Global health experiences – do they do more harm than good?
Summertime for many university students, reeling from aftermaths of their exams, may mean relaxing on the beach with friends. However, for many eager and forward-looking students, it is an opportunity to gain experience: international experience.
Today, one can hardly walk through a university campus without noticing posters taped to lamp posts or bulletin boards with words “international”, “service”, “volunteer” and “experience” highlighted across them. It is a growing trend among undergraduate or medical students to spend their summers working on projects in underprivileged settings around the world, ranging from providing shelter, teaching English, or gaining medical experience. The industry is growing at an exponential rate in North America and Europe, but are there potential pitfalls to these popular programs?
Imagine walking into a clinic and discovering a new face behind the doctor’s desk. You realize that it is a young physician, working alone and without knowledge of your language. You are seen briefly and told to limit your caffeine intake to “see if it helps” with your chief complaint of polyuria. What you do not realize, however, is that the “doctor” was in fact a first-year medical student, who did not have the training to rule out serious or fatal diagnoses for your symptoms. And if you thought things at your clinic were troubling, other first year students were performing surgeries in another clinic and bragging about it.
Unfortunately, this is not a fictional scenario, but an anecdote reported by a participant of a “global health experience” in Mexico.
Global health experiences are common: a 2012 survey of American and Canadian medical students reported 30% of graduates having participated in a global experience during medical school. Though it is unlikely that these ethically unjustifiable practices are the norm, it is alarming that recent studies suggest altruism may not be the motivation for participating in these opportunities. In interviews with 68 Canadian youth returning from short-term volunteer placements in the developing world, researchers reported “the desire to help others” ranked second-last among the most important motivations for their participation. The top three motivations were testing a career choice, cross-cultural understanding, and personal growth. Indeed, most youth justified their time spent in the host communities in personal, rather than humanitarian terms.
When vulnerable individuals and societies are considered mere stepping stones that lead to one’s self-improvement, does it not rob them of human dignity, and along with it our moral compass?
Equally important is that international volunteers very often lack cultural competency. Typically, we answer calls of support for student-oriented projects to “Africa” or “third-world countries” while not being fully informed of the cultural contexts of the destinations, whether community consultations had taken place, or if the project respects the local citizens who are on the receiving end of our benevolence.
This importance of understanding and being adaptive to the local community context was illustrated to me during a conversation with a leading international development organization. I discovered the group’s initial goal of providing literacy expanded into a clean water and alternative incomes project, upon their realization that children were unable to attend the newly constructed schools due to their obligation to spend hours securing potable water for their families, many of whom unable to afford the loss of their children’s assistance. Seemingly straightforward projects may need to be altered based on community input, but these voices may not be heard when learners “parachute” in and out of international projects. More broadly, I wonder whether one summer spent in an under-resourced community with limited support is truly long enough to justify benefit to anyone but the learners themselves.
Should we as students therefore cease our international volunteer efforts? No, but we need to be much more thoughtful about both our reasons for wanting to volunteer abroad, as well as what kinds of initiatives we should become involved with. Thoughtful engagement in development efforts based on mutual understanding and collaboration serves to benefit both learners and the communities that receive them. However, let there be no mistake that providing care to others is a privilege that requires accountability.
It can be difficult to ask probing questions of development efforts. We might worry that we will be perceived as lacking in generosity. Meaningful, constructive and balanced dialogue on the ethics of short-term international assignments can be perceived as opposition to the very concept of international aid. The result, unfortunately, is that we are too hesitant to say “no” to projects that are likely to cause more risks than benefits.
Our ability to probe and assess humanitarianism in our roles as participants or their supporters, no matter how difficult, is the compass that navigates us away from unintentional harm. Educational resources and theoretical frameworks have been developed and should be implemented as part of an accreditation body that provides certification to international service-learning providers. A quote I vividly recall from years ago rings true: while a perfect aseptic environment is not possible, it does not mean that we do surgeries in a sewer.
We can do better, and we must do better – good intentions are not good enough. It’s time that we ask some hard questions of these global health experience programs, and of ourselves, before signing up.
Yan Xu is a medical student at Queen’s University. He was the former coordinator of a student-directed seminar, “Ethics of International Service-Learning”, at the University of British Columbia.