Surgical Missions: Critical Humanitarianism

Faculty: Stephanie Roche, MPH & Rachel Hall-Clifford, PhD, MPH, MSc


Project Objectives
  • To explore the perspectives of Guatemalan health care providers on their experiences with visiting surgical teams in Guatemala
  • To understand the processes and participants involved in short-term surgical missions, from patient identification to triage to surgery to post-operative care
  • To identify points for strengthened collaboration and process improvement between local providers and visiting surgical teams
  • To understand the impacts of humanitarian aid and development paradigms on the Guatemalan health system
  • To develop social justice and occupational justice analyses of short-term surgical missions
Project Activities

With only 3 surgical specialists per 100,000 population, the current Guatemalan healthcare system struggles to provide essential surgical care in a reliable and equitable manner. The concentration of surgical specialists in the urban private sector, coupled with shortages of physical and human resources in the public sector, places low-income, rural-dwelling Guatemalans in need of surgery in an especially precarious situation. In response, some foreign surgical specialists—primarily from high-income countries—engage in short-term medical missions (STMMs), performing surgeries during in-country stays of about 1 to 2 weeks. These volunteers are often supported by local providers who carry out pre- and post-operative evaluations and lead, co-lead, or assist with the surgery itself.

The quality, efficiency, and continuity of STMM care depends, in large part, on the interactions between local and visiting providers. Although several studies have focused on visiting providers, no study to date has collected the perspectives and experiences of local providers who receive and work alongside these visiting teams. In this project, we will interview local providers about what they see as the benefits and drawbacks of this care delivery model as well as areas for improvement. We will also conduct observations of STMMs to further examine the setting and context. Understanding whether and how this care delivery model supports local health workforce is critical given global health’s current emphasis on health system strengthening.

The 2019 project will build on the initial work on this topic of NAPA-OT Field School Students in 2011, An Investigation of the Surgical Referral Process Utilized by Non-Governmental Organizations in Guatemala, in 2013, Patient Experiences of Medical Missions, and 2014, Sustainable Technology for Surgical Referrals: Pilot Implementation of an Electronic Medical Referral System for Short-term Surgical Missions.

Key competencies gained will include: instrument development, in-depth interviewing, ethnographic observation, qualitative data analysis, and executive report writing. Readings and group discussions will explore the role of humanitarian aid, development programs, and technical assistance in capacity- building, program sustainability, and priority-setting in global public health.

NOTE: Students’ willingness to contribute to the report in the 2-4 weeks following the field school end date is requested, in order to complete the writing, editing, and/or posting of the report.