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In April 2006, a thoughtful 2nd year medical student from Yale named Maya Roberts wrote an opinion article published in the Journal of the American Medical Association (JAMA) titled “Duffle Bag Medicine”. This article criticized many short-term medical relief trips that worked in communities with little regard to those communities’ residents. Many of these trips included non-medical volunteers acting in medical roles and the individual groups often had no long-term commitment to the community and lacked even the basic language skills to communicate with the residents.
Ms. Roberts (presumably now Dr. Roberts) pointed out that this approach to medical care would be unacceptable in the United States: poorly trained or untrained volunteers, inability to communicate effectively with a community’s residents, and lack of long-term connection with the community in question lead to unhappy and potentially dangerous results. At best, the medical relief trips may make little difference in the community members’ health and well being. At worst, the trips drain resources that could have been better used elsewhere and run the risk of causing harm or disruption in the community they intend to serve.
This is a great concern of ours. We do not want to fall into the “Duffle Bag Medicine” trap. We have sought a deep and ongoing engagement with the community of Paraiso. We have sought the community’s input throughout the project, and have developed a strong relationship with the community’s leaders: both official and unofficial. We have used a community-oriented focus throughout the medical efforts in the community. Untrained volunteers are not responsible for medical care, but rather work in support roles in the clinic and in community organzation and community development projects.
We recognize that the danger of causing inadvertent harm to the community is very high, and we realize that valuable resources are being used in our efforts in the Dominican Republic. We have sought to be responsible to all of our stakeholders–the community, the providers and other participants, and our supporters–to do right by all of them.
Our eventual goal is to help the community identify the issues that underlie the health of the community (water access, nutrition, etc) and to work with the community members as they develop their own responses to these issues. At the same time, we hope to enhance the medical care we can provide in Paraiso.
We are not providing duffel bag care. We are working with a community-oriented focus and have as a goal a stronger community which is able to address its own concerns and issues in the future–both at the community and medical levels.
(If interested, the JAMA citation is: JAMA 2006; 295(13): 1491-1492)