The ‘gringo’ doctors: how can we sustain their noble cause? – My personal perspective on sustainability and medical brigades

In 2015, I volunteered in a community project in Malawi. One inspiring community member I met there made a lasting impression on me. Imagine a tiny remote village, crossed by nothing more than dusty roads. The first individual you encounter along one of these dusty roads is Mercy, a fifty-year old woman with a smile from ear to ear. She kindly greets you with the Malawian saying ‘Muli bwanji? Ndili bwino kaya inu?’

Unfortunately, Mercy is part of the large group of people living with HIV. When I first participated in the agricultural activities of the HIV support group that Mercy is part of, I immediately noticed Mercy as the leader of the group, the one who works the hardest while joking around the most. I soon realised that Mercy has been of irreplaceable value in establishing this gathering of women living with HIV, as she was the first one to stand up and to start breaking the stigma around HIV in her community. Thanks to her initiative, these underprivileged women not only have a daily nutritious meal, but also gather for weekly support group meetings in which they learn to stay healthy and cope with their HIV status. Mercy’s courage to fight for her own rights and those of her peers sharing the same fate, while living a tough life herself, made a huge impression on me.

I participated in two medical brigades in the coastal communities of Panama and the Amazon of Ecuador both as a medical student and translator. The inspiring idea of serving remote communities that cannot visit a doctor without having to walk or boat for hours motivated me to contribute to the noble cause of medical service trips. But I believe that the most important aspect is to secure continuity and sustainability of care. Imagine what would happen if a group of ‘gringo’ medical professionals provides the best, warm-hearted, medical attention possible to a community, without working together with the somewhat ‘undernourished’ health care system in the region. Would the local government still be triggered to improve its health services? Or would the system start to rely on the arrival of the ‘gringo’ doctor every now and then?

In my view, the goal of the NGO behind a medical brigade should be to collaborate with the local government to improve its health care services. In this way, the NGO can make sure that, in the end, the communities they serve remain healthy without the services of the ‘gringo’ doctors.

During my medical service trip in Panama, no local medical professionals were involved in our work, we could not easily refer patients to the government health centre and, if a patient ran out of medication in the meantime, there was nothing he could do. I had a completely different experience in a similar brigade in Ecuador. I saw how this foundation did an incredible job by establishing a sustainable relationship with the Ecuadorian Ministry of Health, allowing us to refer our patients to the health centre when needed. Likewise, we worked together with the community health workers responsible for promoting health in their community and ensuring the continuity of care. I believe that working closely together with local health services and skilled community members incredibly enhances the success rate of a medical aid foundation.

Mercy, the Malawian woman who inspired me, is a great example of a person who can play an essential role in establishing a sustainable relationship with the local health care services. Moreover, such a person can safeguard the continuity of care by motivating local health care workers to shoulder responsibility for maintaining a healthy population. From my experiences with the different communities I have lived and worked in until now, I believe that people like Mercy exist in every society. I have always met wonderful people who acknowledge the challenges their community faces and are eager to gather their group of likeminded people together to find a solution. I believe we would miss out on a great opportunity if we were to exclude their strengths and capabilities from our strategy to improve the lives of their neighbours.