Tuesday, September 18, 2012

Best Practices and "Free" Medical Clinics

In poor rural areas, where income is very low, often those who are sick will try home remedies, teas, and herbs, before considering a visit to a doctor.  If there is a pharmacy nearby, they will prescribe their own medicine as in this country you don't need a doctor's prescription for most medicines. Neighbors will volunteer the names of medicines that have helped them with similar ailments.  Antibiotics, steroids, viagra, are all sold across the counter without a prescription.  The danger though is that they will misdiagnose their problem and hurt themselves.  They usually continue this home remedy treatment until they can't stand the pain anymore

The Pharmacy for a clinic at a church.
and are forced to go into the big town where there is a public hospital. Now that I think about it, in the U.S. we have people that put off seeing a doctor, but not because they can't afford it (though I think this is happening also), but because they have a fear of doctors and hospitals.  La Vega, where we live is one of these towns with a big public hospital. Treatment is free, conditions are poor, and families are expected to spend the day and night with the patient to make sure  the prescribed medicines are bought, and that the patient is well taken care of. I won't write about the waiting lists for operations that are common.  Considering the resources on hand the medical community is doing the very best they can.

All this was said to help you understand the impact a visiting missions medical team can have on spotting potential problems early.   And how by their directing the patients to the proper care they need, they may head off worse health conditions. Sometimes though we are not able to use to the fullest advantage these team visits.

 For instance, I remember hosting a medical team that brought in medicine and doctors and volunteers to help with a free medical clinic in a rural area.  It went great except that it was almost a madhouse.  Every
one, and their neighbors, and their kids, showed up for the event.  It didn't matter if you were sick or not, you got to see a doctor and receive prayer and free medicine.  This sounds fine except that the amount they could reasonably examine in a day was 300 families or individuals.  This meant that they probably saw maybe 100 patients that actually needed to see a doctor, and 200 that didn't.   But at least every family
This clinic was well organized with local doctors pitching in to help.

member received some medicine that they could perhaps use down the road.  The children received vitamins, and cough syrups, and children's tylenol.  The problem is how to truly make the best use of the team, to make sure that those who have real medical needs are being taken care of.

A veteran medical missionary friend of mine was severely criticized by one of these visiting teams because he decided to charge a small token price for each patient.  He helped us understand the value or reasoning behind the small charge.

1) If you don't charge anything, even in rural settings, there is a question about the value or worth of the clinic.  "You get what you pay for" is a cross-cultural maxim.  If it's free it may not have much value.

2)  By charging a small fee it helps to filter out those who are coming just for hand-outs and actually have no medical need.  The caring relatives of the individual in need will help find the funds if he has no money.  Families pitch in especially for their elderly sick.   We are talking less then.50 cents US.  This means that more of those who truly need to see a doctor will be examined.  Especially when there is a limit on how many patients a team can see in a day. This also helps foster a more serious atmosphere for treatment.

3)  Some of these clinics will last three days in an area.  By charging you are insuring that the same patients are not coming back again the next day.  Usually, a family is counted as one number, and their children will get checked with the adults.

4)  These collected finances can help sometimes to replenish the pharmacy when unexpectantly a medicine is exhausted.  We have run out before to buy parasite medicine, or baby tylenol.

5)  It helps the patients to keep more of their human dignity or worth.  In fact they feel freer to ask questions since they are paying for their care, however humble the price.  You are helping to break the "handout" mentality.

6) Also, the local church is usually the site of the clinic and the church members have worked hard to make sure there is order and that ministry is happening during the event. Every patient is prayed for.  How nice when the pastor can receive an offering at the end to help with a church need.  Maybe buy a few more chairs for the church, or a gas lamp to light the services when the power(electricity) goes off.  This is not uncommon in rural settings.

Recently the term "better practices" has been heard frequently in missions circles.  I think that we need to think through some of our practices and see if they represent the best use of God's resources.  Sharpening the tools God gives us helps us to do a more effective job.  Maybe these thoughts will nudge in the right direction.

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