We Asked, You Answered: Are Fly-In Medical Missions Helpful Or Harmful?

Enlarge this image Chris Nickels for NPR Chris Nickels for NPR

For decades, doctors and nurses from rich countries have flown to poor countries to perform surgery and provide other medical care not readily available. They stay for a limited period of time. Then they head back home.

That model for providing care is being reconsidered, as health reporter Joanne Silberner wrote in a story we published this spring.

We wanted to hear from our readers: If you've been part of a fly-in mission, what was it like? What were the pros and cons?

More than 75 medical workers from NPR's Goats and Soda audience responded to our callout.

The comments included defenders and critics of missions – and some respondents who expressed both positive and negative perspectives.

'A ray of hope'

"Most mission groups are highly effective and give a ray of hope to the primary beneficiaries – the patients," wrote Aubyn Marath, a pediatric and adult cardiac surgeon, arguing that our story did not emphasize that point. "Units do sometimes fail but not for reasons that have much to do with the mission visits." Marath cited "severely substandard settings, shortcomings in personnel, equipment and essential medications" and "bureaucratic inertia" from local governments and adds, "The author [of the NPR story] rightly suggests that visiting teams MUST have a priority to teach."

Respect the locals

Others expressed concern that fly-in missions are potentially problematic.

"I am a nurse who has participated in fly-in missions with a group to Guatemala and then to the Dominican Republic," says Jeanne Leffers. The teams treated both minor and serious medical issues. "I began to feel that this was not right, that the local people knew their culture, their local language and their communities better," she says. She now supports an organization that allows volunteers from the U.S. and Canada to partner with local health professionals "to both teach and learn."

Many misunderstandings

One correspondent, who served as a translator, gave a frank view of what was witnessed during and after such volunteer missions. "As a Creole-speaking liaison between visiting medical teams and the communities they served, I was there the week after teams left," writes this individual, who asked for anonymity "because I would like reader to focus on the impact on the communities in Haiti, not on me."

This reader reports that, "lack of health literacy meant that a woman had misunderstood the directions for blood pressure medication and had to go to the hospital due to the complications. I was there when local health workers encouraged community members to seek care, and they responded they would wait for the "blan" [white folks] to return. I was there when providers looked translators in the eye but not patients. I was there when a translator was translating the patient's needs and mixed up the English words for pregnancy and period. I was there when a patient didn't believe a dentist could be Haitian because the last one to come was white."

Despite leveling these criticisms, the respondent notes, "I think if local health-care providers are consulted and are the drivers of collaboration and learning, there is a possibility that visiting providers can play a role. But care cannot continue with a disregard for local realities and culture."

Pressures on participants

Then there are concerns about the pressures put on the mission participants. Natalie Sheneman, a program and research assistant, is co-author of a Northwestern University study on the experiences of health professionals and trainees in fly-in missions. Of the 200 participants in the study, she writes, "We found that nearly half had been asked to practice a skill or procedure outside their scope, and of that group, about two-thirds went on to perform the requested skill or procedure." The survey also "found evidence of long-term emotional distress following these experiences."

Saving lives

Many of our readers emphasized the invaluable work done on fly-in missions. The surgeries that he performs are literally a matter of life and death, says Woong-Han Kim, a cardiothoracic surgeon in Seoul, South Korea. Kim has performed pediatric cardiac surgeries in developing countries in Asia and Africa. "Without a timely surgery," says Kim, children with congenital heart disease "are not likely to survive." He is an advocate of a "team-based" approach and says he returns to countries every year "to line up the most complex and/or urgent cases and perform them together" with local medical personnel.

An eye to the future

The kind of training for local medical professionals mentioned by Kim was cited by many respondents as a key element in a meaningful and successful medical mission.

"As a pediatric surgeon and medical director of World Pediatric Project, I've had the privilege of working alongside a general surgeon in the Caribbean who's developing her skills with minimally-invasive laparoscopic surgical techniques," says David Lanning. "She represents the future of surgical care in her country."