How in the World Do I Choose a Medical Mission? by Amanda Judd

When I first began to look at organizations, questions began to pop into my head such as how do I choose whom to go with? How do I know what will be right for me? How do I know that it will be a good group?  What even makes an organization good?

It was difficult to find any kind of guidance for picking an organization. Not knowing what questions to ask resulted in me doing work with organizations that I loved and organizations that left me questioning my involvement.

It is important to choose the right group for you whether you want to go on a trip for purely medical reasons, to travel, or for an adventure. In order to help you choose the right group and avoid some of the pitfalls that I fell into while doing mission work, I am sharing some of my own stories along with some personal, organizational/ethical, and safety questions to ask yourself and your organization before you go.

Questions to Ask Yourself

What is my time commitment? Do I want to dip my foot in the water with a short-term humanitarian trip or just dive into a long-term commitment? The answer to this question is key to beginning to narrow down your choices of organizations.  Once you have decided whether you will participate in a short-term trip or a long-term mission you can narrow down what groups to choose from because most groups do short-term or long-term, but not both.

What can I afford to do? Once you have narrowed down organizations, you can begin to ask about financial commitments. Some organizations pay you for your work (these are typically long-term missions), some pay your expenses but do not reimburse you for your time, and some require a fee for volunteering. Some groups offer scholarships for applicants. (My rule of thumb on this is that it can’t hurt to politely ask if there is financial assistance.) Also, will you be expected to fundraise, collect supplies, etc.?

Where are you going? Culture shock is a real and disorienting feeling. You may want to consider whether you’ve traveled in the past and what you might expect at your location. Humanitarian work is often done under primitive conditions with limited resources. Patient’s stories may be shocking and unthinkable. It can be tough for even the most experienced humanitarian nurse.

Do I have a valid passport? Is my passport valid for at least 6 months after to travel date? Virtually everywhere that you travel outside of the US now requires a passport and many countries require that the passport not expire for at least 6 months after the travel date.

Do I need a visa? If so, you should find out what the timeframe is for obtaining a visa. You need to know that there may be a cost for visa/passport services, especially if you need to use an agency to acquire a visa. Fill out your visa application carefully. Any mistake could result in a rejected visa and no trip! Also, be aware if there is an exit tax. You don’t want to be stuck in the airport because you didn’t include this in your budget.

Do I need vaccinations or medications such as antimalarial meds? Vaccinations and medications can be a large expense so it is important to consider them in the cost of the trip. Depending on where you are going and what is needed, vaccines and medication costs can run high and will likely not be covered by the organization that you are travelling with or your health insurance. On one mission, I had antimalarial medications and vaccinations that cost in excess of $650 for a 3-week. It was quite a hit to my wallet. You’ll want to be aware of costs before you travel and you can find these costs through your local health department, travel medicine clinic, or cdc.gov. Start early, some vaccinations are in a series over weeks to months.

Do I have any special health considerations, such as allergies, food restrictions, or medical issues? For example, if you are a vegetarian, it’s likely you won’t have issues finding food in countries with a large vegetarian population like India, but if you are in other regions where meat is in nearly everything, you may struggle. You might want to ask yourself if you are able/wiling to modify these needs for your trip. If you have medical needs or severe allergies, I would strongly encourage you to address them with the organization prior to the trip to see if it’s realistic to accommodate them or not.

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Questions to Ask About the Organization/Ethics

Ethics: it’s something that most people don’t want to talk about when in the excitement of traveling to an exotic location. I would argue that working with an ethical organization is one of the most important parts of mission work. Many articles have been written about the ethics of medical mission work (short-term missions in particular) and are worth a serious read before committing to any organization.  You can do your own search or check out articles like “Duffle Bag Medicine” by Maya Roberts [1]. I would look at ethical issues not to discourage you from doing mission work, but to inform you of the pitfalls and to help prevent issues of moral distress when you are abroad.

One of the basic ethical issues that you want to be aware of is that if you are working on a short-term mission, you want to ensure that the organization has a commitment to the area/region/country where they are working. You can find out more about local commitments by asking questions like does the org have an ongoing relationship with a hospital or clinic on the ground? Who provides follow-up care when we leave?

Why does a commitment to the community matter? Well, if the organization travels many places but has no commitment to the communities that they are working in, you might want to question whether you want to participate because lots of these fly-by-night missions take marginally trained volunteers and many non-medical volunteers providing a sub-par standard of care. This is of critical importance when caring for impoverished populations.

Jan Egeland, former UN undersecretary-general for humanitarian affairs and emergency relief coordinator, eloquently said, “You aren’t allowed to be amateurish if you are in the game of saving lives. The one human right that the poor and vulnerable should have at the very least is to be protected from incompetence.” Simply put, being poor does not mean that one is less deserving. Ultimately, the question that I always ask myself is that if one of my family members was being seen in the clinic, would I be satisfied that they are receiving a basic global standard of care?

IMG_3847Along those same lines, a very important question to ask is who is planning/leading the mission? I went on a mission that was entirely planned by a non-medical staff. Prior to leaving, I asked for a formulary but never received one. As it turned out, medications were thrown in the bag right with seemingly little consideration for the patient population being seen or whether the meds were appropriate or needed. I found myself going through the bags with the largely non-medical team with a foreboding pit in my stomach when I discovered that we had about enough medications for 2 of our 8 clinics and bags full of stuffed animals. The stuffed animals were a nice thought, but being a do-gooder with a smile and a teddy bear serves no purpose in communities where typhoid is rampant and people are dying.

That said, many times non-medical staff participate in humanitarian work to plan and manage the logistics of a mission but should not be the primary medical planners of the mission. Much has been written about unqualified caregivers on humanitarian missions and simply put, medications and procedures can do harm if given inappropriately. Handing a patient a weeks worth of blood pressure medication doesn’t help if they have no ability to follow up. The same could be said for antibiotics or vitamins. Suffice it to say, I now insist on knowing who will be traveling on the trip, who is doing the medical planning, and I like to have a basic formulary for the trip.

Is the organization’s primary purpose mission work or is it secondary to other goals? This goes back to commitment to the country. Does the organization get their funding from donors, corporations, or sales? This can impact whether your goals align with the organization that you are traveling with; for example, if you are traveling with an organization wishing to sell medical supplies with missions being secondary, you want think about whether this benefits the patients that you are serving and whether you feel comfortable providing care within this framework.

On a different note, is the organization religious or secular? Some people only volunteer with religious organizations, others only secular. Many organizations are a combination of the two. Know your feelings about this before you go and try to anticipate your feelings about being asked to participate in prayers or other religious functions. Even when I have traveled with secular organizations, the reality is that many local hospitals and healthcare groups are religious so don’t be surprised if you are called upon to pray or participate in religious functions. Deal with your feelings about this before you go. A developing country is no place to have a crisis of conscience.

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How is your mission structured? Is the mission in a hospital or clinic? Is it research-based? Is it educational where teaching of local staff or volunteers will be done? Your goals for mission work should match the organizations goals. If you are expected to teach, will you be provided materials or do you have to develop your own curriculum? Will you be working side-by-side with local staff in a hospital? Know what will be expected of you on the ground because no two trips are alike and it is helpful to prepare.

What is my expected scope of practice? What will I be required to do? Is my role within my scope of practice? Am I a new grad nurse who will be expected to see patients and practice medicine? I’ve seen this more than once. I’ve even seen an unskilled health aids and people with no clinical background expected to work essentially as physicians. This is a serious ethical issue and a safety issue for the patients. Again, would I want my family to receive this kind of care? Always ask, what is the ratio of licensed doctors and nurses, versus non-medical volunteers. This will help weed out poorly organized trips.

Does the organization that you are traveling with provide translators? If so, you want to make sure that translators are arranged prior to the trip. On one mission, as I neared the end of the day, my translator turned to me and said, “OK, now can I see you?” He was a member of the community who had been pulled from the line waiting to see providers because he spoke English. He acted as a translator for his community for the day, which violated medical privacy laws of the country. I was completely mortified for him and for the patients. We made him work for his care and compromised the care of the other patients. The concept that any care is better than none holds no water here. Translators must be arranged prior to the mission.

Safety Considerations

Safety can mean different things in different regions. The US Department of State lists current travel alerts and warnings that you can get at travel.state.gov. This should give you an idea of the conditions on the ground where you are traveling. I would check for safety issues independent of the organization that you plan on traveling with and if you are traveling to a location that has been flagged for safety issues, consider whether this is a risk that you want to take. Once while traveling in an area with a travel alert, a local store that my group frequented daily was bombed a day after we left. Fortunately, we were safe, but the risks are real. Don’t take them lightly.

Where are you staying? Are you staying in a hotel, dormitory, or a homestay? Is there security at that location? (It may or may not be necessary.) Are you guaranteed to stay where the organization promises? I worked on one mis sion where we didn’t stay in any of the locations promised. We had minimal ability to contact the outside world and someone tried to break into our hotel room. It was nerve-wracking and I will never go on a trip unless I have some guarantee of accommodations.  Fortunately, most organizations take the safety of their medical staff seriously, so this is not a huge issue most of the time, but one worth inquiring about.

Does the organization take steps to insure food safety? Many missions work with established cooks or restaurants because if the medical staff has food poisoning there is no mission. This is not always the case, but a good question to ask. If you want, you can always bring protein bars and a water purifier if you have concerns. You can’t always prevent illnesses but you can try to avoid them.

What are the contingency plans if something goes wrong or you become ill? Do you have travel insurance? If you fall ill in a foreign country you may or may not be able to get adequate care so you want to make sure that you can return home. This may be even more important with long-term work. You may be able to purchase this insurance separately if the organization does not provide it.

That’s a Lot to Consider; Do I Really Want to Do This?

At this point you may be asking yourself, is it worth it? To that I would respond that in spite of the challenges I have faced in global health, it is my life’s passion. I have not met one person who has done global health work who is not a better caregiver for working in global health. For all that doing this work may do for you personally; you must know that what you are doing for the communities that you are working in may be lifesaving if done with commitment, ethics, and a basic standard of care.

If that doesn’t convince you, consider this, in 2006 the WHO declared a shortage of healthcare professionals that had reached a critical level in developing countries [2]. Of those providing care, nurses provide 90% of healthcare worldwide [3]. Nurses, we are desperately needed to help provide care, teach, and train to bridge this gap. Are you up to the challenge?

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  1. Roberts, Maya. (2006). Duffle bag medicine. Available at: https://www.globalbrigades.org/media/Duffle_Bag_Medicine.pdf
  2. World Health Organization. (2006). The world health report 2006: Working together for health. Available at: http://www.who. int/whr/2006/en/.
  3. Davis, Sheila. (2012). Why nurses are the unsung heroes of global health. Available at: http://www.huffingtonpost.com/sheila-davis-dnp-anpbc-faan/international-nurses-week_b_1499802.html