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Surgical Missions to Developing Countries Are Appreciated, but There Are Some Sources of Friction

(Reuters Health) – While medical staff in developing countries may appreciate the extra help from surgeons and trainees participating in missions, they may be put off by the visitors’ implicit biases, a new study suggests.

A survey of 76 clinical and administrative staff from a rural Kenyan hospital revealed that most felt visiting medical professionals provided benefits to the facility, primarily in terms of education and research. But a significant proportion perceived negative effects, including visitors providing education that did not match local practices and imposing medical care concepts onto local practices, according to the report published in JAMA Surgery.

“The interest in global health has increased significantly among medical students and even clinical staff, which is why we have more and more global rotations, especially among surgical residents,” said study coauthor Priti Parikh, an associate professor and research director in the department of surgery at Wright State University. “The people who are going want to do some good for the community. They feel they are doing good. We wanted to know if the feeling was mutual.”

“Our study showed that it is mutual to some degree,” Parikh said. “But there is room for improvement. We as visitors must challenge ourselves in evaluating our own implicit biases.”

Parikh and her colleagues found that 60 of 61 respondents agreed that visitors provided benefits to the host facility, primarily in the areas of education and research (50 of 61, or 82%) and clinical care (46 of 61, or 75.4%). However, some of the respondents (24 of 57, or 42.1%) also perceived negative effects, including visitors providing education that did not match local practices (10 of 24, or 41.7%), the imposition of medical care concepts (nine of 24, or 37.5%), disturbance of workflow (9 of 24, or 37.5%) and higher patient complication incidence (eight of 24, or 33.3%).

The respondents also sensed some implicit biases in some of the visitors. For example, one said, “I suggest visitors to appreciate Africans and to understand that we are well trained and anything done should not be based on color.” And another commented: “They believe that America is superior to Africa, thus hindering their ability to learn from a Black or African colleague.”

The Kenyan healthcare workers also suggested that visitors be better prepared: “It takes weeks for visitors to understand what the expectations of care are in the hospital;” and “Let visitors understand about Africa by getting more information about Africa as much as possible.”

Parikh suggests that if visitors got training and learned more about the culture, practices and financial situation of the country they will be going to, things might go more smoothly.

“This is a very important topic for us to look at and address,” said Dr. Linda Zhang, director of global surgery in the department of surgery at Mount Sinai Hospital and an associate professor of surgery at the Icahn School of Medicine at Mount Sinai in New York City. “A lot of papers in the past haven’t not looked at this from the perspective of the local population.”

The findings of the study, “aren’t surprising,” Dr. Zhang said. “It shows we do really have to be sensitive about what we are doing and ensure that we are sending residents who are more prepared to be in the kind of environment where culturally and medically things just operate differently from the way they do here.”

“It’s really important for us to give our residents and medical students the cultural sensitivity talk before they go abroad,” Dr. Zhang said. “They might not even be saying anything, but their facial expressions may give the impression that they think they are somehow superior.”

While there are things to be fixed, overall, “The local staff still feels that having these visitors is beneficial,” Dr. Zhang said.

SOURCE: JAMA Surgery, online July 14, 2021.

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