International health

These organizations often go in harm's way to provide services to people affected by natural disaster or conflict. For example, Médecins Sans Frontières has lost members in the Darfur area, and Care International's Iraq Director, Margaret Hassan (a long-time Iraq resident with dual Iraqi-British citizenship) was brutally murdered on the Internet by Al Qaeda-affiliated terrorists for the "crime" of providing services equitably among Iraqis. International Medical Corps was begun in response to the suffering of the Afghan people after the Soviet invasion of 1979, and is adept at providing services in dangerous places (see Attacks on humanitarian workers).

One important characteristic of NGO work is that, in the "pure" sense, they provide services based solely upon need, without political, ethnic, religious, or other considerations. Thus, strictly speaking, religious missionary organizations that perform services as part of a proselytizing or evangelical campaign should be separated from the NGO category and simply be referred to as religious missionary organizations. Some religious relief organizations do provide services more as a duty or "charity", however, without requirements for the recipients to attend any preaching, prayer or other religious preconditions.

In another teamwork effort, the Assistant Secretary of Defense (Health Affairs) of the United States Department of Defense, as the DoD's senior medical officer, established the International Health Division in late 2007 to help coordinate military health doctrine and practices in international development. The International Health Division places great emphasis upon working with NGOs to provide sustainable, culturally-appropriate development activities around the world. While critics maintain that DoD does not provide aid equitably and without regard to political influence, the Asian tsunami of December, 2004 (due to the 2004 Indian Ocean earthquake) demonstrated that DoD was capable of working in a supporting role without regard to geopolitical gain. Indeed, the DoD was surprised at the unexpected degree of improvement in American prestige as a result of its role in Southeast Asia and months later, in the Pakistan earthquake. A similar event resulted in rapid mobilization of DoD resources in response to the 2007 Peru earthquake, Bangladeshi Typhoon Sidr[7] and Tropical Storm Nero in the Dominican Republic, all in the last half of 2007, with no reasonable expectation of material gain for America.

In 2005, then-Secretary of Defense Donald Rumsfeld signed DoD Directive 3000.05, "Stability, Security, Transition and Reconstruction Operations".[8] This document requires the DoD to assign Stability, Security, Transition and Reconstruction (SSTR) the same importance in planning and preparation as it gives to war.

The rationale for SSTR is intuitive: stability promotes rule of law and economic development. These provide the base for essential services such as education, public health and sanitation, law enforcement and fire suppression. Essential services, in turn, lead to increased stability and economic opportunity. Health in the general population, and in particular the labor force, is essential to productivity and consequent stability.[9]

Although these relationships are not necessarily linear, and there is no inherent guarantee of equitable distribution of wealth in a developing society, full employment and hope for the future may be powerful disincentives to conflict. In this way, the DoD, through SSTR operations, expects to prevent some potential conflicts and criminal activities.

The International Health Division, charged with policy implications of DoDD 3000.05, is located within the Office of the ASD(HA), reporting through Force Health Protection & Readiness. International Health develops DoD's policy on medical ethics and the practice of medicine in international health and development settings. International Health also identifies needs in developing nations and looks for non-governmental organizations (NGOs), intergovernmental organizations, and private voluntary organizations (PVOs) such as professional societies, that have the ability and expertise to address these problems. In this way, the NGOs develop helping relationships with the nations or regions they work in, fostering stability and sustainability.

Other DoD international health activities occurring on a regular basis include medical civic action projects (MEDCAPs), in which Army, Navy or Air Force medical assets provide direct care, sanitation, and other public health services to host nation (HN) locals. Such MEDCAPs are generally traced to the Vietnam war, when medical units and medical personnel assigned to combat units would organize field medical care to Vietnamese, Hmong and others. There is a growing realization among the military that MEDCAP care may not be the best model, if the result is merely handing out antibiotics for upper respiratory infections and anti-inflammatories for aches and pains. However, projects such as de-worming, dentistry, prenatal education and care, and veterinary care, when performed in conjunction with HN health authorities and the local health infrastructure, have indisputable and long-lasting benefits to the recipients.

Similar to MEDCAPs, the military performs Medical Readiness Training Exercises (MEDRETEs), Joint Combined Exchange Training (JCET), and Humanitarian-Civic Action (HCA) exercises, all of which may have direct and indirect services as a feature of the training.

Finally, the military has unparalleled logistical and lift capabilities to respond to humanitarian assistance/disaster response(HADR) needs.

In conjunction with the Uniformed Services University of the Health Sciences (USUHS), the Center for Disaster and Humanitarian Medicine (CDHAM) develops curriculum, teaches disaster and humanitarian assistance principles to graduate, medical, and post-doctoral students and publishes courses on incident command and other related topics. The handbook on military-NGO relations, "A Guide to Non-Governmental Organizations for the Military" is available free on-line.

Among more recent developments in the area, the formation of the American College of Academic International Medicine (ACAIM) provided a renewed impetus toward the consolidation and formalization of U.S. based coordination of Academic International Medicine (AIM) efforts across the multiple currently existing platforms . Since its inception, ACAIM galvanized the U.S. AIM community to action,[10] highlighting the need for the formation of cross-disciplinary, bi-directional International Medical Programs (IMPs) [11] that foster the sustainable development of AIM efforts while minimizing the deleterious effects of brain drain.[12]

Another aspect of ACAIM's overall mission and postulate is the need for healthcare institutions, both academic and non-academic, to recognize faculty efforts dedicated to International Medical Program development as valid expressions of academic contribution that should be granted credit equivalence with U.S. based medical outreach efforts.[13] Within such proposed framework, faculty members would receive academic RVU based credit for international work, with academic tracks formally recognizing International Medical Program contributions as equivalent to any other academic or educational work.[14]