| Humanitarian Medicine and the Lesson of Sustainability |
Whenever I share stories about participating in humanitarian medical missions, most people react with interest and usually express their own desires to do “something like that.” Humanitarian medicine is one of the most challenging, rewarding, and enlightening experiences a medical professional can have. We all work in health care presumably, because we want to use our knowledge, skills, and talents to improve the quality of life for everyone. There is something exciting about traveling to faraway places and practicing medicine without the comforts of home. Humanitarian medicine was not exactly what I expected at first. Of course I was challenged physically and emotionally; however, I was also challenged in ways I had never imagined. Ways which will forever change the way I look at medicine and its practice. I learned things about myself and my values which altered the way I look at the world and my place in it. This rich and rewarding experience also deepened my understanding and appreciation for the concept of sustainability in healthcare.
I am not talking about doing without such comforts as impressive hospital lobbies, or climate controlled environments, or convenient parking. Instead, how about dealing with the ethical dilemma of standing in front of the world’s largest floating hospital, owned by the richest and most powerful country on the planet, and telling the mother of a sick child we are unable to help? Or what about learning of the 22 year old female at our facility in need of a below the knee amputation, who wants to have the amputation, but cannot because she does not have the authority in her culture to make such a decision? What if you are handing out free eyeglasses and sunglasses after a hurricane devastated an area, believing you are helping, only to learn your “generosity” adversely affected the business of local optometrists who were trying to get their businesses back up and running? You have to ask yourself ,“Who am I helping? Am I doing this for the patients or am I doing this for myself?”
Aside from the introspection and overall feeling of fulfillment and accomplishment following such experiences, I returned from my experience in Fiji and Papua New Guinea with a completely new perspective on how I view healthcare in this country as well as the way we practice. One of the most important lessons is the concept of sustainability. No matter what the project is or how noble the cause, if a project is unsustainable its benefit will be temporary and fleeting. Humanitarian missions provide only temporary relief if they cannot be sustained. We realized this when we were in Fiji for only two weeks. We had the capability to perform complex surgical procedures; however, we had to avoid those procedures because the recovery and rehabilitation exceeded the capability of the host nation and we were not going to be there long enough to provide adequate, necessary care post-operatively. The same goes with healthcare in the United States. After all, if hospitals are unsustainable, there will be no health care.
Opportunities for sustainability include cost containment, energy and resource conservation, and waste management. When you have to walk to your venue while physically carrying all the supplies you plan to use, you become very sensitive to resource conservation. When there is no running water and you can only wash your hands with the hand sanitizer you have in your own pocket, you realize how difficult it must be for the local community to perform basic hand hygiene. Handwashing is among the most basic aspects of community health promotion and disease prevention, yet how can this behavior be sustained when there is little to no available soap or running water? These are very real issues of sustainability on the most basic level. While these are the more extreme examples, its importance cannot be overlooked.
Healthcare costs in the United States are the highest in the world and continue to rise at an unsustainable rate. As leaders, we are all seeking out ways to bend this cost curve. This total cost is comprised of a myriad number of contributing factors so it is imperative that each and every program is effective and sustainable for as long as necessary. Humanitarian medicine is a fantastic way to contribute to the common good, and the benefits of those experiences travel in both directions. We give of ourselves to help those in need. In return, we develop a better understanding of ways to improve our own healthcare system. No matter what project or initiative you are working on or starting, regardless of how important or noble, make sure the plan is sustainable. In doing so, not only will you ensure the success of the project, you will be contributing to the sustainability of our entire healthcare system. To me, that is very humanitarian.
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