so you want to go on a medical mission trip…but don’t know ... · school trip to honduras...

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39th National Conference on Pediatric Health Care

©2018

March 19-22, 2018 CHICAGO

So you want to go on a medical mission trip…but don’t know

where to start.

Kristin S McHarg, CPNP, IBCLC

©2018

Disclosures

• I have no relevant financial disclosures.

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Learning Objective

• Name three components to consider in choosing a medical mission trip.

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My personal experiences

2007

USNS COMFORT Hospital Ship with PROJECT HOPE

2009

HOMBRE ‐ VCU Medical School trip to Honduras

2011‐ 2017

LITTLE BY LITTLE HAITI

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USNS COMFORT

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USNS Comfort – Project Hope “Hopies” and all service military personnel

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Helicopter flights to and from the ship in Guyana and Suriname

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Tents/ school buildings/ other sites for clinics/ screening for possible surgery

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2007


2009


2011‐ 2017


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Church clinic spaces in Honduras

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Applying Dental Sealants in Honduras

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Water filtration system – taking water buckets to villagers in their homes

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Residents learned to filter their drinking water

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Honduran village home and family

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2007


2009


2011‐ 2017


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Port au Prince, Haiti in 2011 – after the 2010 Earthquake

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Tent cities in Port au Prince, 2011

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Gramothe village, across the mountain from our guest house

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Hiking to work – down the mountain, across the river bed and back up another mountain

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Optional ride to clinic on an ATV or in the back of a pick up truck

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Open air clinic spaces – no electricity until 2017!

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Clinic spaces – curtain dividers and 8 “stations” –some with dental chairs

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Line up to be seen on the first day of clinic

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A home in the village of Gramothe

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Villagers washing their laundry in the river bed stream

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Carrying loads of onions to market

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Is it a surprise that many visits to the clinic are for neck and back pain?

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What to Consider in Choosing an Organization

• TIME COMMITMENT

• COST

• RELIGIOUS OR SECULAR FOCUS

• EXPECTED ROLE

• LANGUAGE/ TRANSLATORS

• LOCATION

• PERSONAL SAFETY

• HOUSING/ ACCOMODATIONS

• ETHICAL ISSUES/ QUALITY OF CARE

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TIME COMMITMENT

SHORT TERM –generally one week

minimum

SHORT TERM –generally one week

minimum

LONG TERM – Doctors without Borders,

others may require a 6 month or longer commitment

LONG TERM – Doctors without Borders,

others may require a 6 month or longer commitment

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COST

Paid expenses or stipend with long term

commitments

Short term – individuals pay their own travel, housing, food, etc

Some groups offer scholarships

Ask if you are expected to fundraise or collect

supplies

Will your employer give you time off or will you be using vacation time

or taking off time without pay?

Average cost for a 1 week trip is $1000‐

$2000.00 (about half is travel)

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RELIGIOUS OR SECULAR FOCUS

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EXPECTED ROLE

Within your scope of practice ‐ “First

Do No Harm”

Hospital/ acute care focus versus primary care

Pediatric focused or will you also see

adult patients

Is there a teaching component

Will providing immunizations be

part of your mission

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LANGUAGE/ TRANSLATORS

Are you fluent in another language

Are translators provided and trained

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LOCATION

Passport or VISA

requirement

Vaccines or medications

recommended

Personal Safety

More expensive to travel further

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HOUSING/ ACCOMODATIONS

Homestay with local families

Homestay with local families

Dorm or hotelDorm or hotel

Guest house for volunteersGuest house for volunteers

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Dormitory style sleeping at a church building in Honduras

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Mountain Top Ministries Guest house

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Bunk beds in guest house

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QUALITY OF CARE

Who is planning and leading the missionWho is planning and leading the mission

Will you have necessary medications and suppliesWill you have necessary medications and supplies

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BELIEVE

THERE is

GOOD in

the world

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Resources for Finding Volunteer Opportunities

• International Medical Volunteers Association http://www.imva.org Finding volunteer opportunities; hundreds of organizations

• Health Volunteers Overseas http://hvousa.org Teaching, more hospital based and acute care

• www.projecthope.org

• www.globalvolunteers.org Many volunteer opportunities in health care and other fields

• www.healthcarevolunteers.com – medical volunteer opportunities, national and international

• International Medical Corps www.imcworldwide.org Global first responders, rapid deployment within 72 hours, for 2‐8 weeks

• www.shorttermmissions.com

• www.internationalmedicalrelief.org

• www.medicalmissions.org

• Medical Missionaries www.medmissionaries.org nonprofit, volunteer opportunities in US and abroad. Focus on Haiti/ Dominican Republic border.

• Heart to Heart International www.hearttoheart.org Current presence in Haiti, Guatemala

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References:• Chapman, C.S. (2007). So You Want to Go on a Medical Mission. The

Journal for Nurse Practitioners, Nov/ Dec 2007, pp. 707‐712.• Dewitt, A. (2010). Give Your Best. Create Space independent

Publishing.• Hassler, D. A. (2017). Serving Others Through Mission Trips. Journal

of Trauma Nursing, 24 (1), pp. 57‐60. • Kidder, T. (2003). Mountains Beyond Mountains. New York:

Random House.• Norton, D.P. (2004). International Volunteer Work for the Practicing

Pediatrician. Pediatric Annals, 33:10, pp. 699‐707.• Stone, D. (2008). The Samaritan’s Dilemma. New York, N.Y., Nation

Books.• Walsh, S.M. (2010). Walking in Broken Shoes: A Nurse’s Story of Haiti

and the Earthquake. Grace Acres Press.

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Assessing Health Needs in Rural Haiti Through Community-Based Research

Penny Neal, PhD, MSN, CPNP, PMHS

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Learning Objectives

• At the completion of this educational session:

– The learner will be able to describe the utilization of Participatory Rural Appraisal (PRA) as a guide to empower local community leaders in a global health setting.

– The learner will be able to identify at least two PRA tools and how they are used to assess community health needs.

– The learner will be able to summarize common health needs in rural Haiti.

• Drs. Penny Neal and Amy Knowles have no conflict of interest, sponsorship or commercial support associated with this researchendeavor. Both researchers are employed by King University and have affiliation with non-profit organization, Medic Samaritan.

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Background and Significance

• Population of 10 million people

• Poorest country in the Western Hemisphere

• Ranks 168 out of 187 on the Human Development Index

• (WHO.int, MidwivesforHaiti.org)

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Setting, cont.

• Approximately 80% of residents walk over 2 miles daily for fresh water from river, stream or cistern

• Over 50% of residents live in inadequate or unsafe shelter

• Less than 10% of homes have accessible bathroom or sanitation facilities

• Less than 5% of homes have any type of energy source

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Health in Haiti

• One in every 14 children die before age 5

• One out of every 83 women die during childbirth

• In rural Haiti, 75% of women deliver at home without any trained provider

• For the poorest of families, 90% have no prenatal or skilled care at birth

• (WHO.int, MidwivesforHaiti.org)

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Review of the Literature

• Previous Participatory Health Assessment conducted in rural Haiti

– Key findings: loss of productive land, minimal irrigation & sanitation resources, priorities of maternal health, malnutrition, diarrhea, and general distrust of organizations

• Limited research has been conducted in Haiti

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Methodological Approach

• Qualitative Participatory Rural Appraisal (PRA) study

– Generates knowledge of a social system with the aim of bringing about change

– Cyclic process of action, reflection, and interpretation

– Conceptual Model for Partnership and Sustainability in Global Health (Leffers & Mitchell, 2010)

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Setting A rural village in southern portion of Haiti

Beloc, Haiti- Population est. 4,000

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PRA Tools

• Mapping

• Scoring

• Transect Walk

• Focus Group Discussions

• Institutional Relations Exercise

• Root Cause Analysis/ Preference Ranking

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PRA in Action

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Findings

• Identified needs

– Local clinic/pharmacy

– Food security

– Water catchment

– Latrines

– Business opportunities

– Paving asphalt road

• Developed action plan & disseminated written report

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Reflection & Implications

• Mutual goal setting & establishing priorities to foster ownership of health strategies

• Empowerment

• Trust & relationship building

• Deeper understanding of health needs in rural Haiti

• Creation of long term sustainable partnerships/ interventions to improve health outcomes of the communities

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Limitations

• Limited generalizability

• Timeframe of 1‐2 weeks for assessment period

• Limited number of tools that local participants can be trained to implement

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Questions?

• Dr. Penny Neal

• 1 (865) 804‐1464

• www.medicsamaritan.org

• [email protected]

• [email protected]

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References

Leffers, J. & Mitchell, E. (2010). Conceptual model for partnership and sustainability in global health. Public Health Nursing, 28(1), 91‐102.

Medic Samaritan (2010). Healthcare education and engagement program. Retrieved February 17, 2016 from http://medicsamaritan.org

Midwives for Haiti (2006). Why Haiti? Retrieved February 17, 2016 fromhttp://midwivesforhaiti.org

Sethi, S. & Belliard, J. (2009). Participatory health assessment in Haiti: Practical tools for community empowerment. Progress in Community Health Partnerships: Research, Education, and Action, 3(3), 257‐264.

Sonoma State University (2015). Center for Community Engagement. Retrieved February 17, 2016 from http://sonoma.edu/cce

World Health Organization (2016). Haiti. Retrieved from February 24, 2016 fromhttp://who.int/countries/hti

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Haiti: The Student and Faculty ExperienceAshley Marass DNP, CPNP

©2018

Disclosures

• I have no disclosures at this time for this presentation.

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Learning Objectives

• Understand the benefits of study abroad for nursing students.

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Study Abroad in Nursing

• Excellent experience

• Clinical time

• Cultural competency

• Global view

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Student’s View

• Self efficacy

• Self confidence

• Social responsibility

• Influence inequalities around the world

• Rewarding

• Life‐changing

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Where?

• Haiti, north eastern border with DR

• Danita’s Children

– Orphanage

– School

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Danita’s Children

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Who?

• Three Faculty

• 4 PNP students

• BSN Accelerated new graduate

• PNP DNP new graduate

• Internal medicine MD

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University of South Alabama

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What?

• Treated almost 400 children in 3 days

• Two days of clinic in the new medical center

• One day of clinic in the community at an orphanage /school

• Excursion day

– Local hospital

– Citadel

– Swimming

• Education with local nurses

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Community Orphanage

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Community Orphanage

• Brought essential medications

• Transported through the village

• Treated all classes in the school

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Malnutrition Clinic

• Held babies

• Stabilized babies

• Overnight stay

• Admitted 4 babies

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Malnutrition Clinic

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Education

• Students taught nurses

• Nurses taught students

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Citadel

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Issues

• Weather

• DNP projects

• Travel warnings

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Conclusion

• Wonderful experience for the faculty and students

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References

• Edmonds, M. (2008, January). The lived experience of nursing students who study abroad: a phenomenological inquiry. Lived Experience of Nursing Students Who Study Abroad, 208 p.

• Kelleher, S., FitzGerald, S., & Hegarty, J. (2016). Factors that influence nursing and midwifery students' intentions to study abroad: A qualitative study using the theory of planned behaviour. Nurse Education Today, 44157‐164. doi:10.1016/j.nedt.2016.05.019

• Kent‐Wilkinson, A., Dietrich Leurer, M., Luimes, J., Ferguson, L., & Murray, L. (2015). Studying abroad: Exploring factors influencing nursing students’ decisions to apply for clinical placements in international settings. Nurse Education Today, 35(8), 941‐947. doi:10.1016/j.nedt.2015.03.012

so you want to go on a medical mission trip…but don’t know ... · school trip to honduras...

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