On your typical flight from Amsterdam to Entebbe, by way of Kigali, you will generally notice two distinct types of passengers: citizens and humanitarian aid volunteers, many of whom are participating in medical missions. The capital city of Uganda, Kampala, is home to Mulago National Referral Hospital and Makerere University, the oldest university and medical school in the country, making it a destination of choice for global health activity. From fistula repair and heart surgery to neurosurgery and cornea transplants, the range and number of these surgical missions are astounding. Over the past ten years there has been a slight shift towards academic partnership models, resulting in different levels of collaboration and more sustained interaction between programmatic partners. As global health and surgery groups become more invested in being part of a longterm solution for improving access to medical and surgical care in limited-resource settings like Uganda, it is more and more important to understand and reflect upon how these groups have also been part of the problem. While responsible patient care is paramount to any humanitarian health intervention, it is only the beginning of a much needed dialogue.
There have been relatively few publications to explore and articulate host institution perception of global health activity. This is understandable noting the political nature of these conversations and concerns over support being pulled and resources allocated elsewhere. However, on an individual, if anecdotal level, it is hard to avoid hearing such critiques once you start to listen and ask questions. On one trip to a major medical institution, I spoke with a faculty member who related bluntly the stresses of juggling multiple academic partners and NGOs – while limiting each’s knowledge of the other. Even when groups do know of each other, it is no guarantee that these groups will adapt their implementation strategies to respect and compensate for the stresses put on the institution and coordinate with longterm strategies.
The growing emphasis on strengthening health systems highlights how important it is to see the forest for the trees and the need for for global health actors to be receptive and responsive to criticism.
Surgical Missions to developing countries: Ethical conflicts. Otolaryngology Head and Neck Surgery, October 2010.