Sorry to join this one so late - have been swamped with work and travel, and haven't gotten up on line much.

I will probably repeat stuff I've written before here, so apologies. Externally delivered assistance such as the ship medical missions, or traditional MEDCAPs, deliver some short-term health diplomacy, but fail to address the fundamental needs in these places.

I was listening to some right wing radio knucklehead last night while driving home from the train station, and he was ranting on about "give a man a fish, feed him for a day. Teach a man to fish, and feed him for life." He was directing this lecture toward the NGO community. Despite the obvious contradictions (some organizations aren't particularly motivated to work themselves out of jobs, which is what our work should really be all about), most major, successful NGOs these days figured out the capacity building deal quite some time ago, and the rant is about ten years out of date. However, these MEDCAPs are often the "give a man a fish" element of the cliche.

There have been recent exmples of which I am personnaly aware of the military and/or the USG parachuting clinics and hospitals into Afghanistan and HOA without a lot of consideration of existing public health capacities, gaps, and plans already underway (usually a race to see who can get a facility up and running and "branded" with the appropriate flag/logo). And this, despite having true public health specialists involved in the process who advised differing, more appropriate applications of resources. The incidents I've observed have pretty much been "so-and-so up the chain wants this to happen, and you need to MAKE IT HAPPEN!" So, someone gets a nice writeup on his/her OER Support Form, but little, if any consideration has been given to the sustainability of the facility created, and the anger that's going to develop as local residents see a dilapidated facility that was gifted to them not-too-long ago, and now of little use.

Perhaps some of this is a misapplication of approach? A tendancy to deliver shorter-term support, such as MEDCAPs or other emergency/relief-style services to places that would be better served with a longer term (and less sexy, less OER Support Form filling) introduction of public health capacity building programs. Capacity development is always a hell of a lot harder to quantify for bean counters thousands of miles away than is the number of bandaids delivered to a site.

Cheers,