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Medical aid must not lead to fragmented care

How Canada can better deliver humanitarian medical aid to other countries was the topic of a major workshop recently hosted by the Canadian Medical Association (CMA).

With representation from more than 25 Canadian medical organizations, universities, non-governmental organizations and charities, the meeting ended with a clear call to document current Canadian activities and programs prior to developing any national framework for providing care.

The workshop was prompted by a report prepared by the CMA that noted there are Canadian health care professionals who travel abroad to help in poor communities for strictly humanitarian reasons. Canada is one of the top four countries from which physicians provide voluntary short-term medical services.

However, the report added “this trend has raised a serious number of professional and ethical concerns, especially the fragmented, uncoordinated and ad hoc manner in which some choose to participate.”

The workshop focused on addressing these concerns, and more fully discussing issues of training, education, professionalism and ethics involved with delivery of humanitarian medicine.

Dr. Jeff Blackmer, CMA executive director of ethics, professionalism and international affairs – who helped organize the meeting – said it represents a watershed moment in helping the Canadian medical profession more effectively meet its humanitarian commitments to developing nations.

“We have a wealth of eager and committed medical students, residents and physicians who want to help, but we need to provide better tools and training for them to do so,” he said.

The British Medical Association (BMA) is an acknowledged expert in this field, and Vivienne Nathanson, BMA director of professional activities, provided opening and closing remarks.

She said the BMA’s role in supporting its membership to volunteer overseas has been critical in facilitating the successful work of British doctors in low-to-middle income countries. Part of this support has involved developing an ethics toolkit for medical students.

Another speaker, Dr. Shafik Dharmasi, associate professor at the University of British Columbia, highlighted what can happen if Canadian volunteers are not culturally sensitive and don’t respect human dignity.

Lisa Schwartz, associate professor, McMaster University, Hamilton, ON, followed this by noting many volunteer physicians and students may suffer moral distress when serving as volunteers. She said the attrition rate among returning Médecins Sans Frontières volunteers reaches as high as 50%.

Other speakers discussed the importance of proper training for medical volunteers, and the need to maximize the outcomes of short-term medical volunteerism through advocacy, research and innovation.

Nathanson closed by identifying the need for a Canadian organization to assist in coordinating humanitarian activities, and also for more outcomes research to identify where humanitarian medicine could make the most impact.

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