Neurologists in Medical Missions

November 25, 2015
Heidi Moawad, MD

While the typical services of medical missions are generally outside the realm of neurology, neurologists can provide unique and valuable care.

Medical mission trips are becoming popular among medical students, residents, and practicing physicians, both in cooperation with secular service groups and through religious organizations. Customarily, medical missions are focused on one-time, high value services such as vaccinations, maternal and child health, and surgeries.

The usual services provided by physicians are not part of the expertise of neurologists. In fact, a recent article from Neurology articulately pointed out a number of real, potential dangers that could develop as a direct result of short-term care provided by mission neurologists, including anticonvulsant withdrawal and medication toxicity.

However, specialists who offer personal narratives describing a role for neurologists in impoverished regions illustrate a unique effectiveness of visiting mission neurologists on patient and community care in settings with no resources as well as in settings with limited resources.

Neurology volunteers in regions where there are no resources for neurological care

Epilepsy  - No medical syndrome has been more misunderstood and vilified than epilepsy. While it is certainty true that starting a patient on a short-term supply of anticonvulsants does more harm than good, teaching patients and community members that epilepsy is a medical condition can alleviate social ostracism and violence against people with epilepsy and their families.

Using a practical approach, coaching patients and families to recognize a prodromal aura and even to try to identify seizure triggers has the potential for improving quality of life among patients in most societies, even those with no resources.

Malnutrition - Vitamin deficiencies can cause neurological illnesses such as myelopathy and neuropathy. A neurologist's role in educating patients about the real consequences of nutritional insufficiency of vitamins like B12 and folate can prevent lifelong handicaps.

Movement disorders - Parkinson disease is rarely life threatening, but is always concerning. Even in the absence of accessible prescription medications, patient education regarding the prognosis and lack of fatality can improve safety and mobility.

Neurology volunteers in regions where there are limited resources for neurological care

In regions with an established, year-round medical mission presence, a visiting volunteer neurologist can provide transient patient care using a tag team approach with other neurologists and with primary care providers. Medications may be available in some settings through pharmacies that dispense medication for cash or through contributions.

Neurologists in medical missions around the world have also been part of traveling clinics designed to visit patients in remote areas. The trust built up by medical volunteer teams through services such as cleaning wounds and extracting painful teeth, while seemingly different from direct neurological care for patients with epilepsy, can actually indirectly help patients with epilepsy, stroke, and movement disorders. When neurologists are part of a trusted team who has provided beneficial services in an immediately noticeable way, neurologists gain credibility that opens the door to educating the community. This can help break down myths about epilepsy and paralysis in ways that can help improve the quality of life of patients for years after the neurologist leaves.

Do you have thoughts or personal stories about the role of neurologists in medical mission work?

Berkowitz AL. Neurology mission(s) impossible. Neurology. 2014 Oct 14;83(16):1450-1452.