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BACKGROUND: This study explores the impacts of attacks perpetrated in the context of armed conflict, to female health workers in three Colombian territories. METHODS: We conducted a document review of the reports and databases of the Colombian Truth Commission, 17 in-depth semi-structured interviews with experts on the national and regional armed conflict and the medical mission, and 26 female health workers who were victims of attacks. RESULTS: Experts and female health workers reported attacks to health activities, facilities, equipment, and personnel, including attacks to traditional doctors belonging to indigenous communities. The most frequent attacks were threats and retention of health personnel; theft of supplies and medicines; damage and use of infrastructure and means of transport for purposes other than health care; and hinderance of health service provision. The attacks occurred in a framework of structural violence that intersects with poverty, racism, and gender bias. The impacts of these attacks include gender-based violence, significant disruption of the lives of health workers, and physical, emotional, psychological, social, and economic effects on the victims and their families. The government response to protect victims and populations has been absent or insufficient. CONCLUSIONS: Attacks to health care were reported in all the studied territories obstructing adequate health care. Impacts of these attacks affect negatively the professional and personal life of the workers and are aggravated by structural violence and absent or little institutional response.

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OBJECTIVE: The frequency of humanitarian surgical mission trips has grown over recent decades. Unfortunately, research on patient outcomes from these trips has not increased proportionately. We aim to analyze the safety and efficacy of surgeries in a low- and middle-income country missions-based surgery center in Guatemala City, Guatemala, and identify factors that influence surgical outcomes. STUDY DESIGN: Retrospective cohort study. SETTING: Guatemalan surgery center is called the Moore Center. METHODS: Pediatric patients underwent otolaryngology surgery between 2017 and 2019. All patients required follow up. We analyzed the effect of patient, surgical, and geographic factors on follow up and complications with univariate and multivariate analyses. RESULTS:  A total of 1094 otolaryngologic surgeries were performed between 2017 to 2019, which comprised 37.4% adenotonsillectomies, 26.8% cleft lip (CL)/cleft palate (CP) repairs, 13.6% otologic, and 20% "other" surgeries. Patients traveled on average 88 km to the center (±164 km). Eighty-nine percent attended their first follow up and 55% attended their second. The 11% who missed their first follow up lived farther from the center (p < .001) and had a higher ASA classification (p < .001) than the 89% who did attend. Sixty-nine (6.3%) patients had 1 or more complications. CL/CP surgery was associated with more complications than other procedures (p < .001). Of 416 tonsillectomies, 4 patients (1%) had a bleeding episode with 2 requiring reoperation. CONCLUSION: This surgical center models effective surgical care in low-resource areas. Complications and follow-up length vary by diagnosis. Areas to improve include retaining complex patients for follow up and reducing complications for CL/CP repair.

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Abstract How might we define local innovation challenges that are user-centered but also address strategic goals, such as the Sustainable Development Goals (SDGs)? We propose a design process that introduces a relevant contribution to the practices of the Mission-oriented Innovation Policies (MIPs) field as it goes from Grand Societal Challenges (GSCs) to local innovation challenges, which are more relevant to local needs and capabilities of solution. The main goal of the design process is to go from a GSC, such as "access to health" and one of its missions, like "reducing chronic Non-Communicable Diseases (NCD)," to a more able-to-solve innovation challenge, passing by its mission, and different problems and aspects. Snowball sampling methods allow us to find and mobilize electable subjects and design thinking techniques to process problem mapping, election, and clustering, as well as create challenge statements. It was possible to translate GSC to the local reality while reducing contestation and complexity and producing a problem-grouped map with prioritization and three problem statements (challenges) with open phrasing and solution criteria to foster the users' desired outcomes.

Resumen ¿Cómo podemos definir desafíos locales de innovación local que estén centrados en el usuario pero que también aborden objetivos estratégicos, como los Objetivos de Desarrollo Sostenible (ODS)? Proponemos un proceso de diseño que introduce una contribución relevante a las prácticas en el campo de las políticas de innovación orientadas por misión (en inglés, Mission-oriented Innovation Policies - MIPs), ya que va desde los grandes desafíos sociales (en inglés, Grand Societal Challenges - GSCs), comenzando con los ODS, hasta los desafíos locales de innovación, que son más relevantes para necesidades locales y capacidades de solución. El objetivo principal del proceso de diseño es ir desde un GSC, como "acceso a la salud" y una de sus misiones, como "reducir las Enfermedades Crónicas No Transmisibles (ECNT)", a un desafío de innovación más concreto, pasando por la misión, y por diferentes problemas y aspectos. Los métodos de muestreo de bola de nieve nos permiten encontrar y movilizar sujetos elegibles, y técnicas de design thinking, procesar el mapeo, la elección y la agrupación de problemas; y crear declaraciones de desafío. Fue posible traducir GSC a la realidad local, al mismo tiempo que se reducía la contestación y la complejidad, y se producía un plano agrupado de problemas con priorización, y tres declaraciones de problemas (desafíos) con redacción abierta y criterios de solución para promover los resultados deseados por los usuarios.

Resumo Como podemos definir os desafios locais de inovação que são centrados no usuário, mas também abordam objetivos estratégicos, como os Objetivos de Desenvolvimento Sustentável (ODS)? Propomos um processo de design que apresenta uma contribuição relevante para as práticas no campo das políticas de inovação orientadas para a missão (em inglês, Mission-oriented Innovation Policies - MIPs), uma vez que vai dos grandes desafios societais (em inglês, Grand Societal Challenges - GSCs) aos desafios locais de inovação, que são mais relevantes para as necessidades locais e capacidades de solução. O principal objetivo do processo de desenho é passar de um GSC, como o "acesso à saúde" e uma de suas missões, como "reduzir as Doenças Crônicas Não Transmissíveis (DCNT)", para um desafio de inovação mais capaz de resolver, passando pela sua missão, diferentes problemas e aspectos. Os métodos de amostragem bola de neve nos permitem encontrar e mobilizar assuntos elegíveis e técnicas de design thinking para processar o mapeamento de problemas, eleição e agrupamento; e criar declarações de desafio. Foi possível traduzir o GSC para a realidade local, reduzindo a contestação e a complexidade, e produzindo um mapa agrupado de problemas com priorização e três declarações de problemas (desafios) com formulação aberta e critérios de solução para promover os resultados desejados pelos usuários.

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Introducción: Las redes sociales son formas de interacción social, que fomentan un intercambio dinámico entre personas, grupos e instituciones en contextos disímiles. Objetivo: Socializar la experiencia y los logros de la salud pública y la Colaboración Médica Cubana desde las redes sociales en Venezuela desde enero de 2021 hasta octubre de 2022. Métodos: Se realiza una investigación de tipo observacional descriptiva en el periodo comprendido desde enero de 2021 hasta octubre de 2022 y aplicado en la Misión Médica Cubana en Venezuela con una población de 14 213 profesionales de la salud dividida en 24 estados. Resultados: En el año 2021 se realizaron 21 tuitazos con un millón 876 898 tuits. Para el año 2022 Facebook se comportó con 32 489 seguidores, Twiter con 16 832, Instagram Cubacooperave, 3 905, Yotube.com/c/cubacooperave 2 830, Tiktok 890 y Telegram 371 suscriptores. Se realizaron 26 actividades nacionales, 11 Tuitazos y 15 Jornadas en las Redes, 144 en TV, 200 en Radio y 100 en la Prensa escrita. Conclusiones: El reto es utilizar la posibilidad que ofrece la tecnología para ampliar los horizontes del uso de las redes sociales, realizar acciones de alfabetización informacional dirigidas a los gestores y usuarios de las mismas en pos de una divulgación adecuada del trabajo en la Misión Médica Cubana en Venezuela.

Introduction: Social networks are forms of social interaction that foster a dynamic exchange among people, groups, and institutions in dissimilar contexts. Objective: To socialize the experience and achievements of public health and the Cuban Medical Collaboration in social networks in Venezuela from January 2021 to October 2022. Method: An observational descriptive research was conducted from January 2021 to October 2022 and applied to the Cuban Medical Mission in Venezuela in a population of 14 213 health professionals divided into 24 states. Results: In the year 2021, there was a total of 21 tweets with 1 876 898 tweets published. In 2022, the Facebook network had 32 489 followers; Twitter, 16 832; Instragram Cubacooperave, 3 905; the Yotube.com/c/Cubacooperave channel, 2 830; Tik Tok, 890; and Telegram had 371 subscribers. A total of 26 national activities such as 11 Tuits, 15 Network Events; 144 TV, 200 Radio, and 100 written Press activities were performed. Conclusions: The challenge is to use the possibility offered by technology to broaden the horizons of the use of social networks, as well as to establish information literacy actions directed towards the managers and users of these networks for the sake of an adequate dissemination of the work carried out by the Cuban Medical Mission in Venezuela.

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AIM: To foster equity and make health systems economically and environmentally more sustainable, Responsible Innovation in Health (RIH) calls for policy changes advocated by mission-oriented innovation policies. These policies focus, however, on instruments to foster the supply of innovations and neglect health policies that affect their uptake. Our study's aim is to inform policies that can support RIH by gaining insights into RIH-oriented entrepreneurs' experience with the policies that influence both the supply of, and the demand for their innovations. METHODS: We recruited 16 for-profit and not-for-profit organisations engaged in the production of RIH in Brazil and Canada in a longitudinal multiple case study. Our dataset includes three rounds of interviews (n = 48), self-reported data, and fieldnotes. We performed qualitative thematic analyses to identify across-cases patterns. FINDINGS: RIH-oriented entrepreneurs interact with supply side policies that support technology-led solutions because of their economic potential but that are misaligned with societal challenge-led solutions. They navigate demand side policies where market approval and physician incentives largely condition the uptake of technology-led solutions and where emerging policies bring some support to societal challenge-led solutions. Academic intermediaries that bridge supply and demand side policies may facilitate RIH, but our findings point to an overall lack of policy directionality that limits RIH. CONCLUSION: As mission-oriented innovation policies aim to steer innovation towards the tackling of societal challenges, they call for a major shift in the public sector's role. A comprehensive mission-oriented policy approach to RIH requires policy instruments that can align, orchestrate, and reconcile health priorities with a renewed understanding of innovation-led economic development.

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Introduction: Point-of-care ultrasound (POCUS) has enhanced patient care and safety around the world. Clinicians can now use a small diagnostic ultrasound imaging device to answer some binary clinical questions and manage patients more effectively. Since the COVID-19 pandemic, there has been a significant adoption of POCUS by clinicians worldwide. Materials and Methods: A basic cardiac POCUS training was conducted in Haiti with focus on physics, instrumentation, and basic echocardiography. Results: The Mission POCUS team trained 15 Haitian physicians interested in better serving their patients with the implementation of POCUS cardiac in their patient assessment. Conclusion: POCUS skills will empower clinicians from around the world to make rapid and accurate diagnosis and help save lives by diagnosing life threatening conditions and manage patient appropriately. Our experience in Haiti showed that a short POCUS training course can help improve the knowledge of physicians.

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Resumen Un cirujano académico tiene características y atributos especiales que lo distinguen de otros cirujanos. Su misión no es solo asistencial, sino que además es un investigador, docente, comunicador, deber ejercer liderazgo, debe ser innovador. Además de su función primordial que es ofrecer la óptima atención de sus pacientes. Al estar inserto en un centro académico cumple estas funciones y se convierte, dado su prestigio, en un referente individual e institucional para la comunidad y los futuros cirujanos.

An academic surgeon has special characteristics and attributes that distinguish them from other surgeons. His mission is not only healthcare, but he is also a researcher, teacher, communicator, must exercise leadership, must be innovative and the final goal is his work is to offer optimal care for his patients. Being inserted in an academic center, it fulfills these functions and becomes, given its prestige, an individual and institutional reference for the community and future.

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When managing a constellation of nanosatellites, one may leverage this structure to improve the mission's quality-of-service (QoS) by optimally distributing the tasks during an orbit. In this sense, this research proposes an offline energy-aware task scheduling problem formulation regarding the specifics of constellations, by considering whether the tasks are individual, collective, or stimulated to be redundant. By providing such an optimization framework, the idea of estimating an offline task schedule can serve as a baseline for the constellation design phase. For example, given a particular orbit, from the simulation of an irradiance model, the engineer can estimate how the mission value is affected by the inclusion or exclusion of individuals objects. The proposed model, given in the form of a multi-objective mixed-integer linear programming model, is illustrated in this work for several illustrative scenarios considering different sets of tasks and constellations. We also perform an analysis of the Pareto-optimal frontier of the problem, identifying the feasible trade-off points between constellation and individual tasks. This information can be useful to the decision-maker (mission operator) when planning the behavior in orbit.

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To determine how submarine groundwater discharge (SGD) magnitudes and composition (fresh or saline/recirculated) vary in nearshore low inflow estuaries across ⁓125 km of a semiarid coastline, this study assessed three south Texas estuaries, using radon [222Rn], radium [226Ra and 224Ra], and water isotopes [δ18O and δD]. Mass balance models of time-series 222Rn, found to be representative of total SGD in this study, revealed much higher SGD inputs to the Nueces Estuary (average [x̅] Nueces, Corpus Christi and Oso Bays: 120, 83, and 44 cm·d-1, respectively), attributed to anthropogenically-disturbed substrates and potentially surfacing growth-faults. The lowest 222Rn-derived SGD occurred in the Upper Laguna Madre Estuary (x̅: Upper Laguna Madre and Baffin Bay: 21 and 18 cm·d-1, respectively), explained by the drier climate, lower anthropogenic disturbance, and neighboring groundwater cone of depression. Aransas Bay in the Mission Aransas Estuary received greater average annual precipitation but exhibited low total SGD rates (x̅: 23 cm·d-1). Seasonally, average 222Rn-derived SGD rates increased following Hurricane Harvey (43 cm·d-1 in spring to 64 cm·d-1 in summer). In the Nueces Estuary, the overall 222Rn-derived SGDs were substantially higher than SGDs from 224Ra and 226Ra. The closer agreement between 224Ra and 222Rn-derived SGD and larger 224Ra rates in the Upper Laguna Madre Estuary, Aransas Bay and Oso Bay indicate that saline/recirculated SGD contributions were significant. Values of δ18O and δD confirm these types of inputs, with effects of evaporation/salinization more pronounced where recirculation was predominant and the opposite where terrestrial/222Rn-derived SGD inputs dominate. 226Ra-derived SGDs were lower than the 224Ra due to different behavior of the two isotopes while released into water following transport through saline and fine-grained estuarine sediments or due to wind-driven disturbances.

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Unmanned underwater vehicles perform inspection and maintenance tasks in complex and changing environments. Some of these tasks require synchronous navigation of multiple vehicles, which is challenging. This paper proposes a synchronous navigation scheme for two BlueROV2 underwater vehicles for a coordinated multi-vehicle task. In the proposed scheme, the vehicles perform the collaborative task of grasping, transporting, and releasing an object. In this scheme, no vehicle-to-vehicle communication is required. A model-free second-order sliding mode controller with finite-time convergence is used to accomplish this task. The controller's convergence time is user-defined and does not depend on the physical or hydrodynamic parameters of the vehicle, unlike the other finite-time controllers found in the literature. Simulation experiments were conducted to verify the controller's performance, including high ocean currents as external disturbances. Comparisons were made with two state-of-the-art controllers with finite-time convergence. The results showed that the proposed controller achieved the best results, as the user-defined convergence time was achieved for both vehicles and the collaborative task was completed, no ripples, deviations, or oscillations were observed, and no chattering occurred. The results proved the robustness of the controller in the presence of high ocean currents without the need to readjust the parameters.

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Maderas Rainforest Conservancy (MRC) was incorporated as a conservation nonprofit organization in 2008, and manages two sites where biological field courses have been offered since the 1990s: La Suerte Biological Research Station in Costa Rica, and Ometepe Biological Research Station in Nicaragua. MRC employs a One Health approach to conservation education, and can serve as a model for other biological field sites. The Nicaraguan Molina family, who owns the sites, partnered with primatologist Paul Garber in 1994 to develop a primate field course aimed at introducing university students to field research. Through using their land to further conservation education and research, the Molina family has preserved the forest and engaged the local communities near their sites. Eight graduate theses and 46 refereed publications have been completed since 2010 based on research undertaken at MRC sites. While primate field courses have been offered at least once annually since 1994 and remain popular, a range of other ecological courses are now additionally offered. MRC operates from a One Health perspective, engaging in forest restoration and ecological monitoring projects, and has gradually expanded community outreach initiatives. MRC now conducts regular medical and veterinary missions in the communities surrounding the research stations which provide health care to local people and limit the population growth of domestic animals, thereby increasing the survival of wild animals. MRC is also active in ESL-teaching and conservation education, and funds Proyecto Jade, which empowers local women to make and sell organic jewelry. Through these programs, MRC works to help the local communities live more sustainably with the environment around them. MRC's support of research, commitment to education, medical and veterinary missions, and outreach initiatives to the local community all work together for the well-being of both the people and the environment, thus exemplifying the One Health perspective.

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Introduction Food insecurity directly influences health outcomes and is an important consideration for medical missions seeking to address chronic disease, particularly those serving disaster-prone communities. The region of Peru in which we held an inaugural mission is vulnerable to developing food insecurity following natural disasters. We, therefore, sought to evaluate food insecurity to understand the community's needs and inform future public health efforts. Methods In this cross-sectional pilot study, a convenience sample representing the households of patients attending a student-run health fair at the community medical center in Chincha, Peru was assessed for food insecurity. An adult female (n = 30) of each randomly selected family attending the fair was asked to complete the Household Food Security Survey (HFSS) developed by the US Department of Agriculture. The survey items were aggregated into a single, continuous food security scale reflecting the severity of hunger within a household. Results Two-thirds of respondents (n = 20) acknowledged anxiety about having enough food at home over the past 12 months, making it the most common concern. Nearly three in five respondents were concerned about their ability to provide a balanced diet. We found that 16.7% of all households were food insecure with severe hunger, 26.7% were food insecure with moderate hunger, 30% were food insecure without hunger, and 26.7% were food secure. Conclusion Nearly three-quarters of families attending our clinic experience some degree of food insecurity. Families with children were disproportionately affected. The high levels of food insecurity many years after a natural disaster support the development of future social programs such as food pantries. We intend to continue our partnership in Chincha and perform the HFSS survey on a periodic basis to monitor hunger.

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Based on the work-family enrichment theory, this study analyzes the contribution of work-family and family-work enrichment to explain the military's well-being during a peacekeeping mission. The data used were collected in a sample of 306 Brazilian soldiers, who were married and/or had children, during the phase named "employment of troops" (i.e., when peacekeepers had been in the Haitian territory and, as a result, away from their families, for between three to five months). Data analysis was performed using the Structural Equations Model. It was observed that the military's perception of their spouses' support for their participation during the mission had a positive relationship with both family-to-work enrichment and work-to-family enrichment, and the work-to-family enrichment mediated the relationship between the perception of the spouses' support and the military's health perception and general satisfaction with life. Theoretical and practical implications were discussed and limitations and suggestions for future research were presented.

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BACKGROUND: Diabetes is a growing concern in low-and middle-income countries. Medical missions play a role in increasing access to care and medicines, but often ignore non-communicable disease prevention and advanced management. Increased knowledge of local community needs and resources can lead to the development and implementation of pharmacist-supported interventions to improve diabetes management in rural areas. OBJECTIVES: The purpose of this study was to 1) understand the availability of monitoring for diabetes locally; and 2) describe knowledge and health beliefs regarding diabetes management for those with diabetes, and prevention among those at high risk of developing diabetes. METHODS: This qualitative evaluation used semi-structured interviews with key informants in a community in rural Honduras. Participants included those with diabetes, those at-risk for developing diabetes, and community leaders. Data was analyzed using thematic content analysis through an iterative process of coding and theme development. RESULTS: A total of 35 interviews were conducted with five resulting themes: 1) participants identified multiple barriers to diabetes management including access to monitoring, access to certain medications, and access to advanced levels of care; 2) participants acknowledge the relationship between lifestyle choices and diabetes control, but struggled with adherence to a healthy lifestyle; 3) participants identify that they have limited knowledge of diabetes pathophysiology, diabetes management, and strategies to prevent diabetes; 4) participants felt that opportunities existed within the community to support diabetes education and prevention, and 5) providers should integrate culture, societal norms, and religion in diabetes management. CONCLUSION: This research identifies challenges and resulting opportunities for managing diabetes in rural Honduras. Health care providers including pharmacy personnel should consider strategies to engage communities around self-care and diabetes education. Further, strategies are needed to enhance access to resources and essential medicines for diabetes management. These themes can guide clinicians in supporting communities to enhance diabetes care.

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Objective. To engage health professions students in a photo and caption sharing methodology to stimulate reflection and inculcate principles related to global health at a formative time in training. Methods. Undergraduate and graduate students from multiple colleges enrolled in a course that would prepare them for an in-country global health experience. As part of the course, participants took photos to illustrate one of three topics: global health ethics, interprofessional practice, or social determinants of health. The iterative and participatory photovoice process was used for students to analyze, discuss, and reflect on their work in country and upon return. Final photos with captions were displayed online. Researchers analyzed photos and captions using content analysis to identify unifying themes. All students were required to complete the photovoice assignment, but only those who gave informed consent were included in the qualitative analysis. Results. Twenty-six students were included in the analysis. Two overarching themes emerged: revelation and adaptation. Revelation encompassed novel elements that surprised the students, including differences and similarities between the United States and Ecuador. Coded segments related to adaptation discussed participants' resourcefulness while challenging work environments, and how they would apply this new perspective to their future practice in the United States. Conclusion. This global health photovoice project provided a unique medium for reflection for health care trainees. This project enhanced our understanding of the learners' perspectives and this new means of expression offered the learners a greater opportunity for deeper reflection. The assignment also revealed gaps in learning related to social determinants of health and areas of concern related to solidarity and privilege.

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BACKGROUND: Patient knowledge about arthritis and risks, benefits, and outcomes of joint arthroplasty in developing countries is unknown. We evaluated the effectiveness of a preoperative class on improving knowledge and decreasing anxiety during a surgical mission trip offering total joint arthroplasty. METHODS: A team of US health care providers taught a preoperative class to 41 patients selected for total joint arthroplasty during a surgical mission trip to Guyana. Participants completed a 32-point survey about arthritis; indications, risks, and benefits of joint arthroplasty; and postoperative, in-patient rehabilitation expectations. The State-Trait Anxiety Inventory was used to measure participant anxiety. Participants completed identical surveys before and after class. Matched-pairs Student t tests were used to compare means between preclass and postclass surveys. Significance was accepted at P < .05. RESULTS: Seventy-eight percent of patients (31 of 41) scored less than 12 of 32 possible points (40%) on the preclass knowledge questionnaire. Mean ± standard deviation knowledge scores improved from 14.0 ± 4.5 before the class to 16.5 ± 6.5 after the class (P = .008). Anxiety scores (n = 33) improved from 35 ± 13 before the class to 33 ± 12 after the class (P = .047). CONCLUSION: On this surgical mission trip, underserved patients' knowledge about total joint arthroplasty increased only modestly after taking a preoperative class. Greater understanding of how to educate patients and reduce their anxiety on medical missions is needed.

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OBJECTIVE: Primary objective is to determine the rate of intubation with inappropriately sized endotracheal tubes (ETTs) in a pediatric intensive care unit (PICU) in El Salvador. Secondary objective is to determine effectiveness of a video-based curriculum to teach local providers on pediatric advanced airway management and surgical approach to patients requiring airway reconstruction. METHODS: Data for 296 intubated pediatric patients was collected over a six month period in a 16-bed PICU in El Salvador. Results of a learning behavior assessment survey completed by local healthcare workers informed a curriculum to complement on-site education during annual surgical airway mission trips. The video-based curriculum addressed proper sizing and use of cuffed endotracheal tubes, care of the intubated child and perioperative considerations of the surgical airway patient. Providers completed pre and post-curriculum quizzes to measure knowledge acquisition. RESULTS: Over 6-months, 281 patients were intubated. Sixty-three percent had improperly sized ETTs. Thirty-one percent had a failed or accidental extubation. All-cause mortality was 24%. One hundred and fifty-nine Salvadorian providers completed a learning behavior survey informing a video-based curriculum. Sixty-four providers completed the curriculum. Post-curriculum quiz scores increased by 18.7%. Surgeons, anesthesiologist, intensivists and speech pathologists demonstrated significant improvement (p < 0.05). CONCLUSION: Nearly two-thirds of intubated patients in a PICU in El Salvador have improperly sized ETTs and one-third require reintubation following planned or accidental extubation. The development of this first of its kind video-based curriculum for critical care and surgical training regarding how to properly care for the intubated child is coupled with the development of a longitudinal database to record pediatric airway related morbidity and mortality in the largest pediatric hospital in El Salvador. This model and system can be used to track the reduction in airway related morbidity and mortality directly related to a systems based intervention both in El Salvador and then elsewhere.

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BACKGROUND: The purpose of this qualitative study was to assess the student-reported professional and personal value of a one-week service-learning trip to a Nicaraguan community. METHODS: Five pharmacy students who participated in a one-week service-learning trip to Jinotepe, Nicaragua were invited to participate in this study. Individual, semi-structured interviews were conducted following the trip. RESULTS: A variety of themes and subthemes surfaced, demonstrating the student-reported professional and personal value of the short-term service-learning experience. While each pharmacy student was impacted differently, common themes demonstrated transformative pharmacy student learning. These themes included recognition that every individual has a unique story that is essential to understanding how to care properly for that individual; the benefit of establishing a relationship with a community to more effectively and compassionately serve them; the importance of determining community-specific needs to ensure that service provided is beneficial; and recognition that those who are served have wisdom to offer healthcare providers. CONCLUSIONS: Short-term service-learning opportunities can provide impactful learning for pharmacy students. Established service-learning visits with a consistent host site allow for deeper and more trusting relationships, resulting in the ability to respond to the needs and requests of the partner organization in developing communities and not impose agendas. Organizers of service-learning trips must cater to the needs of the developing community to ensure that the trip is effective in providing value to the host site rather than creating unnecessary burdens and unanticipated hardship.

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Introduction There are more than 6,000 international medical mission trips that are conducted annually by United States medical teams. Successfully planning a medical mission trip relies on careful preparation. The objective of this study is to elucidate common chief concerns, diagnoses, and prescription patterns so that medical mission trip teams can effectively prepare for future medical mission trips in Jarabacoa, Dominican Republic, or similar international sites. Methods A retrospective chart review of 940 patient charts was conducted from two University of South Florida Latino Medical Student Association medical mission trips to Jarabacoa, Dominican Republic (DR) that took place during October 2017 and 2018. A coding system was utilized to categorize the data. The most common chief concerns, diagnoses, and medications prescribed were revealed. Findings were stratified further by age (<18 vs ≥18 years old) and sex. Results Our study reveals that 68.6% (n=597/870) of the patients were female and 59.2% (n=161/870) of males were under 18. The most common chief concerns were "cold/flu" (33.2%,n=289/870), gastrointestinal problems (20.3%, n=177/870), headache (20.0%, n=174/870), and musculoskeletal problems (12.0%, n=104/870). The most common diagnoses were viral syndrome (25.4%, n=221/870), presumed parasitic infection (16.9%, n=147/870), hypertension (12.6%, n=110/870), headache (10.6%, n=92/870), and musculoskeletal disorder (8.5%, n=74/870). The most frequently prescribed medications were acetaminophen (18.3%, n=291/1,587), albendazole (15.2%, n=241/1,587), nonsteroidal anti-inflammatory drugs (NSAIDs) (10.5%, n=166/1,587), antihistamines (6.1%, n=97/1,587), and antibiotics (5.9%, n=93/1,587). Conclusions Our study reveals potential areas for improvement of an annual, medical student-run medical mission trip to Jarabacoa, DR. Dedicated efforts should be made to address long-term management of chronic conditions identified or treated on medical mission trips. Community partnerships should be established to facilitate this. We hope this will encourage other medical mission trip teams to analyze their data in order to be more prepared for their trips.

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Resumo Apresenta aspectos da história e do acervo documental do Grace Memorial Hospital, instituição criada em 1926 na antiga cidade de Ponte Nova, atual Wagner, na Chapada Diamantina (BA), pelo médico e missionário presbiteriano norte-americano Walter Welcome Wood. O corpus documental está sob guarda da Universidade do Estado da Bahia, campus II, Alagoinhas, desde o encerramento definitivo das atividades do hospital, e constitui-se em fonte de pesquisa para diferentes áreas de estudo, especialmente para a história da assistência à saúde no Brasil. Os documentos auxiliam as análises sobre a incidência de doenças, tratamentos médicos e outros cuidados com a saúde em uma população que não tinha acesso a outras instituições que atuassem nesse âmbito.

Abstract The paper presents aspects of the history and archives of Grace Memorial Hospital, founded in 1926 in the former town of Ponte Nova, now Wagner, in the Chapada Diamantina region of Bahia state, Brazil, by the American Presbyterian missionary and doctor Walter Welcome Wood. The documents in question have been kept at the Universidade do Estado da Bahia, campus II, Alagoinhas, since the hospital closed down definitively. They constitute a source of research for different areas of scholarship, especially the history of healthcare in Brazil. The documents are used in analyses of the incidence of diseases, medical treatments, and other care given to a population that had no access to other institutions working in this area.

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