patient well being.
 
The goal of our medical mission is to provide medical/physical needs, spiritual needs if forms or prayer and counseling, social in terms of we get them aware that they have this problem and we also get them meet persons or organizations that can be of help to them.
 
You mentioned about evangelistic tool to persuade people to become Christians?
Really persuade? Ever heard of sharing the gospel? We call this seed planting and we let the Holy Spirit work. This is our primary mandate before becoming doctors as a Christian.
 
Therefore, go and make disciples of all the nations, baptizing them in the name of the Father and of the Son and the Holy Spirit
 
But what does it matter? The important thing is that in every way, whether from false motives or true, Christ is preached. And because of this I rejoice.
The saved person performs good works because he has obtained God's favor.
Sad to say, I don’t see any ethical violation here. And I can’t see where theology and medicine meets in this article.
 
Next Medical and Dental Mission with Care Channels would be on Oct 18, 8am to 12pm Sat Batasan area. You are invited to join our mission if you are Manila by then. You can be a pastor there or a doctor or both.