A recent article on NPR’s Goats and Soda blog highlighted a paradigm shift within the global health sector that is causing many international medical volunteer organizations to rethink and restructure their programs. This shift is a result of the growing recognition that “the best treatment for a [patient] should come from an indigenous surgeon trained, equipped and funded to provide such care — and available for follow-up.”
The Medical Mission Model vs a Systems Approach
The traditional approach to volunteering in the global health sector is best described as the “medical mission model.” Providers fly-in, deliver care to individual patients, and leave. This approach is well-intentioned and certainly many individual patients benefit enormously from these visits. Under certain conditions, such as during an active conflict or following a natural disaster, it is really the only viable option available. However, as the NPR piece highlighted, in most circumstances, a health systems approach centered on building the capacity of the local health workforce far outstrips the medical mission model in terms of impact and effectiveness.
HVO has remained firmly rooted in the health systems approach since its inception in 1986. In 2018, we provided education, mentorship and professional opportunities to over 3,000 health care providers in 25 different countries. The difference between treating 3,000 patients and training 3,000 health workers is the ripple effect that occurs as those health professionals continue year after year to provide high-quality, compassionate care to their communities.
A Legacy of Care
HVO volunteers do not always see the direct impact of their work on the lives of patients. What they do see – especially those who are fortunate enough to return to the same project site more than once – is the impact on the lives, and on the careers, of local health workers in the host country. In turn, these health workers go on to impact the lives of their colleagues and their patients, creating a legacy of care.
Dr. Isaac Kajja, Chair of the Department of Orthopaedics at Mulago Hospital of Makerere University and on-site coordinator for HVO’s orthopaedics training project in Uganda, has seen this legacy first-hand.
HVO re-established an orthopaedic residency at Mulago in the late 1980’s at a time when Uganda was emerging from decades of conflict and economic mismanagement. Dr. Kajja encountered HVO volunteers while completing his postgraduate degree at Makerere University in 1998. He once wrote of his work with HVO:
The HVO teams with which I interacted have shaped my in a number of way and I was fascinated by their kindness…Their critical thinking and inquisitive approach during their facilitated seminars and workshops prompted/inspired me to pursue PhD studies from which I graduated in 2010.”
After completing his PhD in the Netherlands, Dr. Kajja returned to the Mulago to train the next generation of orthopaedic providers.
Today, the orthopaedic residency program continues to draw HVO volunteers to provide specialized training. The department has trained over 80 orthopaedics surgeons who are now dispersed throughout central and western Africa, providing orthopaedic care and training in nearly a dozen countries.
Health System Strengthening 2.0
HVO’s orthopaedics training project in partnership with the Mulago Teaching Hospital is an early example of the health systems-level impact of our education-based model. As HVO enters its fourth decade of service, we are witnessing a similar impact at a number of our project sites, including the anesthesia training project in partnership with Angkor Hospital for Children (AHC) in Siem Reap, Cambodia.
In April, HVO recognized the AHC anesthesia team with our Golden Apple Award in honor of their significant contribution to the quality and availability of anesthesia care in Cambodia and neighboring Laos. Through their dedication and commitment to education, AHC has become a national resource for education and training of nurse anesthetists. The team also volunteers their time to train nurse anesthesia students at their sister institution, Lao Friends Hospital for Children (LFHC), in Luang Prabang, Laos. Together, AHC and LFHC medical staff provide anesthesia to around 2,500 surgical patients annually – far more than any one, short-term volunteer could ever hope to treat.
Transforming Lives Through Education
The appeal of the medical mission model is what attracts many health care providers to their professions in the first place – the opportunity to transform lives.
Correcting a child’s cleft palate, fitting a mobility impaired individual for their first wheelchair, bringing a child safely into the world – these actions forever alter the life of an individual. HVO volunteers recognize that educating local health professionals yields similar, life-altering results, but on a far greater scale.
When an HVO volunteer provides training, professional opportunities and mentorship to a health professional at one of our project sites, that person’s approach to care, their career trajectory, and even their life may change. Moreover, that health professional will transform countless lives – the lives of patients, colleagues, and students – over the course of their career as a result of the training they received. This is how, through a health systems approach, each HVO volunteer and each health worker they train, moves us closer to our vision of a world where everyone, everywhere has access to high quality health care delivered by local health professionals.