Improving Medical Humanitarianism: Pitfalls and Best Practices for International Aid
IN THIS ARTICLE
The necessity of international relief is unending as new crises continue to emerge across the world. International aid plays a crucial role in shaping how affected communities rebuild after a crisis. However, humanitarian aid often results in a variety of unanticipated consequences and negative outcomes. Inadequate aid leaves behind substantial and foundational problems that the local community or healthcare system is not equipped to handle. There exist a number of hurdles to the success of international medical aid, including those posed by medical pluralism, short-term aid, lack of coordination, ethical decision-making and distributive justice, and underlying political and social structures. This paper identifies best practices in light of lessons learned from previous endeavors. These include clustered coordination approaches, training in context-appropriate care, education in local healthcare systems and epidemiology, training of local providers in necessary procedures, and developing meaningful relationships with affected communities.
Whether resulting from war, natural disaster, or hostile political or social environments, the prevelance of international crises around the world is constant and necessitates the response of the international community in the form of medical and humanitarian aid. So many of the victims of these situations end up internally or externally displaced, without a home or the basic needs for survival. Therefore, the role of international aid is crucial, and often shapes the way in which the broken community begins to rebuild itself. Humanitarian aid is now commonly perceived as “rights-based,” implying that there is a “moral duty as global citizens to alleviate the suffering of others and to address the rights to health and protection” (Asgary, 629). The ultimate goal of humanitarian aid is to lessen the burden of suffering nations and peoples. However, despite the best intentions, humanitarian aid can often have a variety of unanticipated negative consequences. The purpose of this paper is to elucidate some common pitfalls of international medical aid and to identify better methods to deal with these challenging situations.
Western Medicine and Medical Pluralism
With the United States and Western medicine in general advancing at a speed faster than the majority of the world, the vast differences in technology and resources can hinder the efficacy of medical humanitarianism. Practitioners of Western medicine have grown accustomed to and dependent on advanced diagnostic technology and therapeutic support systems. However, in low-resource settings, the high cost and scarcity of these technologies is a barrier for Western practitioners to give effective care, when they have not had proper training in independent test interpretation and diagnosis (Asgary, 626). Several issues arise from this disparity. For example, volunteers who are not trained in resource-appropriate techniques will often try to practice medicine in a way that is consistent with Western standards that reply on systemic support, which may be inappropriate for the low-resource setting (Asgary, 626). Areas like these do not function on a structured referral system as Western medicine does, but rather on basic clinical care.
Therefore, practitioners cannot rely on a network of specialists for unfamiliar diagnosis’ and treatments. In an area lacking the controlled settings of a laboratory, certain resources may be unsafe or ineffective, such as certain reagents, diagnostic tests, and disinfectants (Asgary, 626). After the catastrophic earthquake in Haiti in 2010, surgeons who had participated in humanitarian aid claimed that the facilities available “could not nearly accommodate” their expertise or equipment (Asgary, 626). This, however, is not a failure of the Haitian medical system, but a failure of the medical humanitarian team to arrive properly prepared. Trying to apply the newest medical technology in such an impoverished setting is often inappropriate for the needs and abilities of the local community, and often has more to do with becoming the “first” to do certain procedures in low-resource areas than providing needed and sustainable care (Welling, 467). Furthermore, volunteers who are not accustomed to scarcity may consume more resources than necessary to compensate for a lack of basic clinical skills, depleting precious supplies (Asgary, 626).
Despite the temporary nature of medical humanitarian programs, there are nevertheless significant and lasting effects on the local community and existing health system. While relief aid is usually perceived to be short-lived, prioritizing basic needs such as rations, essential medicine, clean water, and first aid, it realistically imposes much larger changes on the community (Carruth, 412). Most importantly, humanitarian aid can influence demand for certain treatments or care and the dynamics of health culture (Carruth, 405).
The Somali region of Ethiopia is an excellent case study of these effects, as a community that has relied on international health aid for a significant period. Over time, humanitarian aid has incorporated itself into Somali popular health culture, “expanding local knowledge and expectations of biomedicine and clinical care” (Curruth, 412). The Western medicine imposed on the community contrasts greatly with the Somalian traditional medicine, which revolves around the humoral pathologies, divine intervention, and herbal remedies, in particular, the use of camel milk (Curruth, 407). Interestingly, the introduction of Western medicine has not eradicated the use of traditional medicine, but rather, has adapted it in unorthodox ways. The most prominent effect of prolonged relief aid has been a rising demand for brand-name pharmaceuticals and new diagnostic tests, yet these are still used in conjunction with traditional beliefs of “humoral flows, divine action, and spirit possession” (Curruth, 405). The local perception of the effectiveness of modern therapies is also influenced by traditional beliefs. The efficacy of prescribed drugs is often valued by its ability to induce diarrhea or vomiting, in line with the belief of humoral flows, and side effects are interpreted in relation to the individual’s camel milk consumption (Carruth, 409). The result of this has been the emergence of a pluralistic health system and new local perceptions of disease and its treatment. Furthermore, medical aid has also become adapted to fit the culture of the community, by incorporating traditional beliefs into clinical care (Carruth, 405).
However, the ultimate consequence of long-term reliance on relief aid is the way in which it can undermine the local health system. The presence of these humanitarian organizations inevitably raises healthcare expectations, especially after the introduction of modern biomedicines. Therefore, once the medical aid organizations depart, the local community often feels abandoned, and mistrusting of their own healthcare system (Carruth, 405). With the recurrence of episodic relief aid as in Somalia, it can be difficult to advance the local health infrastructure to meet these new expectations. In particular, many Somalis feel that local facilities lack the diagnostic tests of humanitarian clinical facilities, which they view as superior (Carruth, 411). Many Somalis fear that local clinicians misunderstand or disregard their ailments, because they lack the definitive evidence of diagnostic test (Carruth, 411). The largest public health facility in the Somali Region is the Aysha Health Center, which is employed mostly by Habasha clinicians who do not speak Somalian, but were assigned there by the government (Carruth, 406). The facility has several issues, including geographical isolation, ethnical separation, and inability to meet the needs of the community and gain its trust and support, due to the continued intervention of international aid (Carruth, 406). As a result, locals scarcely use this and other local health posts, despite the substantial government funding behind it and low cost of services (Carruth, 406).
The departure of humanitarian aid has also resulted in many Somalians purchasing prescription-strength medications over-the-counter from local unlicensed shops or health posts; however, this can be dangerous because these drugs are often sold without original packaging and can be indistinguishable from a variety of other drugs (Carruth, 408). Therefore, there is no way to determine the drug’s origin, expiration, and directions for use. Locals do not trust these contraband medications, yet they also do not believe in the efficacy of the inexpensive Ethiopian generic medications that are much more comparable to name-brand drugs (Carruth, 408). Once humanitarian medical groups leave, there is a general decrease in utilization of local health posts, due to mistrust.
This case study of Somalia is a crucial example of the impact of episodic medical humanitarianism on local health culture and pluralistic healthcare. The lesson to be learned is the importance of incorporating training and funding of local healthcare practitioners and facilities, so they may gain the expertise to provide effective care, as well as the trust of their community.
Disadvantages and Challenges of Short-Term Aid
Previously, healthcare providers wanting to participate in international medical aid would receive public health and tropical medicine training before they could be deployed with an NGO (Asgary, 625). The purpose of this training was to develop the specific clinical skills to practice in a low-resource setting, making the healthcare provider an expert in low-resource medicine, and in turn, they gave their career to international service. Recently, however, there has been a significant increase in the popularity of short-term humanitarian aid. Especially after large natural disasters that receive significant media attention, there is a surplus of humanitarian volunteers. There are several motivations for individuals to become engaged in short-term medical humanitarianism, such as the desire to practice in one’s native country or to travel abroad over vacation time. These motivations are, of course, misguided from the true purpose of providing medical humanitarian relief.
There are professional and ethical issues with short-term aid, namely lack of contextual awareness and proper technical and logistical skills required for working in low-resource settings, which can translate into consequences for patients, communities, and healthcare systems (Asgary, 625). For example, volunteers that lack a thorough understanding of local disease epidemiology, healthcare systems, and culture may cause further harm to patients and the community by providing inappropriate care or misdiagnoses (Asgary, 626). Geographical setting and population characteristics may influence diagnostic probabilities and clinical presentations of disease due to local risk factors, exposures, and disease incidence (Asgary, 626). Differing customs regarding food preparation and storage, sanitation, water treatment, use of vaccinations, and common antibiotic sensitivities as well as resistance among bacterial and parasitic infection must also be considered (Asgary, 626). However, many humanitarian medical volunteers have little to no training in providing care in drastically different environments such as these.
Moreover, short-term volunteers do not maintain relationships with local healthcare systems and communities as long-term volunteers do, which is crucial for determining best practices given the specific context and developing aid into sustainable solutions (Asgary, 625). Providing emergency aid immediately after a major crisis is of great importance, but without diligent follow-up, will leave the crippled community to pick up their pieces on their own. Furthermore, by departing before long-term recovery begins, short-term volunteers are able to separate themselves from any negative healthcare outcomes without accepting responsibility for the regrowth of the community, which burdens the local healthcare system (Asgary, 626).
However, this is not the only negative impact short-term foreign aid can have on local healthcare systems. In non-emergency scenarios, lack of partnership between short-term foreign aid and local healthcare and government systems can actually relieve much needed pressure on local systems to make improvements (Asgary, 626). As mentioned with the effect of Western medicine, humanitarian aid may cause locals to distrust their own healthcare system by developing preferences for foreign aid. This effect is stronger when the intervening humanitarian groups provide resources that are not typically available to the community, such as certain medications or surgical devices or procedures (Asgary, 626). The demand for these resources cannot be satisfied once these short-term agencies leave, causing complications within the community. Eventually, the distributed supplies run out and the donated medical equipment needs maintenance or replacement, rendering them useless (Welling, 468). Therefore, it is significantly more effective to regularly re-visit the same location and implement significant changes, rather than providing little sustainable impact to several unrelated locations throughout the world (Welling, 468).
Finally, short-term medical intervention that is inappropriately prescribed can have negative outcomes for patients. For example, Operation Smile was created in order to treat cleft palate cases in developing countries through surgery and was initially perceived as a “model charity” due to the high number of surgeries performed (Welling, 467). However, the purpose of the organization began to center around its publicity, and several children soon had serious complications with their surgeries, requiring extensive follow-up care by their local healthcare providers after the organization had departed (Welling, 467). Therefore, difficult operations should not be performed routinely by medical aid teams, and priority should remain on the quality of care rather than quantity (Welling, 467). If complex cases are to be done, they should only take place when the visiting medical team is convinced it can be done safely, and proper follow-up care has been established beforehand (Welling, 467). Furthermore, humanitarian medical teams, especially surgeons, should focus their efforts on improving local healthcare by teaching local healthcare providers how to perform certain medical procedures or operations, so that this care may still be received once the medical aid has left. Overall, for short-term medical humanitarianism, it is best to provide minimally invasive and basic care to relieve discomfort and avoid the issue of extensive follow-up (Welling, 467).
Lack of Coordination, Planning, and Poor Expectations
Especially following an influx of various humanitarian groups following a well-reported crisis, lack of coordination between groups can be a major barrier of efficacy of care. The distinct goals of the separate NGOs can cause competition for funding, which often results in more, but less effective, care to prove their effectiveness (Welling, 468). This behavior wastes energy and resources without accomplishing the original goal, whereas humanitarian work out of the spotlight but in collaboration with others is much more impactful. Furthermore, medical aid groups with similar goals should foster intercommunication to prevent repetitive efforts. For example, an aid agency working in Aceh, Indonesia reported that various medical groups were all intervening so heavily in measles vaccinations that some children had received several vaccinations, due to a lack of record-keeping (Sondorp, 163).
It is also important for medical humanitarian groups to coordinate their action with the local government as a curtesy. Foreign aid groups that attempt to respond to humanitarian issues without first gaining permission of the government may end up barred from access to the victims and unable to achieve their goal, even despite true intentions (Welling, 469). Expanding on this, it is also unacceptable for humanitarian groups to enter a relief situation with a condescending or patronizing attitude, which dehumanizes the community in need and conveys a negative impression of humanitarian aid (Welling, 469).
Furthermore, a surge of relief aid often leads to the importation of a large amount of resources, much of which is too extreme for the modest immediate needs of the community (Sondorp, 163). This “outpouring of goodwill” results from the “humanitarian impulse” felt after a well-reported tragedy has occurred, most often with natural disasters, rather than civil wars, in which victims are considered innocent and helpless (Sondorp, 163). A major earthquake in Bam, Iran in 2003 caused the death of approximately 40% of the doctors and nurses in Bam and total destruction of all hospitals (Owens, 11). Afterwards, about 60 countries intervened with medical humanitarian groups (Abolghasemi, 141). Given the number of volunteers alone, there should have been a much stronger impact of international assistance, yet, the assumption that more relief is more effective is misguided. In fact, the surplus of international aid often becomes burdensome on management and coordination of providing aid, such as transportation, storage, and distribution of supplies (Abolghasemi, 146). In such events, medical humanitarian groups should arrive with the capability to achieve their goals in a self-sufficient manner that does not rely on support from the local community (Abolghasemi, 146). Interaction with the local community should center around communication and listening to their needs, and implementation of aid should proceed in a self-contained and self-directed way. The lack of coordination between these intervening groups in Bam also resulted in insufficient care in some crucial areas, such as reconstruction of health facilities and improving sanitation (Abolghasemi, 145). The destruction of the health care system led to a rise in morbidity and mortality from communicable and noncommunicable diseases, which required extensive public health, environmental health, nutritional, and rehabilitation interventions that were not effectively met (Abolghasemi, 143).
There was also an incredible amount of medical intervention in response to the South Asia tsunami in 2004. The healthcare services in Banda Aceh had no surge capacity, with about 16 physicians per 100,000 people, compared to the 548 per 100,000 people in the United States, and much less money was spent per person for medical care than in the U.S. (Zoraster, 14). The Tsunami displaced over a million people, many without any shelter, and there was an extreme scarcity of food, water, and infection control (Zoraster, 14). Over 80 humanitarian agencies registered with the World Health Organization (WHO) as responders, as well as many more unregistered groups, including the Scientology Trauma Unit, yoga groups, and unannounced healthcare providers that arrived for short-term commitments (Zoraster, 15). As a result of the overwhelming and uncoordinated mix, patients were shuttled around in search of surgical sub-specialties or left without clear direction of where to go next or how to get home (Zoraster, 16). Emergency medical technicians (EMTs) were often faced with making difficult final decisions on complex cases outside of their training, while expert physicians in other locations stood by waiting for patients (Zoraster, 16). Moreover, local healthcare providers began to work as translators for international aid workers, which paid more than providing healthcare to their own patients. This ultimately hindered reintegration of local staff into the healthcare system (Zoraster, 15). Finally, the influx of support gave way to an excess of hospital beds, which ultimately became empty, wasting taxpayer and donor money, and leaving physicians with nothing to do while other regions of the world remained underserved (Zoraster, 16).
Therefore, there should be more coordination and communication between NGOs to ensure that other important global health issues that are not reported on as often are also addressed. Unfortunately, other tragedies, such as “millions of long, slow deaths from malnutrition and disease” do not “stimulate the humanitarian impulse” to the same degree as major natural disasters (Sondorp, 163).
Unsurprisingly, many ethical challenges arise with medical humanitarianism, and some of these have been mentioned already. Among the major sources of ethical issues are resource scarcity and allocation, policies of aid agencies, political and social structures, and perceived health norms (Schwartz, 45). Resource scarcity and allocation results is a distributive justice challenge, compounded by the need to provide urgent care in emergency situations. These situations often force medical aid providers to determine what patients are most “worthy” of care, often by considering who has the best chance of survival (Schwartz, 47). This not only forces volunteers to make difficult and unanticipated decisions, but also strains the relationship between medical aid providers and the community (Schwartz, 47). Under these circumstances, it is important that healthcare providers are aware of the parameters of the crisis, such as which groups of society are most heavily affected, and the types of issues the crisis is causing. With this knowledge, healthcare providers can develop realistic expectations of the type and degree of care they will need to provide, as well as a rational plan of how to best meet these needs. At times, it may be necessary to provide care for the most critically injured or ill patients first, and defer care of less life-threatening issues until later, maintaining their progression in the meantime. Additionally, collaborating with another relief group may be an effective way to overcome scarcity when the needs of the community have exceeded the capacity of a single organization.
Furthermore, some aid agencies operate under certain policies that may appear to be unethical; for example, policies requiring that only certain groups of people be treated, such as HIV or tuberculosis positive patients (Schwartz, 49). These policies are often enacted to ensure that the target patients receive the benefit of treatment, while reducing risk of drug resistance in the community (Schwartz, 49). However, this ultimately results in withholding care in some degree from other patients in need. This is similar to the problem of resource scarcity in nature, so it is important here as well that healthcare providers develop expectations and a plan of how they will distribute resources and treatments. While their care may be targeted towards certain groups in critical need, it is crucial that relief groups do not abandon the rest of the community who possess treatment needs of their own. Again, requesting supplementary aid from other relief organizations can be an extremely effective way to overcome this issue.
Political and social structures often impede aid because of the need to respect cultural norms that are often not present in Western culture, as well as social inequalities and violent histories between groups. Due to the environmental context, medical aid providers may be prevented from doing what they feel is right, because it may cause other forms of disruption to the community (Schwartz, 45). For example, gender inequality often plays a major role in patriarchal cultures, in which males are treated first and medical decisions for women are dictated by a man’s, rather than a woman’s, consent (Schwartz, 48). Additionally, in areas of historical conflict between groups, it is common for patients or victims of the opposite side or ethnic group to be abandoned outside of the hospital, or left without assistance (Schwartz, 48). Despite the frustration this may cause Western volunteer practitioners, disregarding cultural norms may jeopardize the ability of the organization to integrate itself into the community (Schwartz, 48).
In most circumstances, humanitarian groups providing medical aid are too small and temporarily present to have a substantial and lasting impact on societal norms, but are well-equipped to provide quality healthcare. Therefore, though it may be internally challenging to provide care under societal norms that do not align with one’s own, volunteers should understand where they can most effectively contribute to the community during their relatively short stay.
Moreover, the last decade has seen a disturbing increase in attacks on medical aid providers in conflict zones, which in turn results in detrimental effects on the community in need, as well (Carmichael, 65). For example, volunteers for Médecins Sans Frontières (MSF) deployed in Somalia were forced to retreat, leaving 700,000 patients without healthcare until the safety of the providers could be ensured (Carmichael, 65). In Iraq, 18,000 (over 50%) of doctors left due to dangerous conflict, creating an extreme vacuum in the healthcare system (Carmichael, 65). In Pakistan, attacks on polio vaccination workers resulted in millions of children without vaccination for the dangerous virus (Carmichael, 65). These actions do extreme harm by perpetuating violence and increasing resource scarcity.
As war continues, more tax-based revenues are directed towards war efforts, often at the expense of healthcare, making international aid an even more essential figure (Carmichael, 65). It was decided at the Geneva Convention that medical aid personnel are to be protected from harm, and all parties regardless of their differences must become engaged in discussing this breach of agreement (Carmichael, 65). However, it may be necessary for NGOs to clearly separate themselves from the governments that largely fund them in order to reduce their dependence and affiliation that often puts their volunteers in danger. By remaining neutral and impartial, humanitarian groups may protect themselves, as well as their ability to provide care.
Finally, perceived health norms and stigmas may negatively impact the ability of medical humanitarianism providers to treat patients with the same procedure they would in other parts of the world. In particular, there are many regions of the world where HIV positive individuals are greatly discriminated against and shunned from the community. A Western volunteer healthcare provider in West Africa recounted a situation in which they were adamantly told by local nurses not to inform the patient of their HIV status, for fear that the man’s wife would leave him (Schwartz, 50). The volunteer dealt with serious internal conflict between the desire to inform the patient so they could seek proper treatment, and uncertainty of imposing Western beliefs in a vastly different society (Schwartz, 52). It can be especially difficult to find solutions in these situations due to the potential harm these stigmas may cause patients regarding their future opportunities and quality of life. Such as with issues arising from political and social structures, relief workers must consider in which part of the community they can have the greatest impact considering their organization’s size and duration of stay. Therefore, cases like these are best addressed on an individual case basis, in which the healthcare provider should weigh the potential harms on the person’s physical health with those of their social health. In best case scenarios, this can be discussed with the patient in order to take their own input into account; however, if this does not seem possible, communication with a local healthcare provider who understands the societal health norms and stigmas may be beneficial as well.
Service with a Misguided Smile
As previously mentioned, there are many misguided motivations for individuals to participate in medical humanitarianism, especially in short-term aid. Individual motivations for entering medical humanitarian range from the attraction of traveling to exotic lands, the bragging rights of performing the “first” of some medical procedure or performing a high number of complex cases in a short amount of time, to potential academic advances (Welling, 470). The recent increase in short-term medical humanitarianism reflects a trend in medical schools preferring applicants who have practiced medicine abroad in some way. Therefore, it has become extremely common for competitive medical school prospects to spend their gap year in a low-resource area providing aid. While it is of course beneficial in many ways to have so many well-educated individuals contributing to humanitarian causes, a lack of genuine intention to serve humanity can lead to half-hearted efforts, in a situation that really requires volunteers to give their all.
The devastating earthquake in Haiti experienced a tidal wave of incoming relief aid as a heavily reported disaster, although not all the medical groups arrived for the right reasons. There were many relief groups who came unannounced and began to see patients without any validation. Pointing again to a lack of coordination, many unnecessary re-assessments of patients occurred, but the patients were not able to comprehend and resist this, due to language barriers (Van Hoving, 201). One group in particular had begun to draw media attention to themselves and the care they were giving. When an elderly man with a bad leg injury sought medical aid, a well-intentioned and established team had determined that he had a poor prognosis and should instead be cared with conservative management, especially because of resource scarcity (Van Hoving, 201). However, the unannounced team that had been working in the spotlight insisted on operating on the man, claiming they had significant surgical experience when in fact they did not, and the man died due to complications (Van Hoving, 201). Therefore, many professional humanitarian workers have uncertainties about the surge of relief after disasters, because many of the responders lack the necessary experience or skills, understanding of local context, or relationship with the local systems in place (Van Hoving, 202). Groups such as these have been coined “disaster tourists,” who give service to receive recognition and media attention, and use up precious resources in inappropriate ways or violate security precautions (Van Hoving, 202). The negative consequences of these groups can result in less-than-friendly receptiveness of communities to international aid.
Politics have also altered humanitarian intentions when governments choose to provide international aid. For example, the U.S. Navy deployed two large hospital ships, the USNS Comfort and the USNS Mercy, to the Caribbean to provide aid, but these trips would only last for about a week and lacked effective coordination with local organizations, as well as accessibility due to the size of the ships (Welling, 469). The truth was that these trips were more about promoting the United States and its diplomacy than it was about humanitarianism, and even Fidel Castro condemned this effort, stating that medical programs cannot be carried out in “episodes” (Welling, 469). President Obama was in agreement and felt that the United States should follow the example of Cuba, which has sent doctors to other Latin American countries for decades to care for the poor (Welling, 469).
Overall, humanitarian aid should be provided as a “duty as global citizens, rather than as an act of charity” (Asgary, 627). The distinct difference here is that the perception of medical humanitarianism as charity finds it acceptable to send any person, despite their lack of training or experience, because it is better than sending no one (Asgary, 627). This perception is misguided, because it is this attitude that leads to inappropriate care and depletion of resources, and intervention by individuals with skewed intentions. This in turn contributes to all of the negative impacts of medical humanitarianism previously discussed. Furthermore, this approach validates a lower standard of care and exploits the vulnerability of the community in need, which disregards patient dignity as humans (Asgary, 627).
Recommendations for Best Practices
The importance of medical humanitarianism is undisputable; however, there are many ways in which it can be improved. One way that has been suggested is the “cluster” approach, which coordinates humanitarian groups into specific areas of the relief response (Cumberland, 661). This strategy has been shown to lead to more effective sharing of staff and resources, technical experience, information, and administrative burden (Cumberland, 661). Moreover, common goals were established to ensure that all groups were working in a unified direction. This strategy speaks to the importance of collaboration, coordination, and communication between different humanitarian groups. When working in tandem with each other, volunteers can provide a much greater overall impact than working simultaneously and adjacently alone.
Before their participation in low-resource setting care, volunteers should be trained in the necessary skills that are outside of typical Western practices, as well as “standards of care, epidemiology, healthcare systems, environmental requirements for medications and laboratory tests, and cultural competencies” (Asgary, 628). The required skills for low-resources areas are vastly different than those for providing care in advanced technology contexts. Therefore, having the ability to independently diagnosis patients and provide basic clinical care is crucial. A thorough understanding of the local healthcare system will help volunteers identify specific gaps and provide care in a way that supplements the local system, rather than degrade it. Moreover, knowing the epidemiology the community will allow healthcare workers to give treatment that is effective for the specific environment they are in. Once abroad, volunteer medical providers should take responsibility for public health assessments in low-resources areas that do not possess the capacity for this, as well as health education campaigns (Asgary, 627). Additionally, training local healthcare providers in certain treatments or operations is an excellent way to develop the internal healthcare system. These trained individuals can then go on and train others, leading to a ripple effect in the community that encourages further growth and advancement. In this way, they can help local communities address their own shortcomings and develop strategies to improve healthcare for the future.
Finally, medical humanitarianism can be improved by higher standards of service, open discussion and reflection, humility, and interaction with the local community (Asgary, 629). Even when providing only basic clinical care, all volunteers should work at the highest standard possible, so that every patient is given the quality care they deserve as a human being with inherent dignity. Developing a meaningful relationship with the community is essential in effective medical humanitarianism because it is through this relationship that relief aid organizations and workers begin to understand the needs and values of their patients. This relationship also promotes peace between peoples, as providers and patients learn more about each other and their similarities as humans. With deliberate effort, medical humanitarianism can be conducted in a purposeful way that will not only benefit the community in need, but contribute to a world-wide growth of justice and peace that benefits all people.
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