April 25, 2012
By David Martin
|Kevin Sykes studied the charts of 197 tonsillectomy patients at a Guatemalan hospital.|
Each year, physicians and other medical professionals in the United States spend thousands of hours in the developing world, repairing cleft palates, treating cholera and distributing medicine.
While admirable, these short-term medical missions go largely unevaluated. Teams return home with a sense of satisfaction but few objective measures of the quality of their work or its lasting impact. A recent University of Kansas Medical Center study was built on the idea that good intentions aren’t good enough. The seven-year review of outcomes is among the first of the kind.
Last June, a team from the department of otolaryngology traveled to Antigua, a city in the central highlands of Guatemala. A Catholic mission hospital there relies on physicians from KU and other institutions to perform tonsillectomies and provide other otolaryngic care.
Kevin Sykes, the department of otolaryngology’s clinical research director, made the trip. While his colleagues worked in the operating suites, he went looking for data.
Using the logbooks maintained by the hospital staff, Sykes created of a list of tonsillectomy patients who had been treated by KU’s mission teams from 2004 to 2010. He then matched the list to postoperative charts maintained by hospital staff.
Sykes, a Ph.D. candidate in health policy and management, gathered the information in an effort to evaluate the safety protocol the otolaryngology team uses. He tracked down charts for 197 of the 204 patients the team had treated over the years.
Some charts were electronic; others were written in Spanish. In any case, they were there. “In many cases, the data is available if people are willing to get it,” Sykes says.
Sykes was looking in the charts for signs of complications. With tonsillectomies, the primary concern is postoperative hemorrhage, which is most likely to develop within 14 days.
The study found documentation of complications in only three patients — well within the acceptable range. There were two instances of postoperative hemorrhage. The third patient returned to the hospital 24 hours after surgery with symptoms of dehydration. The mission team managed all the complications.
The study concludes that the otolaryngology team operates with adequate safety protocol. The paper was published in Otolaryngology — Head and Neck Surgery. Sykes collaborated with Keith Sale, M.D., assistant professor of otolaryngology, and Phong T. Le. Pamela Nicklaus, M.D., clinical associate professor of otolaryngology and pediatric otolaryngology fellowship director, is senior author.
Sale has participated in several medical missions. He made his first trip to Antigua in 2003, when he was chief resident. The tonsillectomy study, he says, “reassures us that we’re doing is right and that we’re not doing something that’s more harmful than good, despite our best intentions.”
Building relationships and lasting success
In researching the topic, Sykes found more than 70 papers on short-term medical service trips. Most of the literature, he says, focuses on procedure or falls under the category of commentary. “It all kind of comes down to the fact that we don’t really know what we’re doing,” he says.
Instead, volunteer medical professionals seem to operate on the belief that they care they provide is better than nothing. Doctors who cross borders want good outcomes, of course. But the academic rigor they apply at home is lacking. Sykes says medical volunteers court the danger of becoming tourists. “It’s a different person, almost, traveling,” he says.
Sykes recognizes that the limitations of his research. It’s possible, for instance, that the study did not capture all the complications experienced by the patients. From interviews, Sykes learned that some patients travel up to nine hours to receive care from the team. The hospital in Antigua provides lodging for patients who travel for surgery so that they can be near the facility in case of postoperative complications. Sykes acknowledges that it may not be practical for patients and their families to stay away from home for more than a week, however. “That’s just the reality of the freedom to move,” says Sykes, who is also working on a qualitative study based on the interviews with patients and families.
It’s also possible that patients who followed direction and remained close to the surgery center for 10 days experienced a secondary hemorrhage once they returned home. Still, the authors are confident the study assembled reliable information. Surgeons from KU often see the relatives of former patients on subsequent trips to Antigua, indicating a level of trust for the hospital staff as well as the visiting teams. “We spent a lot of time building relationships and developing relationships with the people who are there to make a short-term mission trip a long-term success,” Sale says.
Sykes understands the desire to work abroad for the public good. When he was in high school, he went with a faith-based group to Puerto Rico. He spent two months in Brazil on a medical mission. There was a time when he imagined himself working as a physician in Africa.
Sykes says the response from the volunteer medical community has been mostly positive. He wants to be seen as someone who contributes to the effort and not just criticizes it.
"My goal is not to stop the work," he says. "My goal is to improve the work."