Category Archives: News

And… we’re back!

By Lawrence Loh, MD MPH

We’re back after a long-absence: it has been a busy few months this winter here at The 53rd Week. Some of the highlights include:

  • Ongoing work towards launching the web platform: with the help of a great team out of the University of Massachusetts, we went live with the La Romana collaborative platform early in March. Since then, we have been working hard in recruiting local leadership as well as other team leaders to join the website and make use of its tools, particularly the discussion forums and calendar. The response we have received are has so far been encouraging, and our hope is to launch collaborative projects once we have a critical mass of data and teams on the website.
  • We have continued our research work into the needs and baseline trends of disease of the Haitian refugee community in La Romana. We have received ethics approval for two studies: a quantitative analysis of charts collected by visiting medical teams, together with our partners at the University of Massachusetts, and a qualitative analysis of themes in semi-structured surveys examining the basic needs and concerns of batey residents and hospital personnel in the local community. Initial analyses have been conducted and draft manuscripts are being prepared for publication! Ongoing research into the phenomenon of short-term medical volunteer trips in general also continues, with a commentary as well as an economic analysis due out in short order thanks to the great work of our volunteers.
  • We have also begun to carry out our work in advocating for more ethical and responsible volunteer work abroad, speaking out against self-serving “voluntourism” and highlighting that short-term trips can be useful, provided volunteers are realistic surrounding their scope and limitations and conduct themselves to a responsible ethical standard. Our talks highlight The 53rd Week’s philosophy: that in their current form, short-term medical experiences are limited in outcome, but modern life constraints in finances and time make them attractive to young professionals, students, and sending institutions alike, who benefit largely at the expense of the local community partners. Later blog entries will talk about our presentations McMaster University, the March Meeting of the International Federation of Medical Students’ Associations, and the Consortium of Universities for Global Health meeting.
  • Our organization continues to complete the process towards applying for 501(c)3 status, and is also doing some other administrative work (e.g. filing our taxes for 2012!) towards building our profile and infrastructure. A lot of this is being taken on by great new volunteers who will be introducing in future blog entries.
  • At the same time, we are in the process of migrating to our new website (launching soon)! So stay tuned, and we look forward to bringing you more regular updates once we’ve transitioned
  • over to our brand new home on the web.

A productive few months, as evidenced by our inability to update our web, but hopefully we’ll share our new space soon. In the meantime, you can check out some of our recent talks on our YouTube channel at http://www.youtube.com/The53rdWeek – feel free to share widely with your friends and family.

Dr. Lawrence Loh is Chief Medical Officer of The 53rd Week.

New year, new relationships… new potential

By Lawrence Loh, MD MPH

We’ve returned from yet another successful trip to La Romana. With a team of 19 people who hailed from Vancouver, San Diego, Denver, Kansas City, Chicago, Toronto, Washington DC, Baltimore, Philadelphia, and New York, The 53rd Week provided primary pediatric care to over 500 children in the bateyes of La Romana, Dominican Republic in concert with our partners at Hospital Buen Samaritano.

Grateful to our financial and in-kind sponsors who provided monetary, medicinal, and general supply assistance, we were able to make a small impact among the pediatric patients we saw in communities. For many members of our team, this was their first time on a service trip, and they also experienced enormous personal growth and benefit. Many were able to develop their clinical acumen while seeing first-hand the nature of global health primary care.

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Some members of our team. “We’re kind of from everywhere.”

While the literature always talks about the enormous costs and harms associated with short-term trips there are also those intangible benefits that our participants were able to derive. There was the forging of relationships between members of the groups – relationships that have the potential to last over the course of a professional career. As is usually the case when Canadians and Americans meet in the same place, there was plenty of comparisons and discussions – that veritable exchange of ideas and viewpoints that challenged minds and provoked deeper questions (in addition to the more simply fun ones, like trying to figure out what the American equivalent of “eh” is or comparing cereal brands for sale on either side of 49.)

There were also, however, the relationships we forged with the local leadership and team that we worked in partnership with. We know in this life that a lot of it comes down to who you know and relate to personally – it is different seeing someone and knowing them face to face than it is through an email or a wire money transfer. Here there is a reference point, a memory, time spent in their house trying to build that link. What could potentially come of it remains to be seen – but most important is that potential that is there, far beyond just handing out resources for distribution – there is a more important personal connection which can be relied on as the foundation for change and greater efforts together.

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Learner and teacher, but also, friends.

The other intangible benefits derived by our team were individual perspectives and viewpoints on the work being done there. It allowed many of our participants to ask the hard questions about the work they were doing. They were able to immerse themselves in the work and environment while considering the sustainability and ethics surrounding short-term medical trips, as well as the overarching picture and systems view that leads to the poverty that give rise to the related health and social concerns seen in the communities.

For all these benefits, The 53rd Week continues to work on implementing a collaborative model for existing short-term teams in La Romana. With the help of the hospital we’ve been given the go-ahead to launch the web-based collaboration platform. It’s now a matter of persuading other teams that head down that we are stronger together. Indeed, with some of the other teams, we have already begun having monthly teleconferences and initiated research projects together, all with the aim of improving outcomes for the folks down there. Our hope is that the benefit will not solely be borne by us, the visitors, but that some tangible, long-lasting benefit may come for the local community in La Romana as we move these efforts to more than just a week down there – to something bigger than the whole of its parts.

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Individually, can’t lift much, but together, we can lift our trip leader.
Tangible evidence of the power of collaboration.

The relationship piece was something I tackled in a recent publication in the Canadian Medical Association Journal. There is something to be said for being there in person, for building that relationship – the potential for further work and change is that much more real when those networks are maintained.

The 53rd Week continues to be committed to forging connections between groups and individuals both within their home environments and with areas further abroad. We believe that the collaborative benefit of friendships and relationships that transcend artificial divisions is transformative and represents a lifetime of potential good. It’s our hope that  the new year will provide us an opportunity to grow new networks which will be indispensable to creating those multidisciplinary, multinational, multi-idea solutions that will support today’s global health efforts.

You can read my article here. (institution access may be required)

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Photo: this year’s 53rd Week team to La Romana with our local partners from Good Samaritan Hospital.
Thanks again to all our sponsors for their kind support!

Dr. Lawrence Loh is Chief Medical Officer of The 53rd Week.

Getting closer

By Lawrence Loh, MD MPH

While the blog may have fallen silent for the past few weeks, the team at The 53rd Week continues to work on optimizing the outcomes of short-term medical (and volunteer) trips abroad. During the recent American Public Health Association conference in San Francisco, I had the opportunity to meet with a number of young professionals who all expressed an interest in doing work abroad, while presenting research with some colleagues, a paper that examined barriers to physician participation in global heath careers, and another that categorized potential global health areas of practice by physician specialty.

In all our discussions, it did strike me that many young, interested global health professionals are facing the same time and financial crunch that we’ve being describing. Thus, even though they knew it was “wrong”, many did travel abroad on short-term trips. Many still had questions as to the value of what they were doing, and on learning about our paradigm, expressed interest and hope that things would work out.

At the same time, leaders of the global health field expressed the same dismissive view towards short-term trips. One even told me that his goal was to get as *few* people going abroad as possible – and that instead, he would rather have everyone learn about global health issues at home, in their medical school curriculum or at the hospital, without forging out beyond. Yet this faculty himself participates in work abroad, and goes abroad quite commonly.

My simple question, therefore: why him, and why not us? For the longest time that people have decided to ignore the growth in interest of short-term medical trips and volunteer work abroad, the question I have is – why? I believe most of us in the West live in a society that doesn’t just value charity and altruism, but also respects the right of people to decide what they want to spend their time on and how they are best able to do that. Given the challenges and opportunities that young professionals face today, those who want to build on that charity and altruism abroad will undoubtedly choose to participate in short-term medical trips.

As we’ve said before, in their current form, such trips are a detriment to the community. But we need to stop ignoring it. If people are going to go abroad, if they are going to exercise their fundamental right to put their desire to help in a trip abroad, we need to support that, improve it, maximize benefits, and minimize harms.

In all, it was a fulfilling meeting. There is certainly a growing divide, though, between the younger generation of global health professionals that are living the new paradigm, and the older generation who remain unconvinced of the potential that lies in optimizing such short-term opportunities.

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In other news, planning for our upcoming trip to the Dominican Republic is going smoothly. We have a team of 21 people from all over the United States and Canada who will be joining us over the New Year’s break in La Romana. Much as we try to push ideas upstream, our team will provide the usual clinical care, but also has identified a few projects to tackle, including:

  • Needs assessment to be placed on the newly built website platform;
  • Medical Spanish phrasebook;
  • Cost-benefit analysis for short-term medical trips as well as alternatives (improved trips, for example)
  • Curriculum of training for local residents and interns to be fulfilled by visiting medical teams

Our multidisciplinary team is keen on seeing sustainable, longer-term outcomes to fuel our development model.

We hope to allow interested young professionals to participate at a reduce cost through fundraising. Any support is greatly appreciated. Our goal is to raise $5000 to help worthy candidates learn more about a collaborative short-term model and work to improve the outcomes related to the short-term volunteer paradigm and phenomenon.

For more information on how to donate, visit us here. Any amount is appreciated.

Lawrence Loh is Chief Medical Officer of The 53rd Week.

Growing recognition of the potential in short term trips

By Lawrence Loh, MD MPH

In the June 2011 issue of the American Journal of Medicine, a piece by Wilson and others explore potential guiding principles that could be used to engage further development of short-term global health volunteerism.

Rules of Engagement: The Principles of Underserved Global Health Volunteerism
(may require access via institution or subscription)

The piece starts out with a recognition that such trips offer “unique personal experiences for volunteer healthcare providers” but that the concerns of longer term, meaningful, lasting benefits for the community remain. After reviewing potential benefits to participants as well as potentially harmful actions, the authors propose four categories of ethical principles–service, sustainability, professionalism and safety–that could serve as a framework for such short term trips.

Our group is extremely encouraged by the appearance of this work in published literature. It may represent a shift to recognition of short-term efforts in academia, which could hopefully engender more interest and solutions to make sure that we get improve the quality and quantity of such efforts. That said, the paper itself still represents the old paradigm in more than a few ways:

  1. In the first table that describes the potential benefits realized by trainees going on these trips, the authors identify:
  • Opportunity to encounter diseases not typically encountered in United States
  • Opportunity to see more advanced stages of select diseases not commonly seen in United States
  • Opportunity to improve physical examination skills and procedural skill sets (via less reliance on laboratory, radiology, or consultation options)
  • Opportunity to understand the fragile socioeconomic relationship among local government, hospital, and local medical clinics
  • Greater awareness of cultural sensitivity and importance of patient communication

    Save for the fourth bullet, this list still comes from the lens that presupposes all medical trips are solely to improve training and healthcare delivery in the developed world. It is ultimately speaking of the benefits received by trainees as being what they ultimately bring back to practice in the U.S. or wherever they hail from. It doesn’t look at the  potential benefits of medical trips to individuals as they develop a greater awareness and ability to include global health experiences in their future careers.

    The same Wisconsin study we looked at two weeks ago showed that interested young professionals are keen to incorporate some form of global health into their future careers – away from the day to day at home. In that sense, getting to go on short term medical trips means they have the chance to forge connections with a community abroad, and continue to contribute to a cause that they personally feel worthwhile and experienced in dealing with.

    Some other possible benefits: networking and developing important connections that could transpire into ongoing global health experiences and career work. Identifying a personal niche in global health that could guide their work and their inspiration. Valuable research and publication opportunities that could kickstart a career. Mentorship from experienced preceptors as to how to best balance their desire to make a difference with the need to grow their career and specialty at home.

    2. In discussing the harms, there was no balancing of the viewpoint by discussing potential benefits of such trips to these communities. Indeed, stand alone trips likely have a greater balance of harms, but there is always that potential that the community could benefit from coordinated efforts, or from a sudden, passionate commitment by a changed young professional to devote a good chunk of their career into helping the community they’ve been welcomed into.

    Inasmuch as these trips can harm, figuring out how they can genuinely help communities (and what is the best way to make that happen) should become a greater academic focus – look for the successful models. The authors do make this point in their final discussion, concluding that provision of vaccines, basic sanitation and hygiene, and other such initiatives may actually have a more lasting benefit than acute care models.

    3. The ethical principle of “doing no harm” is discussed as the very basis of much of this work. And in a world where many of these short term trips amount to nothing more than medical tourism, moving to “doing no harm” is definitely a worthwhile and worthy goal. But supposing we do manage to minimize the harms within the community and in the care delivered to these populations. Leaving our ultimate goal as to “do no harm” in that sense implies that while benefit would be realized by the U.S. organizations and trainees carrying out the work, the receiving community would not benefit beyond just not being left in a worse off position than they were before. In that sense, the ideal of social justice and equity may still represent the ultimate ethical underpinning of our work; as Bruce Springsteen famously said, “Nobody wins until everybody wins.”

It is encouraging to see academic literature grow on this subject. It will be curious to see how things will unfold over the coming years, as a new generation of global health leaders comes forward with passion and ideas.

Dr. Lawrence Loh is Chief Medical Officer of The 53rd Week, and a physician in Toronto, Ontario, Canada.

A new paradigm in a published paper and big, tragic global health news

By Lawrence Loh, MD MPH

As we’ve worked towards getting our web platform ready we took a brief hiatus over the last little while to devote ourselves to making sure things are ready to go for the collaboration model we’re building with our partners here in North America and abroad. But in the wider global health world, a stunning announcement: after four decades of front-line work and research, the Global Health Council (GHC, website at www.globalhealth.org) is shuttering its doors. This is a stunning reversal of fortune for one of the largest non-profit global health organizations, and leaves an incalculable void as well as plenty of speculation as to what has gone wrong.

It falls to the rest of the global health community to think about how to best challenge the paradigms that a traditional organization like the GHC might have had in adapting to today’s interconnected world with targeted funding and a young, time-and-finance limited workforce. We’re hoping to be part of a new wave of solutions that will enable global health research and projects to continue being a strong

To that end, we have published a commentary / letter to the editor that appeared in Canadian Family Physician with other like-minded colleagues that appears at the following link.

http://www.cfp.ca/content/58/4/376.full

Back to our regularly scheduled programming next week, as we continue to work on bringing you more information about how we plan to maximize the benefit of short-term global health work abroad.

Dr. Lawrence Loh is Chief Medical Officer of The 53rd Week, and a physician in Toronto, Ontario, Canada.

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The 53rd Week’s trip to the Dominican Republic (December 2011)

By Heather Lin

Day 1 // día uno

Lawrence, Henry, Heather, and Shu (you can learn more about the team at Our Team) arrived at the airport in the D.R. and taxied to the Good Samaritan Hospital // Hospital El Buen Samaritano // hospitalbuensamaritano.org in La Romana.  The hospital was built solely to provide primary health care to the cane cutters who work and live in the bateyes.  It has developed programs to address malnutrition of children and women’s health and also sends medical teams into the bateyes to deliver care to the poor. Upon reaching the hospital, Lawrence and Henry (who had visited the hospital during prior short-term medical missions) remarked on the additional levels constructed to increase inpatient capacity and the new water filtration center supported by Rotary International that was adjacent to the hospital.  It was great to see the Good Samaritan Hospital expanding its imprint in La Romana!

All photos by Shu

There, we were welcomed by Emilio, our host from the hospital.  After dropping off our bags at the renovated hospital hostel, we headed to Jumbo supermarket for provisions.  We ended our night with Emilio by enjoying a nice dinner at a nearby Dominican restaurant that consisted of seafood delicacies, mofongo, and Presidente beers!  Aplausos!

Day 2 // día dos

To prepare for the busiest day of the trip, the 53rd Week loaded up on avena caliente (oatmeal) then headed out to the Family Clinic // Clínica de Familia La Romana // clinicadefamilia.org.do, which is funded by the MIR Foundation (a non-profit organization that works to supply the D.R.’s most marginalized people with a variety of life-altering services through social programs).  The clinic provides comprehensive care and HIV treatment options to the community.  As the country’s second-largest provider of antiretroviral treatment (ART), it provides continuous care for over 2,000 adult and pediatric patients.  We hope to coordinate future visits with the well-established clinic.

Following our visit to the clinic, 53rd Week headed to Bateye 62 (you can learn more about the bateyes at the bottom of Our History), a 30-minute drive from La Romana.  There are over a hundred bateyes harvesting sugarcane that surround La Romana.

Though Lawrence and Henry are familiar with bateyes from prior missions providing medical care to residents, this was Heather and Shu’s first time to the D.R. and a batey.  At Batey 62, we were able to gain a better understanding of batey life and see a church where short-term medical missions typically establish pop-up clinics.

After years of providing acute care to batey patients, Henry and Lawrence (the two doctors of 53rd Week) observed a variety of obstacles – foremost, the lack of continuity of medical care presented a challenge.  Some initiatives, like the hypertension project, have helped standardize some aspects of care, but many challenges still remain:

  • Lack of standardized medical record keeping system
  • Poor record keeping of available inventory, leading to running out of certain medications while in the clinics
  • Individual efforts don’t always seem to be coordinated with local efforts
More information on 53rd Week’s mission can be found at About Us and The 53rd Week.  The 53rd Week will host a clinic for batey residents in 2012.
Following the Batey 62 visit, the 53rd Week drove to the nearest sugarcane field being harvested.  Along the way, we pulled off to the side of the road for a Dominican-style tailgate to lunch.
Henry
At the sugarcane fields where workers were harvesting cane, we were able to see how much cane a strong, young man could cut with a machete in a day – 3-4 tons, equivalent to the capacity of one of the railroad cars.
Lawrence
          
Yes, one strong, young man could cut up to 3-4 tons of sugarcane, represented by the cane being lifted out of the car, in one day.  Very hard labor…
Shu
The 53rd Week returned to the Good Samaritan Hospital to meet Moises, the Director of the Good Samaritan Hospital.  There, Shu, the developer of the website that will coordinate care among the 40+ short-term medical missions to La Romana annually, presented the deliverable to Moises.  The 53rd Week hopes that the website will improve coordination of care to batey patients through knowledge sharing on forums, calendar of scheduled missions, and inventory management at the Good Samaritan Hospital.  We expect to release the website for other missions to use in early 2012 and will post when it’s released!

Day 3 // día tres

On our last day in La Romana, the 53rd Week visited a local orphanage.  The children we met and played with were trilingual (Spanish, English, and French).  Afterwards, we visited a public hospital.

Lawrence with Henry and Emilio in the background

Heather

Many thanks to Moises, Emilio, and our hostess during our stay in La Romana.

Shu, Our Hostess, Heather, Henry, Emilio, and Lawrence

Day 4 // día cuatro

On our last day in Santo Domingo and the D.R., we walked along George Washington Avenue // Avenida George Washington, and enjoyed the view of the Caribbean Sea.  We stopped by Adrian Tropical, where we enjoyed a hot ginger chocolate drink // caliente con jengibre followed by a starchy meal.

Following brunch, Lawrence and Shu returned to the hotel.  Henry and Heather attempted to find the elusive underground cave in the Mirador del Sur Park // Parque Mirador Del Sur but were unsuccessful.  However, the park was great for strolling nonetheless!

The 53rd Week regrouped at the hotel then headed to the airport – Shu returning to Austin; Lawrence, Henry, and Heather returning to NYC, then Lawrence and Henry returning to Toronto and Philadelphia, respectively.  I (Heather) had a great time on the trip – 53rd Week’s mission crystallized in my mind, and I got to experience the D.R. for a few days.

Stay tuned for happenings on the 53rd Week!

Heather Lin is the Business Development Lead for The 53rd Week; she is based in New York City.