Universities through America offer students eye opening experiences practicing medical services in third world countries. Trips often last five days to a few months. Students return with a warm glow of philanthropy. Ample volunteer opportunities are available to medical professionals in underdeveloped nations spending as much time as wished. What few act upon, let alone question after returning, is how the patients of those regions receive follow up care. Further considerations of these patients include the sustainability of medications along with medical service to the area, effective allocation of the resources, proper cultural awareness, and the motivation of the volunteers. These arise as consequence of short term medical mission trips, or STMMs. Although medical services are greatly needed in many third world countries, short term medical mission trips pose numerous unintentional side effects to the local community due to the sporadic nature and short duration. Without proper planning and insufficient time spent in a community, the effects of these trips outweigh good intentions of volunteers.

Cleft palate surgeries are a commonly taken medical mission trip, typically with groups for short durations of time. Surgeons from the United States and Canada travel to small communities through South America and Africa to work on children in need of the procedure (Martinuik, 134). Extensive after care is required ensuring proper healing. Post surgery patients see the surgeon plus an additional plastic surgeon in multiple follow up consultations to complete the physical recovery. A dental surgeon repairs damage obstructing the jaw while a speech therapist facilitates speech recovery. If a surgeon travels to a nation for a few weeks while performing surgeries through out a number of patients seen will not see that same doctor again. A majority of patient care is left unfinished (Martinuik, 134). The short duration of these services does not allow adequate follow up consultations so the full needs of patients fail to be met. 

Let's evaluate a case from 2015. An American dermatologist volunteers to an undeserved community outside of the country. Though the mission trip was coordinated by a reputable organization in the global health community, the doctor faces predicaments while serving the community. First issue is a fair distribution of the small amount of topical steroids for treatment of skin infections. A box of sample sized topical steroids given by a pharmaceutical company was packed, totally 15 grams worth of medicine (Stoff, 822).  There are various options how the doctor could proceed. The doctor could distribute on a first come first serve basis. This in turn favors those better off in the area, having the means of travel in order to pick up medication. Or a need based system could be constructed delivering medication to patients who show severe cases of disease. This option limits the number of patients receiving treatment further. A larger portion of medication is allocated to treat a smaller number of patients.

Sustaining the treatment to those receiving it then becomes an issue. The dermatologist stayed for 3 weeks and after she left prescriptions could not be filled. Those with chronic ailments run out of medication allowing the infection to fully resurface, possibly stronger than initially.  Essentially the distribution of medication goes to waste leaving the patient worse than previous and others only needing one dose still left untreated. It is also likely that these patients do not have the money to refill the prescription. The doctor could donate the medication to these families. But, "According to the World Health Organization (WHO), ' ... [M]edicine donations are neither a long-term solution to underfunded health systems nor a solution to the lack of access to medicines in poor countries -- especially for diseases that require lifelong treatment or large numbers of treatments,'" (Stoff, 823). The reason is donation of medications sets unrealistic expectations on local health care providers. Patients return to their local provider expecting a medication refilling but the local system does not have the means to do so. The purpose of the dermatologist's visit was because little resources and funds were available to provide prescriptions. The locals are dissatisfied with the health care that was in place before the doctor and team arrived. Unintentionally the doctor undermines the community's health care system. The good intentions of the doctor and donated medication create lasting problems for the community after the volunteer tour is completed.

This extent of poverty comes as a surprise to first time volunteers. An American volunteer visiting Guatemala is quoted, "universal precautions were an unfamiliar concept ... At the end of each day, the hospital staff would go through our trash and sharps containers, pulling out items that they could sterilize and use again" (Martinuik, 134).  The volunteer staff appalled by these actions did not realize the local doctors' lack of resources rather than inadequate knowledge. Unexperienced students and medical professionals encounter a form of cultural shock. Volunteers are expected to perform to their full ability while respecting cultural norms. Family roles are vastly different in Middle Eastern countries to western family structures. It is societal normalcy for women to be subordinate to men. Therefore formal consent from a woman may not qualify the family's consent (Holt, 215). A western doctor must be prepared to work around this arrangement. An element of global health is respect to local values. Global health is defined as bringing research and service of equitable health care on an international level by partnering with local health care systems (Stoff, 822). STMMs do not adequately prepare nor build upon these skills because little time is spent outside a home country. Adequate time must be put in by the doctor to learn the dynamics and how to ensure proper care under local values. Time is needed to further build a relationship with the patient. The volunteers are simply in place to provide medical care.

A broad accessibility to such trips opens the door to inexperienced to practice medical care overseas. Undergraduate college students jump at these opportunities to gain medical experience, before acquiring medical experience. These students would be unable to practice on patients in the United States, yet encouraged to perform basic medical tasks in communities of third world nations. In the United States any person practicing medicine must follow state, federal, and professional standards (Holt, 215). A detailed data evaluation is conducted and monitored for health care in this nation. In the case of STMMs, no standardized method has been devised measuring their quality (Cauldron, 1).

A phenomenon developed known as "surgical tourism" has clouded the motivation behind medical relief efforts. This is a fear of certain agencies that surgeons volunteers on a short duration tour to vacation outside the country while providing medical service to a poverty stricken area (Martinuik, 134). "Surgical tourism" has become a phrase because of the amount of surgeons looking to boost their own moral and have the accolades to boast their philanthropy efforts. Specifically a group of surgeons have trended in "surgical tourism" performing surgery on a condition known as vesicle vaginal fistula. This conditions is the result of women who experience prolonged obstructed labor. The pressure of the infant's skull against the pelvic wall creates a rock hard layer of scar tissue. The condition leads to extreme physical discomfort to women mainly in African and Asian countries (Wall). To perform the procedure in the United States, surgeons must invest many hours observing, interning, and eventually practicing. Equivalent time is supposed to be put in before surgeons undertake this type of procedure elsewhere but documentation shows many professionals have worked around this system (Wall). A lack of proper training sets the surgeon up for unexpected complications during surgery. Proper execution go the procedure should be planned on a long term basis.

A lack of follow up data and bad relations with the community's doctors poses issues. Without a systematic record of money put into such trips and the value of resources used, it is difficult to gauge a set time and amount which would be most beneficial and practical to the local community and volunteers providing the work. Little articles were found tabulating visiting physician expenditure costs (Cauldron, 4). The resources arguably be used in a more practical way. A participating doctor in a STMM is quoted, 'Abdullah asks "what business did our team of 10 members have spent approximately $30,000 toward travel and hotel costs ...  when the entire cost of building a new 30-bed wing for the hospital in Ghana was $60,000?"' (Martiniuk, 134). The money easily spent flying, nourishing and housing a group for a week could be just as easily spent building infrastructure in the community. This use of resources and time provides directly to the underserved community. Rather, than further providing for first world civilians. In this sense, the money would be preventing disease and illness rather than simply treating it. Weighing out cost effectiveness is a crucial issue that must be further investigated of short term medical mission trips.

Assuming medical service trips are appalling would be disillusioned but overlooking what impact short durations of service have on a underdeveloped area is equally disillusioned. Responses of locals living in an area provided with service should be taken to consideration to accurately evaluate the impact on local communities. A series of cleft lip and palate surgeries were undertaken by Operations Smile Mission in Columbia. These trips are constantly under gone, for short individual durations. In a report of one of the trips, the locals found the services helpful to the community as a whole. They explained that the traveling physicians put a real human face to their problems. Additionally, the volunteers gave hope to the locals that further aid will be provided in the future. Operations Smile Missions aimed to provide lessons on cleft lip and palate surgeries along with patient care. Providing the local doctors with information allows for further aid for the local community without the constant presence of international volunteer (Martinuik, 134). The community will be self sufficient and continue to grow the preexisting health system. 

Service trips could not only provide direct relief but also build upon local infrastructure to allow further improved medical care. STMMs aim to advance medical care, education, and infrastructure to underserved areas of the world. It is only recently realized this area requires extensive improvement of methods. Standardized a recording of physician time and resources would enhance the potential for short term medical mission trips to be beneficial in underserved areas. Currently a lack of follow up care and set evaluation leaves the current system as covering a wound with a band aid and letting the bandage wear away reopening the wound to infection. Like most other world issues, knowledge and awareness are factors contributing to improvement. The purpose of global health is to aid others in need of health care. No matter the nation which one resides, equitable and proper health care should be accessible. 

