Over a decade ago, I was a first-year medical student preparing for my summer research in Guatemala. On arrival, I lived in a township whose lifeblood was centered around a mission which provided jobs, food, schooling, activities – and a health clinic for locals and for volunteers.
Following my experience, I warned about the dangers of such interventions that I witnessed during that summer. I watched volunteers (from laypeople to medical students to physicians) arrive by the busload to donate their time and energy, and I observed efforts that appeared to be problematic.
First, I observed medical students delivering care without adequate oversight or direct accountability. This is theoretically readily preventable. However, I also observed the unintended, but perhaps not unanticipated, consequences of donating a so-called duffle bag full of medicine. Even if volunteers were not delivering medical care – the very act of donation shifted the priorities at the local health clinic. I witnessed patients lined up in the early morning hours for vitamins donated by volunteers, which were at best unnecessary, but at worse, are now requested in place of much needed medical treatment. Even among the most self-sacrificing, well-meaning volunteers, the donation of supplies was problematic.
When “Duffle bag medicine,” my commentary on these dangers of medical missions, was published in 2006, I received many comments. The vast majority shared my interpretation that the current paradigm of medical missionaries was at high risk for causing more harm than good, like the subsequent commentary on “voluntourism” and educational materials on International Aid.
In the last ten years, there has been an exploding trend of globalization. The question is no longer how to safely control medical volunteerism, because the flow of medical care across borders is now beyond any real control. Instead, the question is now how to evaluate the work that is done to ensure it has an impact of which all stakeholders can be proud. My suggestions are as follows:
First, be honest with your own strengths and limitations, as well as your underlying motives. Volunteers can care about the health of a community without providing healthcare. Be transparent about what skills you do have, offer them wholeheartedly, and do not be offended if they end up not being helpful.
Second, allot time and energy to understand what is needed, not just what you can provide. Investing in understanding the expressed and implied local needs often requires even more energy than actually filling them. This is a fantastic exercise for everyone, of all skill levels – the due diligence of preparation through outreach, contacting primary sources, and learning from previous experience.
Third, before, during, and after your trip, find ways to build the local capacity. Invest in ways to promote local initiatives that need publicity, funding, or partners. Most importantly, stay in touch with your collaborators to ensure that the lasting impact is open to all parties. Consider harnessing technology to make the local capacity go “viral,” so that one day, outreach will, with great pride, work itself out of a job.
