Table 3.
Ethical Commitments and Considerations
| Service |
| The best interests and needs of each patient should always be the primary objective. |
| Ensure team “preparedness” for a particular project, including the ability of a group of providers to work together and a familiarization of the common medical problems, cultural beliefs, and local medical system of the host country.17 |
| Health providers should appropriately apply their training and acknowledge their limitations. |
| Visiting teams must have the capacity to exert flexibility in practice, accommodate local health provider and patients' needs, and have patience with project development.15 It remains imperative that as guests of a foreign country, visiting providers must respect the “local ways” of doing things. |
| Sustainability |
| Develop outcome assessments of patient care activities, patient safety, quality control, and overall mission impact.17 |
| Use education and “training the trainers” as a model of intervention. |
| Develop partnerships with local health agencies and supporting nongovernmental organizations. |
| Use medications available locally or through the WHO's list of Essential Medicines. |
| Develop a global health program curriculum with structured didactic sessions, peer-led seminars, journal clubs, and competency assessments.18 |
| Professionalism |
| Ensure that the same ethical patient care standards practiced in the United States are upheld to the same standards in underserved locations. |
| At a minimum, ensure that the community and health clinic are not left worse off as a result of the volunteerism effort. |
| Ensure that the exploitation of 1 partner (local health providers or patients) for the benefit of another is avoided at all cost.19 |
| Ensure that medical students, residents, and other visiting trainees have adequate supervision and mentorship to ensure quality of patient care. |
| Safety |
| Perform pre-travel medical assessments for all team members. |
| Ensure that team lodging, transportation, food and water, and security measures have been confirmed before travel. |
| Team members should be familiar with local laws, customs, and religious beliefs that directly affect interactions with patients. |
| Obtain appropriate approvals by local health organizations if visiting teams will be involved in direct patient care. |
| Outline an appropriate “exit strategy” in case of medical emergency or sudden political unrest. |
WHO = World Health Organization.