Charles Langston:Whatever happened to fly-in medical missions that got kayoed by the pandemic?

A year and Charles Langstona half into the COVID pandemic, we looked at medical fly-in missions, where health professionals from wealthy nations travel to low resource countries to set up and run short-term clinics for everything from dental care to cataract surgery. These missions, often as short as a week or two, are seen as both helpful and controversial. Criticisms abound: Fly-in staff may not understand the sort of care needed and may not be familiar with local culture and language. Untrained personnel sometimes provide services. There's no follow-up care. And there's been a lack of respect for host country health-care workers. A new emphasis on training and equipping local medical staff had recently begun emerging. Then came the pandemic. Travel restrictions led to widespread cancellation of fly-ins. Sociologist Judith Lasker, professor emerita of sociology at Lehigh University and author of Hoping to Help: The Promises and Pitfalls of Global Health Volunteering, has spent much of her career studying missions. We asked how such programs are faring now that the pandemic emergency is over. Here's her assessment.

Medical missions, pre-COVID

Short-term medical missions had been growing in popularity for decades and really took off after the turn of the 21st century. "More and more organizations were getting into the act — some church missions that often combined Bible study and medical clinics, more college students were joining clubs that linked them to NGOs that organized trips during school breaks, more universities were organizing global health programs and sending undergraduates, medical students, physical therapy students, you name it," says Lasker.

No one knows for certain how many Americans used to go on medical missions – the U.S. Census Bureau stopped asking about it years ago. In her book, published pre-COVID, Lasker estimated that at least 200,000 Americans volunteered on overseas medical missions each year.

What COVID did

"Everything came to a sudden halt. People couldn't fly. You couldn't leave the country; you couldn't go to host countries. People were afraid of being exposed to or spreading COVID if they traveled," Lasker says.

Some organizations shifted to shipping equipment and supplies directly to the countries. Some began directly funding local health-care professionals. And some switched to virtual platforms, training local health-care workers with live demonstrations over the internet.

A mixed picture on whether missions are making a comeback

How many organizations are currently active is a mystery – there's no central registry. "It's still a little early to see where this is all going to sort out numberwise," Lasker says.

There's been little research beyond a report from Christopher Dainton of McMaster University in Ontario, Canada, and colleagues. In early 2021, they looked at 359 primary care medical missions in Latin America and the Caribbean that had been active in 2015. They found that about a fifth of the organizations no longer existed or had no web presence. Of the 87 respondees, most reported that they're making some of the changes cited above to be more in tune with local needs.

Lasker herself has heard of various scenarios. Some faith-based groups have told her that they have not resumed fly-in missions because of security concerns or because the countries they visit have been less willing to allow them to come in. Others have said they are going back and operating as before.

Lasker also hears that funding is down. "People stopped donating to these organizations, and it's been a little hard to get back onto full-on funding," she says.

Changing attitudes toward medical missions

COVID may have accelerated the hesitancy to welcome outside help, she says. "With COVID, the poorer countries found they couldn't count on anybody from the richer countries to be there for their health needs and particularly for their COVID needs." It didn't help that the wealthier countries – what some now call the global minority countries — grabbed all the vaccines.

"There's a greater willingness now to say no to outsiders," says Lasker. More locally available health professionals and services, along with a move toward universal health care in some countries, have eased the need in some places.

"There's now a greater sense of control and capacity in many of the countries that have hosted mission programs. They know that they can actually do a lot themselves and that they don't have to say yes to whatever somebody from the outside offers them," she says.

The future of short-term missions

"I don't believe that the short-term visits are all terrible and should never go back," she says.

"I really need to emphasize that the vast majority of people involved in these programs are very devoted and work very hard and really want to make a difference. But if they decide what a community needs without the community deciding, then they're not accomplishing as much as they want to and are perpetuating harmful colonialist relationships."

And she says organizations are beginning to pay attention to recently published ethical guidelines, including the Brocher Declaration which she helped put together. It emphasizes equity in partnerships, sustainability and a focus on needs identified by the host communities. The declaration's publication in 2020 has been endorsed by more than 50 organizations around the world, from large international aid coalitions to small organizations.

Her conclusion: "I think that there's a lot of good that can be done, and I'd like to see it done better, as part of a mutual sustainable partnership. I'd like to see the people in the host countries be the ones who say how things should be done and what they need." And she has hope that what is coming back will be better. "There's a lot more activity and collaboration and agency on the part of people in global majority countries now."

Joanne Silberner is a freelance journalist and former health policy correspondent for NPR. She has covered global health issues since the outbreak of HIV.