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Paper text:
bangladesh - korea friendship hospital is a governmental primary healthcare center in savar at the outskirts of dhaka .
it was built by the korea international cooperation agency ( koica ) in 1998 and donated to the bangladesh government . since then , koica has dispatched physicians specialized in internal medicine every 2 years . the hospital is a 2-story building equipped with 30 beds with specialists of internal medicine , general surgery , obstetrics / gynecology , and orthopedic surgery . after local adaptation training , i worked in the hospital from july 2011 to november 2013 .
the average number of patients referred to me during this period was 206.4 per month and 17.7 per day .
i reviewed medical records of patients with communicable diseases ( cds ) and ncds diagnosed in august 2011 - august 2012 to analyze the dynamics of the diseases .
records of out - patient lists , recorded by previous korean doctors on mission in 1999 , were also reviewed .
between 1999 and 2012 , proportion of patients with ncds referred to korean volunteer doctors increased from 75% to 83% , whereas that of patients with cds decreased from 25% to 17% ( table 1 ) . in bangladesh ,
ncds account for 59% of all deaths in bangladesh ( 4 ) . in terms of disability - adjusted life years ( dalys ) ,
ncds , including injuries , account for 61% of the total disease burden ( 5 ) .
the underlying causes are modifiable risk factors that are common for all countries ( 6 ) : tobacco use , inadequate consumption of fruits and vegetables , and physical inactivity .
the following rates of risk factors are recorded in bangladesh : tobacco use in rural males - 52% , urban males - 41% , in rural females - 29% , urban females - 17% ; fruits and vegetables consumption among adults - 3.2 and 1.7 per day , respectively ; physical inactivity among adults - 35% in males and 64% in females ( 7 ) .
easy access to the hospital improved detection and referral rates of diabetes mellitus in bangladesh - korea friendship hospital .
however , the lacks of diagnostic and therapeutic facilities , such as cardiac catheterization lab , are possibly responsible for the delayed diagnosis and inadequate treatment of cardiovascular disease .
many patients suffer from chronic respiratory disease , which is caused by indoor air pollution due to burning of solid fuel and high tobacco use .
there are many patients complaining of chronic myalgia and arthralgia ; most of them are blue collar workers in the garment factories near the hospital .
bangladesh - korea friendship hospital is one of the two governmental medical centers in savar upazila , providing free anti - tuberculosis treatment under the directly observed treatment short - course ( dots ) program .
many patients who can not afford the cost of the treatment are referred to that hospital .
medical missions of high - income countries offering services to lmics are intensifying globally ( 2 ) .
simple surgical interventions and distribution of medicines for acute infectious disease are the main services , which are offered during the short missions .
some experts have raised concerns about unintended consequences of such short volunteer services ( 891011121314 ) .
one of the issues is that patients with chronic ncds often require sustainable and systematic interventions over a long period .
although diagnostic and curative standards of ncds are common worldwide , patients in lmics are deprived of effective services due to socioeconomic and cultural factors ( 15 ) .
chronic care of ncds requires a clear understanding of the patients ' values and their active involvement in the management .
foreign doctors are encountering numerous difficulties in the interaction with local patients and healthcare specialists .
unavailability of essential chronic care services hinders the overall management of ncds ( 16 ) .
the lack of medical equipment , shortage of healthcare providers and weak referral system are among the factors lowering the efficiency of healthcare services .
paucity of medical records and follow - up data negatively affect continuity of chronic care services .
preventive measures as essential components for controlling chronic diseases ( 17 ) are too often neglected .
local health practitioners are also unaware of the importance of lifestyle modifications , and hospitals rarely employ screening tools .
many medical missions pay more attention to treating illnesses rather than preventing them , which is due to the lack of interest and intention to deliver preventative programs .
lack of finances is an impediment for regularly purchasing medicines , healthy nutritious food , and covering expenses for transportation .
foreign doctors on medical mission confront language barriers , leading to poor communication throughout the management of chronic conditions .
many volunteers have little knowledge of the depth of poverty and are unaware of the limits of local medical facilities and healthcare system . social and cultural factors and contradictions between indigenous and allopathic explanations of ill health question the efficacy of medical services rendered by foreign doctors .
to be successful in tackling ncds , long - term medical missions should prioritize preventive measures .
i presented several options for modeling sustainable medical missions ( 18 ) . identifying and managing modifiable risk factors
professionals skilled in addressing community healthcare needs should be recruited to serve in the most vulnerable areas .
it is also important to form a team with members from diverse specialist backgrounds capable of working with local community healthcare personnel .
such team should deliver cost - effective , affordable , and feasible services ( 19 ) .
provision of medicines and technologies should be effectively organized alongside with intensive logistical planning , financial support , training personnel , and institutional support for practitioners .
properly handled individual medical records and arrangements for referrals are important components of long - term care for ncds .
finally , volunteer specialists should receive extensive pre - departure training with courses of local language and cross - cultural communication . without proper preparation and collaboration , medical missions can be seen as self - serving ( providing value for only foreign visitors without meeting the local community 's needs ) , ineffective ( providing temporary , short - term therapies that fail to address the root causes ) and inappropriate ( failing to follow current standards of healthcare delivery or public programs ) ( 20 ) . to succeed in a medical mission for lmics , organizers of the work have to focus more on preventive strategies for ncds and recruit skilled and experienced professionals capable of supporting local community health personnel .
specialists of developing countries are facing the epidemic growth of noncommunicable diseases ( ncds ) . from 2011 to 2013 , 
 i , as a korean volunteer doctor , had been working in a local primary healthcare center in bangladesh , assessing rates of ncds . 
 proportion of patients with ncds was increased from 74.96% in 1999 to 83.05% in 2012 , particularly due to the spreading of diabetes mellitus , cardiovascular diseases , and tuberculosis . 
 to succeed in medical mission in developing countries , volunteer doctors have to take measures for preventing chronic diseases along with proper treatment .