While educating local providers, teams of health care professionals provide rehabilitation to amputees; promote the establishment of burn clinics and reconstructive surgery; train midwives, with a focus on abnormal labor, postpartum hemorrhage, eclampsia, and neonatal resuscitation; and provide surgery for obstetrical fistula, cleft palate, and other conditions.7 Volunteers spend from 1 to 6 weeks providing care and education. The AAPA guidelines for PAs working internationally (HP-3700.3.1) are as follows: (1) PAs should establish and maintain the appropriate physician-PA team; (2) PAs should accurately represent their skills, training, professional credentials, identity, or service both directly and indirectly; (3) PAs should provide only those services for which they are qualified via their education and/or experiences, and in accordance with all pertinent legal and regulatory processes; (4) PAs should respect the culture, values, beliefs, and expectations of the patients, local health care providers, and the local health care systems; (5) PAs should take responsibility for being familiar with, and adhering to the customs, laws, and regulations of the country where they will be providing services; (6) when applicable, PAs should identify and train local personnel who can assume the role of providing care and continuing the education process.24 At the core of professional identity is the desire to assist those in need.
Special Article FROM PPC, THE PROFESSIONAL PRACTICE COUNCIL OF THE AAPA Health care volunteerism: What PAs need to know before making a trip “I spend one week every year in South America working with about volunteering for a short-term global medical mission a university-based group that provides pediatric surgical care. (Resources for information on global volunteerism). When I volunteered, I just assumed everything was arranged. Boy was I surprised! On our first trip, even though we had BEST PRACTICES worked with the government to arrange the trip, the govern- Agencies that work directly with existing systems or orga- ment clearly was not in charge of what was happening on the nizations in developing countries—even those limited by ground. The local military junta controlled everything; we had Western standards—have the best chance of making a posi- to go through them to do anything. Getting equipment into and tive, sustainable impact on community health.2,3 Working out of the country intact was a challenge. We lost a lot of equip- with community leaders allows short-term medical teams to ment that first year. Also immediately clear was that the nurs- learn local customs and culture, understand the local “heal- ing staff did not have the education to provide safe, effective er” and “healing arts,” and avoid making erroneous assump- postoperative care. tions about local needs.4,5 This cultural sensitivity increases “Now, we partner one of our nurses with two local nurses the effectiveness of care and may facilitate long-term relation- on every case so the local nurses will have the skills needed to ships that help build local health care infrastructure. take care of the children after we go home. We also collaborate Shoulder to Shoulder, a private, nonproﬁt, nongov- with the local providers concerning the care and maintenance of ernmental organization (NGO) incorporated in 1996, is equipment. They are much better at getting what patients need Continued on page 36 locally than we are. I love going. If we did not go, these kids would not get the surgery they need, but I wish I had known a lot more before making that first trip.” —A volunteer, in a conversation on January 27, 2009 P eople reach out to impoverished or devastated global communities as a profound expression of basic humanity. Participation in short-term medical missions—whether religious, secular, professional, or academic—is at an all-time high. Annually, approximately 6,000 short-term missions from Photo courtesy of Shoulder to Shoulder the United States provide care in resource-poor countries at an estimated cost of $250 million.1 Physician assistants can and do play an important role in these medical missions as partners with physicians, nurses, pharmacists, dentists, and other health care professionals. The desire and commit- ment to help is made clear by the time, effort, expertise, and money that are committed to these efforts. The goal of this article is to provide the PA with back- ground information, questions to consider before volunteer- ing, a familiarity with the ethics of providing care abroad, A Honduran family physician treats a young boy with burns in and suggested readings to assist with decision-making Shoulder to Shoulder’s medical center in Santa Lucia. 28 JAAPA • MAY 2010 • 23(5) • www.jaapa.com Special Article an example of a program founded in the United States Africa, Asia, Central America, and the Caribbean (www. (Cincinnati, Ohio) with strong partners abroad (www. physiciansforpeace.org). The primary focus of the organiza- shouldertoshoulder.org).6 Six years before its ofﬁcial incor- tion is to provide “long-term, sustainable, replicable medical poration, Shoulder to Shoulder worked with local com- education and training.” While educating local providers, munity leaders in Honduras to form Hombro a Hombro, teams of health care professionals provide rehabilitation to a grassroots, community-based nonproﬁt NGO registered amputees; promote the establishment of burn clinics and in Honduras. The organization states on its Web site, reconstructive surgery; train midwives, with a focus on “Shoulder to Shoulder and Hombro a Hombro work in abnormal labor, postpartum hemorrhage, eclampsia, and tandem to achieve a single mission: to develop educational
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