Contemplation in Action: Lessons from Medical Mission Work

Stepping outside a clinic’s walls can broaden the horizons of providers who are interested in extending compassion across the globe. Medical missions yield a unique opportunity for clinicians to gain experience with diverse patient populations, according to Nicole Martinez, MSN, APRN, FNP-BC, PHN, a Georgetown University School of Nursing & Health Studies faculty member, who has worked in a California refugee clinic.

“You can do that anywhere,” she said, “but the patients who need it most are likely underserved.”

The challenges of providing care in underserved communities are complicated by fluctuating variables such as the availability of a sterile field, institutionally recognized scope of practice, and amenable sleeping and eating conditions.

How can clinicians who pursue medical mission work feel empowered to provide care in arduous circumstances?

How to Prepare for a Medical Mission

Before planning for the trip, advanced health care providers must identify an organization through which they can complete medical mission work. Shauna King, president and founder of International Medical Relief, encourages clinicians to explore the wide array of opportunities to provide care around the world.

When choosing an organization, providers interested in mission work may think about:

Professional Considerations

  • Time commitment: Programs range in length from weekends to months. Clinicians should take into account how much time they can dedicate to a trip by weighing their professional and personal obligations at home along with their level of comfort while working abroad.
  • Organization history: Some organizations have been around longer than others, meaning their infrastructures have been tested and have garnered a wider variety of reviews from past participants. Clinicians can research the history of an institution as part of their exploratory process.
  • Scope of practice: A clinician’s scope of practice may not be recognized uniformly by different medical institutions and regulations in other countries. “A question that someone will want to ask is how their education will be valued, and will they be able to practice in their scope of care?” said Evelyn Farkas, who leads medical team members during International Medical Relief’s trips. The answer can inform clinicians about what to expect from their experience.

Personal Considerations

  • Safety and security: Medical missions are often located in communities with different safety resources than what some providers are used to; the communities may also be centered in areas recovering from a natural disaster or infectious disease. In addition, some organizations require malpractice insurance as a safety measure for participants. “It’s not just to keep the team safe; it’s also to keep the patients safe,” King said.
  • Destination: Medical mission trips take clinicians across the globe, and conditions — distance traveled, climate, seasonal weather — can vary widely. Some programs involve camping outdoors; staying with local host families; or living in hotels, schools, or places of worship.
  • Personal reflection: How can providers know they are well-suited for mission work? Supporting others during critical times is a central component of medical care no matter the location. “Most advanced care nurses, for example, are equipped for this type of work,” Farkas said. “It’s often a natural fit.”
  • Cultural sensitivity: Martinez said cultural sensitivity training is a common part of most clinical education programs, but some organizations might offer training specific to the community of deployment before and during the trip. Participants can consider building language skills that may be useful while providing care to indigenous groups. “Being familiar with cultural expectations was helpful, not just as a provider, but as a person, to develop rapport and to help patients trust me,” she said.

Prospective participants will be best prepared by taking a structured approach to professional and personal obligations before committing to a medical service mission.

Preparing for a Medical Mission:
A Timeline

6 Months
Before

Research existing organizations

Consider destinations

Consult employer about taking time off

Connect with past participants

3 Months
Before

Schedule recommended vaccinations

Complete pre-attendance trainings

Update travel documents

1 Month
Before

Access a recommended packing list

Establish plan for time off with employer

Follow local news about the area

1 Week
Before

Set up international phone plan

Share itinerary with family members

Sign up for safety updates at Step.state.gov/

During

Reflect at the end of each day

Participate in cultural education

Learn phrases in local language

Be a support to other clinician participants

After

Take time off before returning to work

Consider advocating for the organization

Keep in touch with other peers and trip leaders

Incorporate lessons into practice

What to Expect on a Medical Mission

Medical mission teams work together to holistically treat patients and solve community problems that may contribute to health concerns.

“Are they experiencing gastrointestinal issues because they don’t have clean water?” King said. “We are always working to get to the root cause of why a community is experiencing the conditions that they have.”

Facilities

Clinicians may be accustomed to a sterile workplace, but providing care in the field doesn’t guarantee stable conditions. A clinical mission setting may be an open room with chairs and curtains, so creating a sense of privacy and comfort for patients might be a part of a clinician’s role.

Mission work is an opportunity for bedside clinicians to lead patient care with accommodation and affirmation.

“Sometimes a team gets together to create private space by holding up sheets or curtains or by creating a human wall to shield the patient from others in the clinic,” explained King. With some ingenuity, “mobile medical units can still provide amazing care.”

Patient Care

According to Martinez, medical missions provide clinicians with a learning opportunity by caring for adolescent or adult patients who have lived their entire lives with conditions that have never been treated.

“The adaptations that people are able to accommodate in other areas of the world is unreal,” she said, noting how her experience working in a refugee clinic changed her perspective on how other cultures adjust to pain and disease.

Environmental conditions and epidemiological challenges also require medical providers to think creatively about patient care in mitigating conditions. For example, some patients will have a lower antibiotic resistance if it is their first exposure to Western therapies. If refrigeration is not readily available in regions that exceed 86 degrees Fahrenheit, a prescriber may forgo administering some temperature-controlled antibiotics in favor of an alternative. Understanding these nuanced differences in patient care can transform patient-provider interactions.

“We would try to keep families together,” Martinez said. “Sometimes in Western clinics, we try to keep from having too many people in one room, but we understood the cultural impact and expectations of patients. So we made sure to keep a mom with all of her children, to keep everyone comfortable.”

Patient education is a pivotal part of making sure care has longevity. Distributing resources and information, as well as spending one-on-one time with patients to ensure they understand a medical treatment plan, can optimize the outcome of treatment over time.

“Our goal is to work ourselves out of an area,” Farkas said. “We want to have created so much healthy and sustainable change that we can move on to the next place that needs help.”

Culture

It’s common for mission teams to collaborate with a multidisciplinary team, including a translator who can help patients and providers communicate.

Cultural sensitivity includes communicating with the community in a meaningful and affirming way. Learning and using common phrases in a local language or dialect can optimize health literacy when speaking with patients, ease comfort with a patient-provider relationship, and give providers a deeper understanding of a patient’s needs.

Beyond language skills, participants can become aware of nuanced expectations about eye contact, body language, physical touch, gender, and age-related customs.

Even in the presence of a translator, “learning cultural customs and basic language can transform your relationship with a patient,” Martinez said. “It shows respect, builds trust, and helps them be more comfortable to show that you are trying to see them where they are.”

Support Systems

During a medical mission trip, providers may find camaraderie with other participants who can help navigate the emotional impact of their experiences.

“We debrief with the team at the end of each day,” said Farkas. “It allows providers time to share their experiences, talk about things that surprised them, help each other solve problems, and relate to people who are experiencing the same things.”

Martinez said this form of professional support is something clinicians can bring back with them.

“We don’t debrief enough in our clinical practice at home,” she said. “We come home at the end of the day to another person who worked at a job that’s also exhausting, and they might not be able to relate to how we feel or have the ability to hear our experiences the way other providers might.”

After Returning from a Medical Mission

After returning to their regular practice, participants may still feel the effects of their immersive experience. Staying involved with the organization can sustain inspiration and motivation after returning to one’s daily routine.

  • Make time to reflect: Returning to work immediately can strain recovery from travel, contribute to culture shock, and set providers up for exhaustion that may affect their ability to provide quality care. Participants can use this time to consider the lessons learned on their trip and contemplate how to incorporate them into their practice.
  • Consider becoming an advocate: After the trip, participants may be encouraged to help fundraise for the organization or be an ambassador for the program.
  • Nurture relationships with other participants: Some organizations may offer social media groups to continue communicating with their peers, or they may encourage participants to do it on their own.

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Citation for this content: Nursing@Georgetown, the online FNP program from the School of Nursing & Health Studies