Emergency Medicine Expeditions to the Developing World: The Loma Linda University Experience in Papua New Guinea

Abstract

Emergency physicians (EPs) are increasingly participating in international medicine in regions that are chronically medically underserved. In August 1994, a ten‐member emergency medicine team from the Loma Linda University School of Medicine staffed a 70‐bed bush hospital in the primitive highlands of Papua New Guinea, providing both outpatient and inpatient medical care. Typhoid fever, malaria, polio, and numerous other infectious diseases were encountered. Rampant local tribal warfare resulted in regular penetrating injuries from arrows, spears, and machetes. The expedition was judged highly successful, in that 1) substantial medical service was provided to tribespeople accustomed to minimal care, 2) education was provided to local health care providers, and 3) team participants became adept at managing medical conditions uncommon in industrialized societies, and gained valuable ethical and utilitarian perspectives regarding health care delivery in underserved areas. In this article the objectives, organization, and experiences of the team members are described. This information may encourage other EPs to participate in medical expeditions to the developing world, and to provide general principles to assist in their organization and implementation.

Ethics for international medicine: a practical guide for aid workers in developing countries

“…Resources for wound care are frequently unavailable in developing countries, so many postoperative patients die of simple infections (Berger 2006). Intensive care units for recovery are rare in developing countries, and those that do exist generally lack basic equipment such as ventilators and cardiac monitors (Abrams 1998;Clem and Green 1996). All these limitations increase the risks of morbidity and mortality of surgeries in international medicine, thereby changing the risk-benefit profile of these interventions (Bosenberg 2007).…”

“…This means that medical aid workers are often the most qualified general health care providers in the area where they are serving, even if they are specialists in their home countries. As such, they may be asked to perform interventions that are beyond the scope of their training because there is no one more qualified to intervene (Clem and Green 1996). In addition, because local medical personnel are in short supply, they may not be available to provide continued care to patients after medical aid workers leave.…”

“…Traditional healers are generally less expensive than medical clinics or hospitals (Ekortarl, Ndom, and Sacks 2007). Because traditional healers live with and know the people in their communities, they are often more trusted than medical aid workers who are outsiders (Clem and Green 1996). Traditional healers are aware of the cultural, social, and psychological context of disease within their communities, which allows them to design treatments that are consistent with cultural fears, superstitions, and beliefs (Baskind and Birbeck 2005;Ekortarl, Ndom, and Sacks 2007).…”

The Context of Ethical Problems in Medical Volunteer Work

“…Resources for wound care, which are readily available in developed countries, are frequently unavailable in developing countries, so many postoperative patients die of simple infections (Berger 2006). Intensive care units (ICUs) for recovery are rare in developing countries (Clem and Green 1996). Even when ICUs do exist, they do not have the same equipment as those in developed countries.…”

“…Even when ICUs do exist, they do not have the same equipment as those in developed countries. They lack ventilators, electrocardiogram machines, and cardiac monitors (Abrams 1998;Clem and Green 1996;Eddleston et al 2006). Without ventilator support and close postoperative monitoring, the risks of morbidity and mortality are higher than in the developed world (Bosenberg 2007).…”