My Research

The Short Version

After participating in, leading and hosting a myriad of short-term medical missions (STMM) in a variety of Latin American countries, it is time for my intellectual curiosity to catch up with my passion for service.  While I have immensely enjoyed every STMM I have participated in, their short-term nature has caused me to question their effect on the communities in which they work.  My research this summer will take place in one community that has been served by STMMs and will ask questions that elucidate how community members perceive and utilize the services of short-term medical teams.  

The Long (Official) Version  

Dominican perception and utilization of short-term medical missions

 in Consuelo, San Pedro de Macoris

Topic and Objectives: Short-term medical missions (STMM) have become an increasingly popular way for health professionals and pre-health students to get involved in providing health care to people in need. Conservative estimates show approximately 6000 short-term missions sent from the U.S. annually with annual expenditures of at least $250 million.[1] Though several authors[2] have raised questions regarding the ethics of such interventions, the proposed research seeks to move beyond general ethical questions to discover how those served by STMM compare them to and integrate them with their usual health care. In her ethnonursing study, conducted in a rural Dominican village 60 miles northwest of Santo Domingo, Gretchen Schumacher, PhD, found three themes surrounding Dominican’s health care decisions: “(a) family presence is essential for meaningful care experiences and care practices, (b) respect and attention are central to the meaning of care and (c) rural Dominicans both value and use generic (folk) and professional care practices”[3].  This study seeks to expand upon her research, testing the validity of the recurrent patterns and themes discovered in a semi-rural setting.  Additionally, this study will question how short-term medical missions (STMM) are perceived and utilized by the communities they seek to serve.

Contacts with individuals and institutions:  I will be working closely with Daniel and Shana Gower, resident American missionaries who have lived and worked in the Dominican Republic for seven years.  They have annually hosted short-term medical teams and have many ties within San Pedro de Macoris, where they reside, as well as the surrounding local communities.  My main contacts with medical health professionals will be doctors at Hospital Consuelo, a small semi-rural hospital in a community that regularly receives short-term medical teams. These doctors have volunteered with said teams in the past and have themselves conducted weeklong clinics in rural areas. Contacts with key informants, those who “reflect the norms, values, beliefs, and general lifeways of the culture,[4]” will be facilitated by the Gowers and/or through the doctors from Hospital Consuela. Because health is a highly personal subject and because I want to conduct interviews with those who have utilized STMM, either for themselves or someone in their family, I will use the snowballing method to gain contact with other key informants[5].

Anticipated length of stay, planned research agenda:  This research will be conducted during a five to six week stay in the Dominican Republic.  All interview methods and questions will undergo IRB approval prior to field research being conducted.  During the first week, interviews with local medical professionals will provide background on how the Dominican health care system operates practically in their communities.  These interviews will also provide insight into how medical professionals view short-term medical missions.  I will then spend four weeks in Consuela, a small, semi-rural community near San Pedro de Macoris, conducting semi-structured interviews aimed at elucidating the factors that go into making decisions regarding when and how Dominicans seek health care.  For a research schedule, see Appendix A.

 In a review on health care seeking behavior studies,[6] John Grundy and Peter Anneear of the Nossal Institute for Global Health suggest that in contrast to strictly quantitative studies, “qualitative or mixed methods approaches are more likely to capture both prevalence of behaviours according to specific health conditions and the rationale for specific HSB [health-seeking behavior] pathways” (10).  Therefore, my interviews will contain a few quantitative aspects, but will for the most part focus on obtaining qualitative information about how people compare and integrate STMM with their usual health care.  Initial shorter interviews (30-45 minutes) will identify key informants who will then be interviewed again for longer periods of time (1-2 hours).  For a list of proposed interview questions, see Appendix B.

Relevant Foreign Language Skills:  As a Spanish major who has spent a significant amount of time abroad, I am fluent in Spanish—speaking, writing and reading.  Thus, I will be able to conduct interviews and interact with Dominicans without need of an interpreter.

Comparison with past research on related topics/themes:  Past research has been done in the Dominican Republic and elsewhere on health-seeking behaviors; however, previous studies have usually focused on one specific disease and its related behaviors.[7]  The proposed research is more culturally based, as it seeks to understand how STMM are perceived and utilized by Dominicans.  As previously stated, this research relies heavily on Schumacher’s ethnonursing study as a starting point.  The interview methods will use in-depth interviews with key informants to elucidate cultural beliefs and relate them to practices.  However, my questions will focus on how the addition of STMM as a health care option affects her model and how STMM are viewed by Dominicans. Additionally, it will be conducted in a more urban setting that Schumacher’s research, closer to health care facilities, which could affect how her findings play out in this population.

Why is it important and to whom?     Upon my return, this research will form the basis of my independent study and senior honors thesis in the Spanish department, adding to the body of scholastic work produced by Duke undergraduates. 

Additionally, this research is relevant to organizations that send short-term medical teams and are seeking to better understand how the communities in which they work view them.  It is also relevant to local doctors and health care providers as they seek to find ways to effectively interact with visiting teams to better provide health care for the communities they serve.  The end goal of this research is to provide insight into how communities served by STMM perceive and utilize this form of healthcare.

---

[1] Maki, Jesse, et all. (2008) “Health impact assessment and short-term medical missions: A methods study to evaluate quality of care.”  Bio Med Central Health Services Research. (p. 2)

[2] Langowski, Michelle K. & Iltis, Ana S.. (2011) , Anderson, F.W.J. & Wansom, T.. (2009).

[3] Schumcacher, Gretchen. (2010) .“Culture Care Meanings, Beliefs, and Practices in Rural Dominican Republic.” Journal of Transcultural Nursing. 21:93-103. 

[4] Leininger, M. (2001). Culture care diversity and universality: A theory of nursing (2^nd ed.). Sudbury, MA: Jones & Bartlett. (p. 110).

[5] Snowballing is particularly applicable “…when the focus of the study is on a sensitive issue, possibly concerning a relatively private matter…” Biernacki and Waldorf. (1981). “Snowball Sampling: Problems and Techniques of Chain Referral Sampling.” Sociological Methods & Research. 10, 2: 141

[6] Grundy, John. (2010) “Health-seeking behaviour studies: a literature review of study design and methods with a focus on Cambodia.” Health Policy and Health Finance Knowledge Hub. 7: 1-14.

[7] Thind, Amardeep & Andersen, Ronald. (2003)., Person, Bobbie, et all. (2006),