Dr. Comninellis has an extensive history in serving short term medical assignments in a multitude of countries across the world. He introduces his discussion with an emotional point of view and telling individual patient encounter stories where access to care is compared to how differently care might have been received here in the states. He also discusses the war in Angola, a Southern African nation, and the experiences of being a physician in an area where “there are more land mines per person than any other nation.” Dr. Comninellis should be highly respected for his faith in the healthcare system and willingness to also put his life in risk to be able to pursue his passion of helping those in countries with limited healthcare resources, however he also does an amazing job of educating listeners about the realistic nature of medical missions. Targeting younger populations, those seeking to enter the medical field, so many companies glorify medical mission trips, and it essentially becomes a business transaction for profit, however there are much deeper layers rooted in understanding the resources needed, cultural competency, and the need for long term continuity of care. With a short-term mentality, Dr. Comninellis was able to portray how it may not be ethically sound to enter countries with the intention of “helping,” however he demonstrated how through his experience of continued care and familiarity in cultural context, there are ethical ways to be beneficial and practice non-maleficence. He encourages us to think from a more educational and preventative viewpoint as medicine in the states is more treatable, with access to medications and technology, however in other countries - more so thinking of root problems such as water, sanitation, and basic nutrition. Dr. Comninellis has encouraged us to practice medicine ethically across the world using the mindset of being educated by hosts and programs that can teach the culturally relevant and proper way, to ensure long term efficacy, continued care, and essentially doing more overall good than harm and creating a disruption in a community we might not be completely aware and originally in tune with.
I would like to start this off by thanking Dr. Comninellis for sharing his knowledge and life experience with us today. This is a discussion that I have honestly never put much thought into, but I found it fascinating. It really odes to the fact that good intention does not mean that the result will be good. We talk a lot in ethics about beneficence and non-maleficence. Beneficence being to promote the most good and non-maleficence meaning to do no harm. Yes, it is a great thing when physicians go to a less fortunate part of the world to provide care, I am not saying that this is a bad thing by any means. I do believe though, that more thought needs to be put in ahead of time whether or not we are truly being beneficent by these practices. I think the example of the cursed babies that Dr. Comninellis presented fits this point precisely. He was attempting to be beneficent and non-maleficent however the result was malfeasance in relation to the mothers emotional health due to the language and cultural barriers that were not understood. Yes, the babies were healthy and protected, but in the process several barriers were breached. His intention was pure and his concern displayed that; however, the result was not what he wanted. These are the things that we do not really learn until we do it, which is why this is such a great talk and why other practitioners should watch before considering going to a foreign country. I think that in terms of non-maleficence we also need to do extensive research into the susceptibility of populations to disease. While we do have vaccines and treatments for a vast array of infections, we do not want to bring in new disease that will case epidemics or endemics while trying to solve other issues. Creating a new problem while trying to solve another is a futile effort at best. Regardless, I think Dr. Comninellis has done a great job of brining these issues to light and stimulating thoughts in other providers and I thank him for that. Thank you for reading.
As discussed by Dr. Comninellis, the creation of medical outreach trips stems from good intentions. Offering the opportunity to expand access to healthcare out of the United States, these trips follow the ethical principle of justice. That is, the equitable distribution of benefits and resources as defined by the National Institute of Health. However, as Dr. Comninellis discusses, the execution of a goal is just as important as the intention behind it. This is apparent through the criticisms that medical outreach trips face. The term “white savior complex,” follows the idea that the Western world feels entitled to “save” a community that might not need saving. Critics question whether those participating in medical outreach trips are doing more harm than good by showing up to a community for a week with barely any follow up. These criticisms are certainly fair and brings up the ethical principle of “beneficence.” As described by the NIH, this principle focuses on acting for the benefit of others. Is true beneficence being met through these trips if healthcare volunteers are only able to help these communities for a limited amount of time? Furthermore, are these communities actually benefiting from these trips if the healthcare providers are not being fully trained on how to provide diverse and culturally competent care? I appreciated Dr. Cominellis’ proposed solution to this ethical dilemma through the idea of focusing on committed continuity of care. That is, having healthcare providers be committed to their work in these communities outside of their one-week commitment. Prior to their trip, providers should be tasked with learning about the diverse cultures of their patient populations and how it might affect their healthcare decisions. After they leave, this proposed solution calls for continued care either through established health clinics or by frequently returning to these communities. One final suggestion that Dr. Cominellis recommended was the idea of being intentional about our help. Taking the time to listen to these communities and figure out what help they actually need. The video suggests ideas of providing the physicians within the community with access to materials or teaching their physicians new skills. This allows our healthcare community to uplift these populations, rather than trying to come in and impose Western medicine to communities that might not want it. Through these recommendations by Dr. Cominellis, I believe that true beneficence will be achieved. One aspect of medical outreach trips that I believe is necessary is the collaboration between the United States and these communities. Critiques have suggested that Americans come to “help” countries that may not want our help. This falls into the ethical principle of “autonomy.” Normally, physicians are expected to respect the right for each patient to make their own decision. Looking broadly, I believe that the American healthcare system should ensure that these countries they are aiming to help not only wants the help but acts as an active collaborator when deciding how America provides said help. With these standards, medical trips can certainly provide ethical help.
I would like to commend Dr. Nicholas Comninellis on his articulate and balanced views on medical missions and how to best execute them. I think it is safe to say that the healthcare professions, be it physicians, nurses, pharmacists, and many others, attract altruistic people with big hearts and the best of intentions. However, intention does not equate to impact. What has been particularly concerning to watch is a rising trend in "voluntourism" - this is when companies or other organizations combine volunteering with tourism. While this practice is not just restricted to the healthcare professions, it has become increasingly alluring to students and healthcare professionals alike. As Dr. Comninellis states, medical missions can benefit both the volunteers and the intended communities, however, they do raise both structural and ethical concerns. An ethical consideration Dr. Comninellis did not touch on was lack of training and expertise. Prior to medical school, I remember many of my pre-med classmates attending medical missions to nations facing structural and economic instability. Many of these programs do not require volunteers to have any formal training, licenses or qualifications. In this case, it is important to weigh the ethical principles of beneficence and non-maleficence. Healthcare providers take an oath to "do no harm" (non-maleficence). Furthermore, the ethical principle of beneficence requires healthcare workers to provide a "net benefit to patients: the benefits of an intervention must outweigh the burdens and be proportionate" (Lo, 2020). In allowing underqualified students, especially at the high school or undergraduate level, to serve beyond their scope in medical missions, challenges these very notions. This can lead to inadequate care and treatment for patients, along with the potential for medical harm. As Dr. Comninellis mentions, medical missions are often restricted to short-term impact. Healthcare professionals and students from other countries only have a certain number of days in the year to dedicate to a mission. Unfortunately, this can result in a lack of long-term solutions to complex healthcare inequities in nations struggling to provide care to their citizens. I agree with his solution to this issue of running missions alongside local clinics or organizations that are open year-round. The creation of a long-term plan and commitment to the region intended for service can greatly further the ethical principle of beneficence by effectively addressing the underlying health issues in the community. I greatly enjoyed Dr. Comninellis' s story about "lifting a curse" from a child he was treating, emphasizing that volunteers must have a deep understanding of the cultural practices and values of the communities they serve. This brings me to my last point: in the event that a medical mission is not carried out with the utmost cultural sensitivity, it can result in the infringement of patient autonomy. Patients may not understand the purpose of a local medical mission, and thus may not fully be able to provide informed consent for treatment.
Sources: Lo, B. (2020). Resolving Ethical Dilemmas: A Guide for Clinicians (6th edition). Wolters Kluwer.
Hi, thank you so much for this comment. You brought up a lot of intriguing points regarding voluntourism. I also want to comment on the idea of non-maleficence in terms of voluntourism. Regarding medical missions, I find that a majority of them involve going to the country, helping for a brief amount of time, and then leaving, which essentially leaves the community without proper medical resources until the next group of individuals come along, whenever that may be. Like you said, that can cause significant harm in these communities. I appreciate how Dr. Comniellis mentioned the idea of knowing the culture of the community that is being visited during these medical missions and his story emphasized the importance of this. If individuals truly wanted to follow the ethical pillar of non-maleficence, learning about the culture is the first step, as it builds trust. I personally have been on a medical mission through an organization at my undergraduate institution. The organization works with the local communities and asks them what they needed and we worked together to help them fulfil their needs. Additionally, multiple groups visit these communities year round to continue the work the last group left off with. Dr. Cominellis mentioned these ideas during his speech on how to improve the beneficence and non-maleficence of short-term medical missions. It’s good to see some organizations are working to make medical missions more ethical.
Short term medical missions are a very interesting ethical topic. I think the most interesting point is that the individuals who go on these trips have no mal intentions, yet many believe that these missions are fraught with harm. The ethical principles most relevant to this debate are non-maleficence and justice. Non-maleficence is the principle to do no harm. In these situations, it is hard to see what harm is being caused but it is important to think about what we allow in our country vs what happens on these medical missions. For example, healthcare professionals in training often go on these missions and are asked to preform skills they are not certified to perform in the United States of America like venipuncture, or blood withdrawal. Because of this fact, medical missions are seen as a way for students to get clinical experience without a certification and then afterwards spend a day on the beach or doing other tourist activates. This is ethically wrong because people in these countries are not test dummies or Guinea pigs, they are real living people who deserve the standard of care that we hold ourselves to back home. It is understandable that some argue these people who rather have access to this healthcare even if the standard is lower, and that may be true. However, it is the job of the medical mission to make these trips as ethical as possible by limiting the number of untrained individuals needing to do complex tasks. Now this brings up another problem with missions. The untrained individuals who are going on the trip are the people funding many of the supplies and other essentials that make these trips possible. I believe the best solution is to allow these individuals to help in clinics within their scope of practice. There are many roles in a clinic that do not requires certifications but just minimal training such as taking vitals, scribing for doctors, and taking history. The second ethical pillar that is entailed in the dilemma of medical missions is justice. Justice is defined as the most benefit for the most amount of people. Medical missions are providing a lot of good to a lot of people, but to outweigh the potential harm it is important for these missions to prioritize doing the ‘most good’ possible. Dr. Comninellis brings up many ways that the ‘most good’ on these trips is ensured. Most of these suggestions describe practicing medicine in a way that is ethical. This includes using interpreters for language. Even if someone speaks a little bit of Spanish or the language the patient speaks, medicine is complicated and fluency with language is required for optimal care. Culture also needs to be taken into account when treating patients around the world. Even though medical mission personnel may feel more superior to the individuals they are treating it is important that they restrain from inflicting their own cultural norms onto their patients and actually seek to have cultural competence in the place they are visitors. Lastly, missions can work to teach skills and knowledge to the native people in the country they are visiting. This allows for even more people to receive help and continuity of care can somewhat continue. Overall the best way to hold an ethical medical mission is to integrate into the community. Thank you Dr. Comninellis for such a great talk.
Dr. Comninellis has an extensive history in serving short term medical assignments in a multitude of countries across the world. He introduces his discussion with an emotional point of view and telling individual patient encounter stories where access to care is compared to how differently care might have been received here in the states. He also discusses the war in Angola, a Southern African nation, and the experiences of being a physician in an area where “there are more land mines per person than any other nation.” Dr. Comninellis should be highly respected for his faith in the healthcare system and willingness to also put his life in risk to be able to pursue his passion of helping those in countries with limited healthcare resources, however he also does an amazing job of educating listeners about the realistic nature of medical missions. Targeting younger populations, those seeking to enter the medical field, so many companies glorify medical mission trips, and it essentially becomes a business transaction for profit, however there are much deeper layers rooted in understanding the resources needed, cultural competency, and the need for long term continuity of care. With a short-term mentality, Dr. Comninellis was able to portray how it may not be ethically sound to enter countries with the intention of “helping,” however he demonstrated how through his experience of continued care and familiarity in cultural context, there are ethical ways to be beneficial and practice non-maleficence. He encourages us to think from a more educational and preventative viewpoint as medicine in the states is more treatable, with access to medications and technology, however in other countries - more so thinking of root problems such as water, sanitation, and basic nutrition. Dr. Comninellis has encouraged us to practice medicine ethically across the world using the mindset of being educated by hosts and programs that can teach the culturally relevant and proper way, to ensure long term efficacy, continued care, and essentially doing more overall good than harm and creating a disruption in a community we might not be completely aware and originally in tune with.
I would like to start this off by thanking Dr. Comninellis for sharing his knowledge and life experience with us today. This is a discussion that I have honestly never put much thought into, but I found it fascinating. It really odes to the fact that good intention does not mean that the result will be good. We talk a lot in ethics about beneficence and non-maleficence. Beneficence being to promote the most good and non-maleficence meaning to do no harm. Yes, it is a great thing when physicians go to a less fortunate part of the world to provide care, I am not saying that this is a bad thing by any means. I do believe though, that more thought needs to be put in ahead of time whether or not we are truly being beneficent by these practices. I think the example of the cursed babies that Dr. Comninellis presented fits this point precisely. He was attempting to be beneficent and non-maleficent however the result was malfeasance in relation to the mothers emotional health due to the language and cultural barriers that were not understood. Yes, the babies were healthy and protected, but in the process several barriers were breached. His intention was pure and his concern displayed that; however, the result was not what he wanted.
These are the things that we do not really learn until we do it, which is why this is such a great talk and why other practitioners should watch before considering going to a foreign country. I think that in terms of non-maleficence we also need to do extensive research into the susceptibility of populations to disease. While we do have vaccines and treatments for a vast array of infections, we do not want to bring in new disease that will case epidemics or endemics while trying to solve other issues. Creating a new problem while trying to solve another is a futile effort at best. Regardless, I think Dr. Comninellis has done a great job of brining these issues to light and stimulating thoughts in other providers and I thank him for that. Thank you for reading.
Well done. Dr Comninellis presents great insights well worth considering when planning international medical service.
You kept my attention! You are a great example of dedication. I hope there is some fun in your life as well!
As discussed by Dr. Comninellis, the creation of medical outreach trips stems from good intentions. Offering the opportunity to expand access to healthcare out of the United States, these trips follow the ethical principle of justice. That is, the equitable distribution of benefits and resources as defined by the National Institute of Health. However, as Dr. Comninellis discusses, the execution of a goal is just as important as the intention behind it. This is apparent through the criticisms that medical outreach trips face. The term “white savior complex,” follows the idea that the Western world feels entitled to “save” a community that might not need saving. Critics question whether those participating in medical outreach trips are doing more harm than good by showing up to a community for a week with barely any follow up. These criticisms are certainly fair and brings up the ethical principle of “beneficence.” As described by the NIH, this principle focuses on acting for the benefit of others. Is true beneficence being met through these trips if healthcare volunteers are only able to help these communities for a limited amount of time? Furthermore, are these communities actually benefiting from these trips if the healthcare providers are not being fully trained on how to provide diverse and culturally competent care? I appreciated Dr. Cominellis’ proposed solution to this ethical dilemma through the idea of focusing on committed continuity of care. That is, having healthcare providers be committed to their work in these communities outside of their one-week commitment. Prior to their trip, providers should be tasked with learning about the diverse cultures of their patient populations and how it might affect their healthcare decisions. After they leave, this proposed solution calls for continued care either through established health clinics or by frequently returning to these communities. One final suggestion that Dr. Cominellis recommended was the idea of being intentional about our help. Taking the time to listen to these communities and figure out what help they actually need. The video suggests ideas of providing the physicians within the community with access to materials or teaching their physicians new skills. This allows our healthcare community to uplift these populations, rather than trying to come in and impose Western medicine to communities that might not want it. Through these recommendations by Dr. Cominellis, I believe that true beneficence will be achieved. One aspect of medical outreach trips that I believe is necessary is the collaboration between the United States and these communities. Critiques have suggested that Americans come to “help” countries that may not want our help. This falls into the ethical principle of “autonomy.” Normally, physicians are expected to respect the right for each patient to make their own decision. Looking broadly, I believe that the American healthcare system should ensure that these countries they are aiming to help not only wants the help but acts as an active collaborator when deciding how America provides said help. With these standards, medical trips can certainly provide ethical help.
I would like to commend Dr. Nicholas Comninellis on his articulate and balanced views on medical missions and how to best execute them. I think it is safe to say that the healthcare professions, be it physicians, nurses, pharmacists, and many others, attract altruistic people with big hearts and the best of intentions. However, intention does not equate to impact. What has been particularly concerning to watch is a rising trend in "voluntourism" - this is when companies or other organizations combine volunteering with tourism. While this practice is not just restricted to the healthcare professions, it has become increasingly alluring to students and healthcare professionals alike. As Dr. Comninellis states, medical missions can benefit both the volunteers and the intended communities, however, they do raise both structural and ethical concerns.
An ethical consideration Dr. Comninellis did not touch on was lack of training and expertise. Prior to medical school, I remember many of my pre-med classmates attending medical missions to nations facing structural and economic instability. Many of these programs do not require volunteers to have any formal training, licenses or qualifications. In this case, it is important to weigh the ethical principles of beneficence and non-maleficence. Healthcare providers take an oath to "do no harm" (non-maleficence). Furthermore, the ethical principle of beneficence requires healthcare workers to provide a "net benefit to patients: the benefits of an intervention must outweigh the burdens and be proportionate" (Lo, 2020). In allowing underqualified students, especially at the high school or undergraduate level, to serve beyond their scope in medical missions, challenges these very notions. This can lead to inadequate care and treatment for patients, along with the potential for medical harm.
As Dr. Comninellis mentions, medical missions are often restricted to short-term impact. Healthcare professionals and students from other countries only have a certain number of days in the year to dedicate to a mission. Unfortunately, this can result in a lack of long-term solutions to complex healthcare inequities in nations struggling to provide care to their citizens. I agree with his solution to this issue of running missions alongside local clinics or organizations that are open year-round. The creation of a long-term plan and commitment to the region intended for service can greatly further the ethical principle of beneficence by effectively addressing the underlying health issues in the community.
I greatly enjoyed Dr. Comninellis' s story about "lifting a curse" from a child he was treating, emphasizing that volunteers must have a deep understanding of the cultural practices and values of the communities they serve. This brings me to my last point: in the event that a medical mission is not carried out with the utmost cultural sensitivity, it can result in the infringement of patient autonomy. Patients may not understand the purpose of a local medical mission, and thus may not fully be able to provide informed consent for treatment.
Sources:
Lo, B. (2020). Resolving Ethical Dilemmas: A Guide for Clinicians (6th edition). Wolters Kluwer.
Hi, thank you so much for this comment. You brought up a lot of intriguing points regarding voluntourism. I also want to comment on the idea of non-maleficence in terms of voluntourism. Regarding medical missions, I find that a majority of them involve going to the country, helping for a brief amount of time, and then leaving, which essentially leaves the community without proper medical resources until the next group of individuals come along, whenever that may be. Like you said, that can cause significant harm in these communities. I appreciate how Dr. Comniellis mentioned the idea of knowing the culture of the community that is being visited during these medical missions and his story emphasized the importance of this. If individuals truly wanted to follow the ethical pillar of non-maleficence, learning about the culture is the first step, as it builds trust.
I personally have been on a medical mission through an organization at my undergraduate institution. The organization works with the local communities and asks them what they needed and we worked together to help them fulfil their needs. Additionally, multiple groups visit these communities year round to continue the work the last group left off with. Dr. Cominellis mentioned these ideas during his speech on how to improve the beneficence and non-maleficence of short-term medical missions. It’s good to see some organizations are working to make medical missions more ethical.
Short term medical missions are a very interesting ethical topic. I think the most interesting point is that the individuals who go on these trips have no mal intentions, yet many believe that these missions are fraught with harm. The ethical principles most relevant to this debate are non-maleficence and justice. Non-maleficence is the principle to do no harm. In these situations, it is hard to see what harm is being caused but it is important to think about what we allow in our country vs what happens on these medical missions. For example, healthcare professionals in training often go on these missions and are asked to preform skills they are not certified to perform in the United States of America like venipuncture, or blood withdrawal. Because of this fact, medical missions are seen as a way for students to get clinical experience without a certification and then afterwards spend a day on the beach or doing other tourist activates. This is ethically wrong because people in these countries are not test dummies or Guinea pigs, they are real living people who deserve the standard of care that we hold ourselves to back home. It is understandable that some argue these people who rather have access to this healthcare even if the standard is lower, and that may be true. However, it is the job of the medical mission to make these trips as ethical as possible by limiting the number of untrained individuals needing to do complex tasks. Now this brings up another problem with missions. The untrained individuals who are going on the trip are the people funding many of the supplies and other essentials that make these trips possible. I believe the best solution is to allow these individuals to help in clinics within their scope of practice. There are many roles in a clinic that do not requires certifications but just minimal training such as taking vitals, scribing for doctors, and taking history. The second ethical pillar that is entailed in the dilemma of medical missions is justice. Justice is defined as the most benefit for the most amount of people. Medical missions are providing a lot of good to a lot of people, but to outweigh the potential harm it is important for these missions to prioritize doing the ‘most good’ possible. Dr. Comninellis brings up many ways that the ‘most good’ on these trips is ensured. Most of these suggestions describe practicing medicine in a way that is ethical. This includes using interpreters for language. Even if someone speaks a little bit of Spanish or the language the patient speaks, medicine is complicated and fluency with language is required for optimal care. Culture also needs to be taken into account when treating patients around the world. Even though medical mission personnel may feel more superior to the individuals they are treating it is important that they restrain from inflicting their own cultural norms onto their patients and actually seek to have cultural competence in the place they are visitors. Lastly, missions can work to teach skills and knowledge to the native people in the country they are visiting. This allows for even more people to receive help and continuity of care can somewhat continue. Overall the best way to hold an ethical medical mission is to integrate into the community. Thank you Dr. Comninellis for such a great talk.
Honest and helpful.thank you doctor.
Very inspirational!
Very good! My sentiments exactly.
thanks Doc.