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Background

The last two decades have seen an increase in international volunteer work, with a major portion of that growing volume being medical related. Medical volunteer work may be sponsored by educational, non-governmental, and for-profit organizations and include trained professionals, students, and lay volunteers. While these trips are described in various ways, we will be using short-term experiences in global health (STEGH), where “short-term” refers to activities lasting several days to months and “global health” refers to medical activities in lower-resourced areas such as low- or middle-income countries (LMICs) by individuals from high-income countries (HICs).

While STEGHs can undoubtedly offer benefits to both volunteers and host communities, such as kindling a life-long interest in global health and providing access to medical care that may otherwise be unavailable, the effectiveness, ethics, and legality of such trips have been increasingly called into question. Common concerns include “volun-tourism” with lack of sustainability, the displacement or devaluing of local providers, programs that don’t match local needs, medical care being provided by participants without adequate training and/or expertise, failure to arrange follow-up care for patients, poor continuity of care, overburdening of hosts, and insufficient cross-cultural understanding.

Both of the authors have personally witnessed many of these concerns during their years spent living in LMICs. One example involved a group of medical providers on a two-week trip to Papua New Guinea to provide obstetric care to patients at a local hospital, where one of the authors was shadowing local providers. The visiting team proceeded to deliver babies using a high standard of care, but failed to engage in bidirectional learning or capacity building. Instead, they interacted very little with the local providers and made disparaging remarks about their practices. Furthermore, they had not arranged for translators so were unable to communicate with most of their patients. When it came time for them to leave, they noted that there was no refrigerator in the nursery for storing breastmilk, so they arranged a fundraiser to purchase a refrigerator without obtaining any input from the staff as to whether this met current needs, was a priority, or could be maintained. While this team’s behavior is easy to criticize, at the time, the author did not consider whether her shadowing experience provided any value to her local hosts or whether she was a burden to staff. While everyone in this situation had good intentions, when it comes to STEGHs, good intentions alone are not enough.

Recommendations

Concerns about the ethics and effectiveness of STEGHs can be mitigated by adhering to the following recommendations from Lasker and colleagues’ (2018) review of current guidelines for effective and ethical STEGHs, and Compton and colleagues’ (2021) actionable suggestions based off of that framework:

Resources

For more information on building and participating in ethical and impactful STEGHs:

  • Guidelines from the Association of American Medical Colleges for medical students engaging in international clinical experiences.
  • Lecture from the Harvey Institute for Global Health on ethics in short-term global health clinical experiences.
  • TEDx Dartmouth presentation with recommendations for building strong global health partnerships.

Conclusions

While STEGHs are sometimes perceived negatively due to the concerns described earlier, there have been many positive changes amongst these trips in recent years with numerous STEGHs being operated in an exemplary fashion that benefits host-communities and participants alike. As such, volunteers’ interest in providing medical care in low-resource areas should be encouraged when paired with ethical motives and a careful evaluation of the goals, implications, and practices of the project.

Photo Credit: ReSurge International - an organization that builds capacity during surgical volunteer trips through ongoing partnerships with host country reconstructive plastic surgeons, educational workshops informed by information gathered from working alongside local surgeons, and the identific of candidates and sites for new partnerships.

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