Reflections on medical volunteerism: free medical days for refugees

THE HISTORY

The Lebanese Medical Students’ International Committee organised a free medical day under the slogan of ‘Your Health, Your Right’. This activity was sponsored by the Ministry of Public Health and involved several partners. Classes in a public school in Beirut were turned into clinics for the purpose of this day. Medical encounters and blood tests were offered free of charge.

A young woman presented complaining of body and headaches. She reported an old fracture in her skull, which she attributed to a fall from a roof. An initial exam revealed a poorly groomed woman with an obvious nystagmus suggestive of central nervous system pathology. As the examining doctor discussed with her the need for brain imagining, she broke into tears explaining her financial difficulties.

Money was not the only problem; her husband has been physically abusing her for years. This was the cause of the skull fracture and consequent nystagmus. A referral to an ophthalmologist was arranged and the patient encouraged to consult a non-governmental organisation (NGO) that deals with domestic violence and another to cover the expenses of her brain imaging. By the time she had her scan arranged, the patient found herself alternating between unyielding medical visits. Her hopes were fading away; eventually she was lost to follow-up.

THE REFUGEE CRISIS IN LEBANON

Lebanon has accommodated around 1 million refugees since the start of the Syrian crisis.^1,2 This has taxed the infrastructure, strained already compromised sectors, and incurred losses of almost US$ 13.1 billion as estimated by the World Bank.³ Providing care to the refugees has been an exceptional challenge to the Lebanese government.

Refugees have access to the primary care sector at subsidised fees in clinics run by the United Nations, NGOs, and the Ministry of Social Affairs.⁴ The poor coordination between partners, the multitude of donors, and the scarcity of international aid were major impediments to the provision of health services for refugees.

Hence a ‘free at point of service’ type of care delivery was necessary to respond to the increasingly unmet needs.

FREE MEDICAL DAYS

Free medical days (FMDs) represent a platform for young physicians to show their enthusiasm and commitment to community work. They foster the humanitarian dimension among volunteers and create a momentum to challenge an unpleasant reality. Similar to students practising during conflict, volunteers learn to develop ‘sympathy, compassion and professional pride’.⁵ Such initiatives are also an exciting opportunity to exercise leadership skills, as they require extensive planning and organisation.

Seen from the perspective of patients, FMDs serve as a ‘quick fix’ for acute illnesses, especially when patients are offered free medications and laboratory tests. They represent a catchment point for people with chronic conditions who can be identified and referred to clinics for further care. Most importantly, they create a sense of empathy towards beneficiaries and an affirmation of health as a right.

FMDs’ greatest challenge is ensuring continuity and sustainability of services. The potential inadequacy of follow-up can jeopardise their potential benefits. Patients diagnosed with chronic diseases such as diabetes or hypertension during FMDs are unlikely to adhere to treatment and follow-up. In many cases, they feel frustrated as they realise they have been labelled with a lifelong illness, the treatment of which they cannot afford. Similarly, it is difficult to offer patients with psychological distress, commonly encountered during FMDs, with the help they need on a single short-lived encounter. In all of these instances, detecting the problem is not enough; it may even be harmful as it exposes problems without necessarily offering solutions.

WHAT CAN BE ACHIEVED ON FMDS AND BEYOND?

All efforts employed during FMDs risk being futile in the absence of a proper strategy that ensures continuity of care. Having referral mechanisms in place is crucial to avoid up-streaming beneficiaries, particularly refugees, within a paying system and overburdening them with medical expenses. Organisers should coordinate with different stakeholders involved in provision of health care to refugees or other vulnerable communities. This ensures free and timely access to health services and prevents duplication of efforts. It entails extensive planning and networking, engaging key players and orchestrating care. For young doctors and medical students, it may seem overwhelming. Yet, if successful, it is a real exercise in medical leadership.

FMDS AND MEDICAL VOLUNTEERISM

FMDs are an example of medical volunteerism and an expression of good intentions in response to urgent needs within vulnerable communities. Such initiatives are spontaneous in many cases. Occasionally, however, the intentions of organisers and volunteers may go off track. This drift has been described among volunteers in community health programmes and medical service trips.^6,7 International volunteering has been associated with ‘exploitation and neo colonialism’, the latter as a cause and a consequence.⁸ Medical volunteerism including FMDs, therefore, needs to be structured within a clear, ethical framework that prioritises the benefit of the community served and protects it from potential harm.

FMDs are the culmination of good intentions, hard work, and genuine interest in serving the community. However, measures need to be taken to ensure continuity of services beyond FMDs and preserve their moral essence. The zealous spirit of young doctors who deeply believe in health as a right remains pivotal for such initiatives to survive and blossom in times of crisis.