OMED: Local alliances vital for successful medical missions
If you’re interested in establishing a medical clinic in a developing country, having a well-trained staff, adequate medical supplies and boundless goodwill—while necessary—won’t suffice.
That was the message Dixie Tooke-Rawlins, DO, delivered Oct. 25 during the AOA’s 115th Annual Osteopathic Medical Conference and Exposition in San Francisco. Dr. Tooke-Rawlins, the dean and executive vice president of the Edward Via Virginia College of Osteopathic Medicine (VCOM) in Blacksburg, has taken a lead in establishing and coordinating the school’s medical missions in the Honduras, El Salvador and the Dominican Republic.
She told members of the American Osteopathic College of Occupational and Preventive Medicine that successful year-round clinics abroad are built on strong relationships with the host countries’ national and local governments, medical associations, medical schools, and hospitals.
In fact, failing to register with the national government can cause problems on a number of fronts, she noted. “Nothing can get you in more trouble than if someone very sick were to visit your clinic and later die—and you’re not approved to be in the country,” said Dr. Tooke-Rawlins. “So the country’s ministry of health should always be among the first offices you contact for approval.”
Making contact with a country’s government also is important to ensure mission volunteers are familiar with the native population’s medical history. Dr. Tooke-Rawlins described clinic programs that have visited Honduras unannounced and, unbeknownst to the volunteers, provided unnecessary immunizations. “Health officials have often found people who had been immunized three or four times for the same diseases, and yet other populations in the country had received no immunizations,” she said.
Registering with a country, however, obliges mission clinics to meet sometimes challenging requirements. All of the countries that host VCOM clinics, for example, mandate that physicians work for a year in a government clinic or hospital before being licensed to treat patients. Because this wasn’t an option for VCOM students, Dr. Tooke-Rawlins turned to the countries’ medical schools for a solution.
“Our projects are very much a team effort with local medical schools.”
She asked for lists of the schools’ top graduates during the previous five years. The aim was twofold. The young, licensed local physicians would staff the clinics year-round. Also, unlicensed VCOM students and faculty would be approved to practice in the countries as long as they did so under the supervision of the native physicians.
The approach proved a success in each of the three countries with VCOM clinics. “Our projects are very much a team effort with local medical schools,” said Dr. Tooke-Rawlins. “It has helped us to attract very qualified physicians, and we pay their salaries.”
Because other physicians in the host country might view a new clinic as an economic threat, Dr. Tooke-Rawlins makes a point of meeting with local physician associations to discuss osteopathic medicine and assure them the VCOM sites will focus on nonpaying patients.
“The first time I went to El Salvador,” she said, “I presented education on osteopathic medicine to the physicians association. For many people in these countries, our emphasis on preventive medicine and the whole person is encompassed in their philosophy as well. And they’re intrigued by the fact that we use our hands.”
But during the presentation, one physician in the audience said he didn’t understand osteopathic manipulative treatment. Dr. Tooke-Rawlins offered to demonstrate the technique on anyone who had a musculoskeletal problem. “Someone came up complaining of a painful third rib,” she said. “After I treated him, he said, ‘I feel great. No pain.’ And then someone else asked for a treatment. When I finished with that physician, we were ready to break for lunch. But when I turned around, I saw about 40 physicians had lined up for treatments. So I worked through lunch.”
Connecting with community beacons
Building ties with local leaders can be a bridge to connect with a populace who may initially be wary of foreign health care workers. Dr. Tooke-Rawlins typically will invite a mayor, religious leader and others who are well-regarded in a community to join her on a medical advisory counsel to address local health issues. When she and her staff are seen in the company of respected officials, it helps build people’s trust and makes it easier for them to visit the clinic, she said.
Other important sources to help connect with a local population are nongovernmental organizations, such as Rotary International and Feed the Children, Dr. Tooke-Rawlins added. “Find an organization that’s been there for a while. Partnering with it can be very helpful to rid people of any myths of how they will be treated at your clinic.” And once a clinic does have patients, staff members need open lines of communication with local hospitals to ensure continuity of care for referred patients, said Dr. Tooke-Rawlins.
Beyond patient care
Dr. Tooke-Rawlins added that the VCOM clinic program helps students hone important skills: how to work with and help people of a different culture, and how to build the relationships to effectively provide needed treatments. “Our projects are as much about creating community among various groups as they are about patient care.”