Massey University Departments
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Item An exploration of the role of short term medical missions in health care provision in Honduras : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Development Studies at Massey University, Turitea, Palmerston North, New Zealand(Massey University, 2005) McLennan, Sharon Joy; McLennan, Sharon JoyShort term medical missions, or medical brigades are teams of expatriate health professionals and lay people, who travel to Latin America and other parts of the world for a week or two to provide health care to the poor. While the number and popularity of these teams appears to be increasing, to date there has been little literature or critical research addressing their role. This thesis addresses the role of Short Term Medical Missions (STMMs), who they are, what they do and how they fit into health service provision in developing nations. In particular it outlines the services provided by STMMs, including clinical services, resource provision and preventative services, it discusses the motivation for using STMMs as service providers and it also begins to explore the impact they have on the populations and on local health care services in the areas they operate. This is done within the context of Honduras, a nation that has seen an influx of these teams in recent years, particularly since Hurricane Mitch in 1998. Honduras faces many challenges in health and health care and STMMs have been seen by some as a means of “filling gaps”. This study questions whether STMMs are indeed actually filling real gaps, and if they are, whether they most appropriate means of doing so, as there are many limitations to the ability of short term, outside volunteers to provide quality services. While not directly measuring the impact of STMMs on the health status of the population, this study discusses the actual and potential impact of STMMs on local health services, and argues that there are potential long-term consequences to their use. These consequences include an increasing dependency on outside assistance that may be detrimental to the long-term development of National health services.Item Community participation in health development in Thailand : a thesis presented in fulfillment of the requirement for the degree of Doctor of Philosophy in Nursing at Massey University(Massey University, 1997) Tassniyom, NitThis thesis is a chronicle of research into the implementation of community participation in health development in Thailand. Community participation is recognised as the key concept of primary health care. Participation in this study has been conceptualised as power. Therefore, to participate is to achieve power, and participation is a process of empowerment. The research participants were health workers employed at the subdistrict health centre, and village health volunteers. These participant groups were chosen because the researcher perceived that they were groups with relatively little power in the Thai health service. The research involved the participants in a two stage process. The first stage was an examination of the concept of participation in relation to the community's experience with development projects. During this stage it became apparent to the researcher that the original concept of community participation was poorly understood by both participant groups. The second stage involved the use of participatory research to achieve community empowerment by supporting the participants in an analysis-action-reflection process. Dialogue, with equal respect between the researcher and participants, was the key method to encourage analysis of their existing situation in order to raise their awareness, the most important step of empowerment. Simultaneously, action research was also utilised to solve a selected health problem, dengue fever control. A comparison between the results of the implementation of action research processes and that of the participatory research processes utilised in this study revealed that participatory research better ensured community participation in health development. The findings provide an understanding of the theoretical concept of community participation in health development, and its enaction by the use of an empowerment process. The utilisation of a new primary health care approach, whereby the community is empowered to be self reliant and solve its own health problems, would depend on the acceptance and application of the empowerment approach by health workers. The empowerment approach would need to be pivotal in the work of all health personnel, including the implementation of policies and routine practice. Specifically, the empowerment approach has much to offer community health nursing and its adoption would support the World Health Organisation's recommendation that a problem-solving, process-oriented and community-based curriculum is necessary to adequately prepare these practitioners. The adoption of this approach would require expansion of the present curriculum to include not only public health science and nursing science concepts, but also those related to community development. The new curriculum would uniquely equip nurses to work in communities and this in turn would provide specialised knowledge for community health nursing, allowing it to be differentiated from other nursing specialties.