Best practices: Eight things your medical volunteer mission might not do (but it probably should)

Medical missions, Quality assurance on medical missions

August 21, 2016 | Christopher Dainton

crowd-at-medical-volunteer-mission-clinic
How should a medical volunteer mission make sure that it provides high quality care?

What clinical best practices should volunteers look for in a medical volunteer mission before they agree to donate their time and money toward a project in a developing country?

Below, we continue our summary of stolen gems from Greg Seager’s “When Healthcare Hurts”. Most are adapted from World Health Organization (WHO) standards of practice.

We have edited Seager’s suggestions for length.

Safe medication use key best practices medical volunteer mission
1. Adopting a “less is more” approach to medication

The medicine your team distributes might be sold, traded, or misused because of cultural misunderstandings and illiteracy. First of all, keep things simple. A good formulary consists of 12 to 24 medications, dispensed in child resistant containers (never Ziploc bags). Except with “one-time” medications (antiparasitics and vitamin A), a pharmacist should also oversee dispensing in a private consultation room. Finally, leave surplus medication with medical professionals.

Dominican kids posing
2. Using clinical treatment pathways to discourage variations in care

For example, Integrated Management of Childhood Illness (IMCI) can guide triage and case management for children under 5, and helps practitioners (and parents) to identify danger signs. Other pearls:

  • When it comes to prevention, focus on immunization status, parasite treatment, vitamin A, and iron supplementation. In addition, note that the use of inexpensive hemoglobin colour strips can help diagnose anemia.
  • Measure mean upper arm circumference (MUAC) to assess nutritional status. Under 13.5cm is malnourished. Weight for height is also useful.
  • Provide zinc supplements to children with diarrhea.
  • Finally, remember to check glucose in pregnant patients. Refer onwards if at risk for HIV, diabetes, or preeclampsia.
    • Getting patients to healthcare key best practices challenge on medical volunteer mission
    3. Getting patients to healthcare efficiently

    Keep in mind the three delays in getting patients to a healthcare provider:

  • The decision to seek care (based on both knowledge and ability to pay). In the clinic, community members can often distinguish who can and cannot pay for care.
  • Their ability to travel to the facility
  • The wait time at the facility. This might also be based on ability to pay, and to obtain necessary medical equipment.
    • Volunteer at a medical missions clinic in Latin America
    A volunteer clinician reviews the medical record at a medical mission clinic in Latin America
    4. Putting patient safety on paper

    Most importantly, every medical volunteer mission should have written safety protocols, a patient safety officer, and even malpractice insurance.

    Best practices in patient safety medical volunteer mission
    5. Empowering the host community

    Never subvert the authority of local providers, who are the best equipped to care for their own communities. Collaborate with them and with regional healthcare services and workers.

    6. Facilitating community projects

    Ensure the host community leads the effort. Some ideas might include:

  • Conducting community health assessments (growth monitoring, collecting immunization data) or immunization programs.
  • Birth attendant training, prenatal/infant care classes led by a community member.
    • PlumpyNut on medical volunteer mission
  • Distributing energy dense therapeutic foods like PlumpyNut, or helping the community to cultivate the nutrient-rich moringa leaf.
    • 7. Training providers and communities

    Training in best practices such as the GHEC Global Health competencies, Integrated Management of Childhood Illness (IMCI), and palliative care (HIV, spiritual training) can be high yield learning goals for providers.

    Moreover, training for community health workers and translators has a higher impact than teaching the general population. Focus on healthcare seeking behaviour, nutrition, diarrhea management, and malaria prevention.

    Using QuickChart EMR for medical records best practices
    8. Keeping medical records and measuring outcomes

    The WHO Millennium Goals prioritize impacts on child mortality, maternal health, and communicable disease. Measuring outcomes is difficult, but the chosen metric should be direct, objective, and practical.

    Furthermore, when the trip is over, send copies of patient medical records to local health services. One way to create such medical records is QuickChart EMR, our homegrown electronic medical records app designed for the remote settings in which medical volunteers often work.

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