Is Surgical Outreach to Foreign Countries Misguided?

“We have been offering the Asian nations the wrong kind of help. We have so lost sight of our own past that we are trying to sell guns and money alone, instead of remembering that it was the quest for dignity of freedom that was responsible for our own way of life.” The Ugly American

When you think of short-term mission trips, what comes to mind? Voluntarily helping others in third-world countries who are in great need especially with health related issues for a couple of weeks. You can help a village out and be on vacation all at once; kill two birds with one stone, right? Have you ever wondered if maybe we are not actually helping these other countries that we donate our ‘time and money’ to? Cultural differences, language, economical, and sociological barriers can play a large role when going to other countries, but Americans do not always take that into consideration. When it comes to healthcare, limited access, rural settings, economics, and lack of infrastructure often makes long term success hard.

When I attended the ASC, I was struck the advancement of surgery in many institutions. As a rural surgeon myself, very few of these advances can be instituted in West Texas let alone a third world country. Most surgeons in these countries do not have the skills or the equipment to do basic surgical procedures like laparoscopy. The patients live too far away to make these procedures impactful to the society as a whole and often, act to separate the entitled from those that do not have the means to access this level of care.

Basic surgeries, such as setting broken bones or delivering babies via Caesarean section are among the most cost-effective health interventions in developing countries based on data from the World Bank. By focusing on the importance of disease control and injury prevention alone, we would advance healthcare in most countries immensely. The key to improvement is education. Train surgeons with the skills they require to serve their patients and allow them to train future generations of local surgeons. This is the model suggested by the World Health Organization. But how do we find the right candidates? Who is a good educator and a good surgeon?

Not all areas in the United States can provide healthcare at the level of the top institutions. This is not because the surgeon does not want to provide good care but the limitations of the patients, community, and the hospital inhibit their success. You cannot discuss the surgeon and their outcomes without knowing the institution they work within. The true goal of surgical outreach must be to provide the knowledge to develop systems of care that are sustainable and effective. These systems must also be cost effective, use minimal equipment, and be reproducible in broad areas of the country they are developed for. This will not occur without understanding our personal desire to reach out and the other country’s needs and desires.

[co-authored by Meesha Mammen: Meesha is starting her higher education, looking to pursue a career in healthcare. She is also a first generation Indian American, and has traveled extensively in her young life.]