“Students take the college of medicine to new heights,” reads a Michigan State University’s College of Medicine travel brochure, boasting an image of two white men in sunglasses, holding t-shirts of their medical school, atop Mount Kilimanjaro, Tanzania. In recent years, an increasing number of American pre-med and med students looking to “bolster [their] medical school [or residency] applications” choose to volunteer abroad. From short stints of one week to as long as three years, medical students traipse to so-called developing nations to “save” patients abroad. Such programs boast travel opportunities, a chance to practice “real medicine,” and gain professional skills. The rhetoric surrounding medical volunteers abroad is often congratulatory, which enforces the archetype of the morally pure, adventuring Western medical worker. The number of global health programs grew by over 400% between 2003 and 2009, as well as the amount of American and Canadian medical students who partook in volunteer experience abroad. Over one-quarter of all 2008 U.S. medical school graduates participated in a global health program abroad during medical school.
Secular medical volunteerism originated in the 1960s with the advent of non-governmental organizations in Western countries and the recognition of inadequate healthcare globally. Western doctors began traveling to “Third World” countries to apply their western-centric medical practices to foreign environments. Most of these programs for medical students are run through private for-profit organizations, such as Volunteering Solutions and International Volunteer HQ, where participants pay to attend. Despite their public approval, these opportunities perpetuate colonial imaginaries and negatively impact patients on the ground and the larger healthcare systems they touch.
Short term medical programs regularly have adverse effects on patients: medical students are overly confident and underqualified. Volunteers often perform medical procedures without the appropriate experience. From delivering infants to placing chest tubes in patients, to performing amputations, medical students overstep their qualifications in a desperate attempt to prove their prowess and provide assistance. Additionally, many medical students use these experiences as a ‘practicing ground.’ Oftentimes, patients are used to perfect students’ medical capacities; for example, a foreign medical team used impoverished children in Southeast Asia to train medical residents to operate on cleft lips and palates. Further, volunteers test out risky or difficult medical procedures on patients as opposed to using training dolls or simulations. For example, students and residents can go on “fistulae tours” in the Horn of Africa to attempt fistulae repairs, which are rare in the West. These actions, although they may have been conceived with good intentions, cross ethical lines, and often put patients in danger. Moreover, it enforces within medical students the notion that a lesser quality of health care can be applied in such a context and that their patients are unworthy of equal healthcare.
In addition, these medical volunteers often harm patients’ treatment plans. Medical volunteers stay for short periods of time, posing serious problems for patients who need follow-up care. For example, cleft palate patients require post-surgical care, such as follow-up visits to physicians or plastic surgeons, orthodontists, and speech therapists. Yet, many patients, such as those in the Philippines, are left unable to access these vital aspects of care when short-term medical missions depart quickly after performing the procedure.
Medical volunteer trips disrupt the functioning of local healthcare systems and divert urgently needed health care from patients. They slow down hospital function because local medical staff often have to train foreign volunteers in cultural norms or translate for them. Furthermore, these programs foster a sense of distrust from patients towards local practitioners. For example, Honduran physicians noted that some patients were forgoing local medical care to wait until the “better physicians” arrived from the U.S. Local providers are also unable to compete with the large volume of free healthcare from abroad, so many doctors are left unpaid and/or unemployed. This ultimately creates a system where local healthcare systems depend on foreign aid programs to function.
These programs also enforce a system that amplifies structural inequalities. Medical care in these programs is curative (rather than preventative) and vertical, focusing on treating singular diseases (such as tuberculosis), rather than addressing the larger array of influences (such as malnutrition, lack of clean water or immunizations) that facilitate the acquisition and spread of disease. This inattention to the wider needs of the people is exacerbated by the fact that the abundance of such programs curtail incentive for many governments to invest in local healthcare. For example, the Guatemalan government only considers the number of services per region (regardless of quality), when deciding where to build new medical infrastructure or invest public funds. Thus, just the presence of medical volunteer programs can divert resources from patients in need, which perpetuates systemic inequality.
Medical volunteer trips can place many people in danger and enforce standing inequalities. Rather than funding programs that ignore the larger healthcare problems, institutions should focus on ways to improve healthcare in resource-poor regions. For example, a study by Laura Montgomery, an anthropologist at Westmont college, suggested paying local health workers to work in underserved regions rather than sending in short-term foreign volunteers and subsidizing care for those unable to pay. Moreover, foreign institutions should look to invest in other aspects of healthcare, such as ensuring patients have access to proper infrastructure and clean water, in order to actually positively impact patients. One model these organizations should look to is Partners in Health. Partners in Health is a non-profit medical partnership organization that provides horizontal treatment plans, treating disease as a product of a patient’s socio-political environment in addition to the pathogen itself. For example, their work regarding tuberculosis in Peru catered to the patient by providing psychological support and social support (in some cases even monetary or nutritional supplements) and addressed the external factors influencing the spread of the disease. Additionally, Partners in Health incorporates visiting medical staff from the U.S., but also partners with local hospitals and governments to build healthcare systems, and trains local doctors and nurses to treat their communities, ultimately constructing an enduring solution to global health problems. Medical volunteering is, at its core, a well-intentioned action, yet it is imperative that medical students volunteer in a way that is not harmful or counterproductive. Ultimately, medical schools and residencies should be more critical of global health initiatives on résumés. They should discern what types of programs students are participating in, and what they are doing, rather than simply a volunteer experience abroad. The large influence of medical schools and residencies could trigger a shift in how organizations structure their volunteer opportunities and lead to the emergence of more programs like Partners in Health. By emulating the goals of Partners in Health, medical volunteer programs can work to improve health care systems globally and sustainably improve the lives of patients all over the world.
Photo: Image via Grant Neufeld