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Unforeseen Consequences and the Context of Short-term Medical Volunteer Work

  • May 8, 2018
  • Blog
Jean N. Scandlyn, Department of Health and Behavioral Sciences, University of Colorado Denver

Jean N. Scandlyn, Department of Health and Behavioral Sciences, University of Colorado Denver

Jean Scandlyn is a medical anthropologist who teaches in the undergraduate program in public health at the University of Colorado Denver. She has worked in a variety of settings in the US and Latin America and consulted on research projects in Africa. Her research focuses on the transition from adolescence to adulthood, and her most recent work concerns the effects of multiple deployments on soldiers, their families and communities published in Beyond Post-Traumatic Stress: Homefront Struggles with the Wars on Terror (Left Coast Press 2014), co-authored with colleague Sarah Hautzinger.

Each year medical providers from wealthy countries participate in short-term medical volunteer work in resource-poor countries. In removing cataracts, repairing cleft palates, or vaccinating children, volunteers focus on the safety and quality of care they deliver. But healthcare services take place in the context of complex social, economic, and political relations. How does providing free care affect the practice of local physicians who charge a fee for their services? Who will provide follow-up care if complications occur after the medical volunteers have left? How does the presence of medical volunteer programs affect government planning for public clinics that serve poor or underserved populations? Are short-term medical programs reaching those who have the least access to care?

We know surprisingly little about how people who receive these services and healthcare providers within these communities perceive these programs and their contribution to health. To begin to understand how one community views the effects of short-term medical volunteer programs, from October 2006 to March 2007, medical students Heidi and Tyler Green from the University of Colorado Denver, working with Dr. Andrew Kestler and me from the Center for Global Health, interviewed 72 individuals in a rural area of Guatemala on the southern shore of Lake Atítlan. They spoke with Guatemalan health care providers and health authorities, foreign medical providers, non-medical personnel working on health projects and a group of parents whose children were treated by a short-term volunteer group.

Participants identified positive aspects of short-term volunteer programs as improved access to free care for the underserved, access to highly-trained specialists and procedures in rural areas, and professional and cultural exchange between foreign and local healthcare providers. The interviews also revealed the complex consequences of short-term medical volunteer work though unforeseen effects on the healthcare system including free care that undermines local providers, disincentives for the government to provide care in areas where short-term volunteer groups operate, and lack of development of primary care systems.

Below is a summary of our key findings. For a complete report of the study please see the article we published in Globalization and Health in 2009:

  • Short-term volunteer services address the “tip of the iceberg” as one Guatemalan surgeon noted. “Poverty is the root of the problem, and surgery does not address poverty.”
  • Guatemala does not lack trained healthcare providers, instead it lacks the resources and infrastructure to deliver services to high-poverty areas.
  • Foreign medical volunteer teams may remove or lessen the incentive for the government to invest in healthcare for its people.
  • Short-term volunteers often assume that “all Guatemalans are poor.” As a consequence, they do not always reach patients who most need free services. Participants suggested that social workers from the community assess patients’ financial status to determine need.
  • Medical volunteer teams can place a burden on local healthcare providers and systems.
    • Volunteers who don’t speak the local language may create problems through misunderstanding or require local healthcare providers to translate for them.
    • Local providers may assume the cost of lodging and feeding volunteers.
    • Local providers may assume the cost of supplies and electricity in operating rooms and clinics.
    • Large foreign teams may interfere with regular operations in the clinic or hospital.
    • These burdens can be reduced by covering all expenses related to the medical volunteer care. This requires working closely with local providers and administrators to determine these costs and find practical solutions. Teams might consider bringing only essential foreign personnel and employing local nurses, cooks, doctors, and translators.
  • Foreign medical volunteers who work in isolation from local providers may erode trust and confidence in local providers.
  • Coordination is essential so that short-term work is part of more long-term healthcare programs. A co-founder of an NGO that organizes US surgical teams going to Guatemala noted that short-term volunteer work that is not coordinated with a long-term presence is “the worst kind of care.”
    • Local providers can give volunteers knowledge of resources, customs, and opportunities available to the local population.
    • Lack of coordination may lead to duplication of services and services that do not meet local needs and priorities.
    • Coordination is essential to coordinate follow-up care.
  • If coordination exists between visiting and local healthcare providers, these short-term medical interventions can be a positive experience for local providers as well as for the volunteers.
  • Volunteers must provide the same quality of are as they would at home, stay within their scope of competency, and ensure that patients receive services they need and not what the volunteer wants to deliver.

We undertook this study to move the discussion of short-term medical volunteer programs beyond the counting the number of surgeries performed or vaccinations administered or benefits that medical volunteers gain. This preliminary study highlights the need for more intensive, in-depth exploration and analysis of the effects of short-term medical volunteer programs for patients who receive care and for local healthcare providers and systems.