International Volunteer MedicineInternational Volunteer Medicine

To the Editor: In her A Piece of My Mind article entitled “Duffle Bag Medicine,” Ms Roberts¹ highlighted the pitfalls of practicing international medicine. Although agreeing with her suggestions for better integration of missions with local communities, as medical students we were dismayed by her generalizations that are based on observations of and conversations with a single group of missionaries. Opportunities to participate in respectful and integrative medical missions exist. In March 2006, the Eastern Virginia Medical School International Medicine Society sent 20 medical students, 2 faculty members, and 7 physicians (13 of whom spoke Spanish) to Honduras for a week. We partnered with Sociedad Amigos de los Niños (SAN), an organization founded 38 years ago by a Honduran nun, Sr Maria Rosa Leggol.

Roberts discussed how volunteers ignored cultural norms. However, SAN surveys the region by meeting with community leaders to determine local conditions and specific medical needs. A local Honduran physician educated our physicians about diseases specific to the area. Students only provided care within their level of training, including triage, translating, and organizing the pharmacy. SAN keeps detailed medical records, and patients with chronic illnesses are referred to regional clinics for continuing care. With roughly 30 groups volunteering each year, the 25 communities SAN supports are served every 3 to 4 months.

Roberts described overeager, irresponsible distribution of medications without accountability. She did not reference World Health Organization guidelines,² which were established to prevent such behavior and which state that all drug donations should be based on an expressed need and be relevant to the disease pattern in the recipient country.

Despite Roberts' reservations about the impacts of “duffle bag medicine” and her suggestion to “[restructure] how the volunteers interact with the community,” she fails to acknowledge that successful, culturally sensitive opportunities already exist. We hope that physicians are not discouraged by “Duffle Bag Medicine” but instead seek out integrative, sustainable organizations. Although groups such as those portrayed by Roberts no doubt exist, it is still possible to participate in responsible international medicine. Not all duffle bags are packed the same.