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Non-Governmental Hospital Ships

Short-term medical missions (STMMs) are a well-established means of providing health care to the developing world. Despite over 250 million dollars and thousands of volunteer hours dedicated to STMMs, there is a lack of standardized evaluation to assess patient safety, quality control, and mission impact. Short-term medical missions (STMMs) have become a well-established vehicle for extending the reach of health care professionals to the developing world. They appeal to physicians and other medical professionals due to their unique combination of philanthropy and direct approach to patient care. The National Library of Medicine MeSH heading defines "Medical Missions, Official" as "travel by a group of physicians to a foreign country for the purpose of making a special study or of undertaking a special study of a short-term duration. This broad definition encompasses a wide range of services, ranging from surgical missions providing craniofacial reconstruction or cataract extraction to medical and/or pediatric missions providing care for acute illness and chronic disease.

These differences extend to the organizational structure of STMMs. Missions differ widely in size (2 to 90 health care providers per mission), budget (from a few hundred dollars to $39 million in annual expenses), and duration (from 2 days to a month in length). Equally important, the emphasis on logistical detail is highly varied between missions. Paucity of follow-up data, poor relations with the local health care system, and lack of sustainability can challenge the good intentions of missions.

The number and popularity of STMMs have continued to rise, and considerable financial and human resources are expended on providing these services. While there is no official or complete compendium of medical missions, a search of the 3 largest mission websites - the International Healthcare Opportunities Clearinghouse, Diversion Magazine, and - yielded a list of 543 medical mission organizations. Each of these organizations sends anywhere from 3 to 20 missions per year, for an annual total of approximately 6,000 short-term missions sent to foreign countries from the United States. Some of these STMMs are large and well recognized, such as Mercy Ships, Project Hope, and Operation Smile, but the majority is sponsored by smaller groups and is known only to the people directly involved with the missions. Thus, with the 543 organizations listed sending an average of 10 missions per year at an average expenditure of $50,000 per mission, a very conservative estimate of annual expenditure on STMMs is $250 million but may be considerably more than that.

Increasing numbers of American and European surgeons are volunteering to go on short-term medical mission trips to African and Asian countries. Although motivated by genuine humanitarian concerns, such projects may serve to promote 'medical tourism' rather than significant improvements in the medical infrastructure of the countries where these problems exist. There are practical and ethical questions that ought to be asked about trips of this kind. Strategies are needed to help insure that unintended harm does not result from such projects. The importance of accurate data collection, thoughtful study design, critical ethical oversight, logistical and financial support systems, and the importance of nurturing local capacity are stressed. The most critical elements in the development of successful programs are a commitment to developing holistic approaches that meet the multifaceted needs of the patients and identifying and supporting a patient champions who can provide passionate advocacy at the local level to sustain the momentum necessary to make long-term success a reality for such programs.

Individuals who travel for charitable purposes such as on a short-term medical mission or construction project, can deduct the travel and lodging expenses as well as a per diem meal allowance based on the U.S. Government's maximum per diem allowance. Financial contributions to support short-term mission trips by others are generally considered tax deductible; however, in accordance with IRS regulations, these designated offerings are subject to the governing board's control and discretion. When contributions for a particular individual exceed trip expenses, or if that volunteer is unable to participate on the trip, the governing board may redirect contributions to another activity within the recipient's short-term mission program.

A number of NGOs have worked aboard US Navy hospital ships during deployments in 2005. Project HOPE "is dedicated to providing lasting solutions to health problems, with the mission of helping people to help themselves." and has ongoing missions across five continents.Aloha Medical Mission is an NGO with ongoing missions to "provide free and voluntary medical, surgical and other health-related services, supplies and equipment to medically indigent areas of the Philippines, Southeast Asia, and the Pacific." The International Relief Team (IRT) is an "internal relief organization dedicated to organizing volunteer teams to provide medical and non-medical assistance to victims of disaster and profound poverty worldwide." Save the Children "is an independent organization creating lasting change in the lives of children in need in the United States and around the world. They ensure that children can survive and thrive, and that their families, and communities have the resources and skills to enable them to do so."

Non-governmental organizations operate white-hulled "mercy ships" that operate in the waters off developing countries providing medical care to those in need. The ships do not bear red crosses but in other respects appear similar to military medical ships. The Second Geneva Convention and Additional Protocol I made provisions for hospital ships owned or operated by neutral states, private citizens, officially recognized relief societies, and impartial international humanitarian organizations [Geneva II, articles 24-25, p. 231, and Additional Protocol I, article 22(2)]. One of the primary conditions for such ships to receive the same protections as military hospital ships is that they have to be made available to or under the control of a state party to the conflict. The presence of hospital ships not under the control of a party to the conflict would certainly complicate the targeting solution if they operate in waters near belligerent activities.

SS Hope

William Walsh, M.D., founded Project HOPE [Health Opportunities for People Everywhere] in 1958 and acquired the mothballed World War II hospital ship, USNS Consolation. Dr. Walsh persuaded President Eisenhower to donate a U.S. Navy hospital ship, the U.S.S. Consolation. With $150, a dream, and the support of corporations and individuals, the ship was transformed into the S.S. HOPE, and the organization known as Project HOPE was born. Over the next two years, the S.S. HOPE was refitted and equipped for its new role as a peace-time hospital ship. The call was put out for American doctors, nurses, and technologists to share their skills and knowledge with the people of developing nations - teaching while healing. For every American on board, there would be a counterpart to be trained.

Finally, on September 22, 1960, the S.S. HOPE set sail from San Francisco bound for Indonesia. It contained three operating rooms. Although the SS HOPE was much smaller than current naval hospital ships, it fit the core mission of Project HOPE well - to teach and assist local doctors and nurses.1 Project HOPE characterized this as "helping people to help themselves," which differed from most overseas medical services that emphasized patient care. Project HOPE leaders often quoted the Chinese proverb, "To feed a person for a day, give him a fish. To feed him for a lifetime, teach him to fish."

Between March 1960 and September 1974 Consolation operated under charter as the civilian hospital ship Hope. The SS HOPE, the world's first peacetime hospital ship, voyaged outside the United States eight times between 1960 and 1973. She completed 11 voyages between 1960 and 1973, traveling to Indonesia, South Vietnam, Peru, Ecuador, Guinea, Nicaragua, Colombia, Sri Lanka, Tunisia, Jamaica, and Brazil. Project HOPE abandoned the ship due to its high expense. Retired in 1974, the SS HOPE survives as the model for the ASA Overseas Teaching Program (OTP). Consolation was stricken from the Navy Register in September 1974 and sold by the Maritime Administration in January 1975 for scrapping.

Mercy Ships

Mercy Ships is a global charity operating hospital ships since 1978 in developing nations to bring medical, relief, and developmental assistance to the poor and needy in third world developing nations. It operates hospital ships as a platform for providing thousands of specialized surgeries to patients in the developing world. Mercy Ships is the leader in using hospital ships to deliver free world-class specialized healthcare & community development services to the poor.

Mercy Ships' other programs within the health sector include HIV/AIDS, mother and child nutrition, child development, and community health education. Mercy Ships implements activities in the areas of disaster relief, crop and livestock development, water and sanitation, vocational training, and education. Mercy Ships provides services primarily in Latin America and Africa. In addition to the platform of the hospital ships, Mercy Ships has established long-term development projects in Sierra Leone and Honduras.

Founded in 1978, the organization's 1,200 staff members and volunteers serve all people, regardless of race, religion, gender, or ethnic or national background. Since Mercy Ships began as an organization in 1978, it has treated over 200,000 people and donated over $25 million in medical supplies. Total expenses in the year 2005 were $35,799,826.

In 2004 the Senate Foreign Relations Committee encouraged USAID and the Office of the Global HIV/AIDS Coordinator to work with Mercy Ships on the development of a medical hospital aboard a ship to provide HIV/AIDS-related treatment and education to people from countries with high HIV infection rates.

The flagship of the Mercy Ships fleet for nearly three decades, the Anastasis retired in June 2007. Formerly the Victoria, the 1953-built Italian cruise liner became a Mercy Ship in 1978. The former passenger liner was modified to contain three fully-equipped operating rooms, a 40-bed hospital ward, a dental clinic, a laboratory, an X-ray unit, three cargo holds and accommodation for 420 crew. The 159-meter vessel carried a fleet of over 20 vehicles for onshore work. A volunteer crew of 350-400 from more than 30 nations served onboard. Over her 29 years of service, the Anastasis contributed more than half of Mercy Ships total output in terms of number of services, value and beneficiaries. In it's long history of service, an estimated 25,000 volunteer crew members served on the Anastasis. Over 250 couples met as crew, and several weddings were held onboard, including one at sea.

Formerly a Norwegian ferry (Polarys), the Caribbean Mercy was acquired by Mercy Ships in 1994. In 2006, she was sold to a family foundation to be renovated. In her 12-year history, the Caribbean Mercy contributed more than 20% of Mercy Ships total output in terms of number of services, value and beneficiaries, serving primarily in Central America and the Caribbean basin. While in port, she housed an average crew of 120 volunteers from more than 20 nations. The Caribbean Mercy offered an eye surgery unit, cargo capacity conference and seminar facilities used for a variety of programmes. Her fuel and water tanks provided a cruising range of 12 days, or 3600 miles. During her first 42 years, the ship only travelled within Norway. During her 12 years of service as a Mercy Ship, she visited 18 countries.

The former Newfoundland coastal ferry Petite Forte was donated to Mercy Ships in 1983. She sailed for 11 years as the Good Samaritan serving the Caribbean, Central and South America, until 1994 when she was renamed the Island Mercy and redeployed to the South Pacific where she served until 2001. The vessel went through extensive renovations including the building of operating theatres onboard. The ship was sold in 2001 to a Philippine interest. As the Good Samaritan, she carried cargo and personnel to the Pan-American games for the U.S. Olympic committee in 1991, and became the first ship to legally sail from the United States and Cuba in 30 years.

As the founding Executive Director of international healthcare charity Mercy Ships UK, Allan Guinan led the development of this now well established charity and developed a $60m campaign to launch the world's largest, state-of-the-art NGO hospital ship - Africa Mercy. A comparable new vessel would be more than double this price. The newest ship in the fleet, the Africa Mercy, is 499 feet in length and measures 16,572 GRT. Built in 1980 as a train and car ferry, the Ingrid was bought from Scandlines of Denmark. After being renovated from a rail ferry into a hospital ship, this vessel left England and is now in docked in Africa. With six operating theatres and a 78-bed ward the Africa Mercy is the world's largest non-governmental hospital ship. Mercy Ships UK executive director Allan Guinan said: "There is an ever-present and growing need for the provision of ship-based relief aid and hospital treatment in many parts of the world. In recent years this has stretched our existing fleet of three ships. This new vessel, once fully commissioned, will provide a vital new capability."

The hospital ship is expected to have a working life of around 30 years. The projected surgical capacity onboard the Africa Mercy is approximately 7,000 operations per year including, cataract removal/lens implant, tumor removal, cleft lip and palate reconstruction, orthopaedics and obstetric fistula repair.

Two million dollars worth of hospital supplies, equipment and materials are onboard, transforming this vessel from an empty shell into a state-of-the-art hospital ship and small village. In addition to the hospital supplies, essential goods including 26.8 tons of frozen meat and fish (four month supply), 8,800 pounds of breakfast cereal, 925 pounds of coffee (courtesy of Starbucks) and 3000 rolls of toilet paper (three month supply) have been loaded.

Crew on the Africa Mercy are volunteer professionals from around the world who pay monthly room and board costs while volunteering. Doctors, dentists, nurses, community developers, teachers, builders, cooks, seamen, engineers, and many others donate their time and skills to the effort.

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