Five billion people around the word lack access to safe surgical care (International Journal of Surgery Open 2021;28:202:63-9). Approximately $4 billion is spent annually on medical mission trips to provide medical services to countries in need (Global Health 2016;12:45). Despite this, a dire need continues to exist. The SARS-CoV-2 pandemic temporarily halted many humanitarian outreach missions, further exacerbating existing global inequities. The questions we must now ask are not only how we can help bridge this gap, but how we can strengthen our efforts in promoting sustainable change within the communities we seek to serve.

“Residents who have participated in such initiatives have reported an improved adaptability to new health care settings, communication with patients and professionals from different backgrounds, and increased cost-consciousness in medicine, as well as a greater appreciation for the impact of culture on health.”

Engaging providers who are relatively early in training, such as students, medical residents, and fellows, can foster a greater awareness and understanding of the needs that exist in the developing world. Residents who have participated in such initiatives have reported an improved adaptability to new health care settings, communication with patients and professionals from different backgrounds, and increased cost-consciousness in medicine, as well as a greater appreciation for the impact of culture on health (Med Teach 2014;36:1057-63). As we encounter greater diversity in the patients we will care for, these become increasingly invaluable lessons in cultural competency, which have the power to span an entire career in medicine and be transferred to the next generation of health care leaders.

Our institution’s medical mission program focuses on collaboration with host institutions in providing medical care and education, which are key elements in equipping our international partners with greater tools required to provide long-lasting and sustainable safe practices. Additionally, we are looking at innovative ways to incorporate telemedicine into our approach as we recognize this as a powerful tool that allows us to expand the discourse with our global partners. Although used before, the COVID-19 pandemic accelerated the progression of telehealth in international medicine. From consultations to assessments of critically ill patients, as well as daily “virtual rounds” between international partners, our conference rooms have become global playing fields.

Effective global engagement cannot be a single, isolated encounter, but rather a practice and awareness that span an entire career. Global engagement should strive to be a bidirectional effort in which providers on both sides learn from one another for a common purpose. A significant factor is the often-inequitable power dynamic as it pertains to medical mission trips and global health initiatives. Eichenbaum et al. state that “if global health is to be based on principles of equity, we must confront the historical legacies of colonialism that continue to perpetuate imbalanced power dynamics and inform attitudes and perspectives in our global health partnerships and educational programs” (Acad Med 2021;96:329-35). Stated another way, the aim of these initiatives should be to establish a discourse on a level playing field with the intention of empowering providers in the developing world to create a change that is widespread and long-lasting. At our institution, we have initiated a collaborative approach to our international medical mission program that includes trips by our multidisciplinary team of health care providers, as well as multiple “host missions” where we welcome various physicians from our affiliate medical centers to observe our practices. This continued engagement with our global partners is paramount in creating a long-lasting relationship that has the potential for positive change in practices and patient safety. These critical steps empower providers to become global health leaders in their own countries, which will ultimately improve the quality of care that patients receive.

As we hope to emerge from the COVID-19 global pandemic and begin to resume some sense of normalcy, health care providers from the developed world will continue to be at the forefront of the effort to expand safe practices to global regions with the most need. One of the most important aspects of our roles is our continued focus on quality of care and education in the developing world. This has less to do with performing a predetermined number of surgical procedures, which may risk devaluing and alienating local providers, and more with fostering a robust working relationship with host institutions to significantly impact regional practices. These efforts underscore the importance, not only of siloed missions, but rather of continued bilateral global engagement, which at its best builds mutual trust and powerful relationships that can lead to safer and more evidence-based practices.