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Background Various governments in Ghana have tried to improve healthcare in the country. Despite these efforts, meeting health care needs is a growing concern to government and their citizens. Short term medical missions from other countries are one of the responses to meet the challenges of healthcare delivery in Ghana. This research aimed to understand Ghanaian perceptions of short-term missions from the narratives of host country staff involved. The study from which this paper is developed used a qualitative design, which combined a case study approach and political economy analysis involving in-depth interviews with 28 participants. Result Findings show short term medical mission programs in Ghana were largely undertaken in rural communities to address shortfalls in healthcare provision to these areas. The programs were often delivered free and were highly appreciated by communities and host institutions. While the contributions of STMM to health service provision have been noted, there were challenges associated with how they operated. The study found concerns over language and how volunteers effectively interacted with communities. Other identified challenges were the extent to which volunteers undermined local expertise, using fraudulent qualifications by some volunteers, and poor skills and lack of experience leading to wrong diagnoses sometimes. The study found a lack of awareness of rules requiring the registration of practitioners with national professional regulatory bodies, suggesting non enforcement of volunteers’ need for local certification. Conclusion Short Term Medical Missions appear to contribute to addressing some of the critical gaps in healthcare delivery. However, there is an urgent need to address the challenges of ineffective utilisation and lack of oversight of these programs to maximise their benefits.

Secrecy is often a central issue in discussions of artificial insemination with a donor's sperm, the oldest of the alternative methods of conception and one which has been used by a few hundred thousand families worldwide. Secrecy is a key issue for people involved in donor insemination. It is almost always surrounded by secrecy—secrecy about the identity of the donor, secrecy between the couple and their friends and family about what they are doing, and secrecy from the child conceived about his or her true origins. The secrecy inevitably produces some awkwardness at times, especially when family members and friends speculate, as they always do, about which parent a child resembles. The explanation for secrecy which is not often offered explicitly is the desire to protect the two fathers, both the sperm donor and the social/ legal father. Some physicians indicate a preference for secrecy based on a concern that it will be impossible to recruit sperm donors without a guarantee of anonymity.

This paper examines the goals of organizations that sponsor short-term volunteer trips in global health, whether they be NGO’s, faith-based, educational, or corporate organizations. Results from a U.S.-based national survey of 177 such organizations and 27 interviews with trip organizers suggest that organizations often sponsor volunteer trips to achieve goals that are quite different from the improvement of health outcomes in poor countries. While providing health services is often cited as the most important goal, volunteer activity is also considered important in enhancing the organizations’ reputation, recruitment and retention, and financial well-being. The prominence of other goals has the potential for diverting resources and focus from what is presumably the primary purpose of serving host communities in the most effective manner possible.

Background Growing concerns about the value and effectiveness of short-term volunteer trips intending to improve health in underserved Global South communities has driven the development of guidelines by multiple organizations and individuals. These are intended to mitigate potential harms and maximize benefits associated with such efforts. Method This paper analyzes 27 guidelines derived from a scoping review of the literature available in early 2017, describing their authorship, intended audiences, the aspects of short term medical missions (STMMs) they address, and their attention to guideline implementation. It further considers how these guidelines relate to the desires of host communities, as seen in studies of host country staff who work with volunteers. Results Existing guidelines are almost entirely written by and addressed to educators and practitioners in the Global North. There is broad consensus on key principles for responsible, effective, and ethical programs--need for host partners, proper preparation and supervision of visitors, needs assessment and evaluation, sustainability, and adherence to pertinent legal and ethical standards. Host country staff studies suggest agreement with the main elements of this guideline consensus, but they add the importance of mutual learning and respect for hosts. Conclusions Guidelines must be informed by research and policy directives from host countries that is now mostly absent. Also, a comprehensive strategy to support adherence to best practice guidelines is needed, given limited regulation and enforcement capacity in host country contexts and strong incentives for involved stakeholders to undertake or host STMMs that do not respect key principles. Electronic supplementary material The online version of this article (10.1186/s12992-018-0330-4) contains supplementary material, which is available to authorized users.

Objectives. Primary biliary cirrhosis (PBC) is the second most common reason for liver transplants among women in the USA. While survival rates are high, there is evidence of persistent problems post-transplant. This study aimed to identify significant contributors to quality of life (QOL) for women with PBC on waiting list (WL) and post-transplant (PT) and compare QOL in each group with US population norms. Design. A cross-sectional, two-group study design was used. Methods. WL and PT participants were recruited through medical centres and on-line. QOL was measured by the Short Form-36 and an indicator of Social QOL created for this study. A biopsychosocial model incorporating demographic, biomedical, psychological, and sociological factors guided choice of variables affecting QOL. Analyses examined (1) all factors for differences between WL and PT groups, (2) association between factors and QOL outcomes within each group, (3) multivariate regression of QOL on factors in the model for the sample as a whole, and (4) comparison of QOL outcomes with national norms. Results. One hundred women with PBC participated in the study, 25 on WL and 75 PT. Group comparisons showed improvement for PT participants in most biomedical and psychological variables and in QOL outcomes. QOL was related to many, but not all, of the variables in the model. In multivariate analysis, Fatigue, Depression, Coping, and Education – but not Transplant Status – were identified as indicators of QOL. Physical QOL improved significantly after 5 years PT, when it was no longer worse than national norms. Mental QOL remained worse than national norms despite distance in time from transplant. Conclusions. The model proved useful in identifying a range of factors that contributed to QOL for women with PBC before and after transplant. Recommendations were made for clinical practice to improve QOL through a combination of treatment and self-management.

This study explores stigma experienced by women with the autoimmune liver disease Primary Biliary Cirrhosis (PBC). Liver disease is commonly stigmatized due to an association with alcoholism and drug abuse, and persons with PBC may be subjected to stigma even though there is no etiological connection to substance use. Women with PBC (25 waiting list, 75 posttransplant), recruited through an online organization and two transplant centers, completed a survey regarding demographic, biomedical, psychological, and social contributors to overall quality of life (QOL). Two measures of stigma were analyzed in relation to the other variables and QOL. Open-ended questions concerned stigmatizing experiences and participants' reactions to them. Almost one in five reported experiencing stigmatizing behaviors from others, in particular from medical professionals, that resulted in hurt and anger. Higher stigma scores were associated with diminished mental and social dimensions of QOL as well as with greater uncertainty about illness, more symptoms from the disease and medication effects. Depression, fatigue, and age (younger) were key predictors of stigma. Those experiencing stigma should receive support and access to counseling. The knowledge and sensitivity of the public and medical professionals regarding the damage inflicted by stigmatizing any disease should be addressed through professional continuing education programs and public campaigns by organizations that support people with chronic liver disease.

Uncertainty is a frequent feature of chronic illness and can have a particularly important impact in the case of organ transplantation. This study of 100 women with primary biliary cirrhosis who were either waiting for or had already had a liver transplant focused on both changes in uncertainty with transplant and the correlates of uncertainty both pre- and post-transplant. While those who were post-transplant had significantly lower uncertainty scores (measured by the Mishel Uncertainty in Illness Scale-Adult Version-MUIS-A) than those on the waiting list, uncertainty was still persistent and associated with a reduced quality of life. The most significant factors in relation to uncertainty were fatigue, depression, anxiety, and dissatisfaction with medical information received. It is important for both patients and transplant team members to recognize the impact of uncertainty on a patient's well-being, both before and after a transplant, and to address the underlying factors that continue to compromise quality of life even after a life-saving procedure.

Objectives Fatigue is a nearly universal symptom of many chronic diseases, yet it is often poorly understood and underappreciated as a factor in quality of life (QOL). Generally, clinicians have relied on subjective measures of fatigue, if they consider it at all. This study uses well-validated instruments to examine fatigue as a predictor of QOL in women with primary biliary cirrhosis (PBC), an autoimmune, chronic liver disease. Methods Eighty-one women with PBC completed a survey that included measures of fatigue (Fatigue Impact Scale) and QOL (SF-36) as well as demographic variables (age, education) and medical information (symptoms, stage of illness, time since diagnosis). QOL results for the sample were compared with those of a nationally normed U.S. population. Bivariate and multivariate analyses were conducted to identify contributors to variation in QOL. Results Compared with national norms, QOL for this PBC population was significantly impaired. When all variables with bivariate significance in relation to QOL were included in multivariate analyses, results showed fatigue to be the primary predictor of QOL, including all 8 QOL scales and the 2 summary scales. Regression results, dominated by fatigue, explain 25–59% of the variance in QOL. Conclusions Fatigue has profound effects on every aspect of life for women with PBC—physical, social, emotional, and psychological. The results lead to recommendations for health care providers to assess fatigue in their patients with PBC and to take steps, where warranted, to mitigate its effects.