People on such short trips usually don’t stick around long enough to realize how ineffective they are being. In Uganda, I got used to seeing groups of young people come for week-long visits at the orphanage where taught English. They would play with the kids, give them a bracelet or something, and then leave all-smiles, thinking they just saved Africa. I was surprised when the day after the first group left, exactly zero of the kids were wearing the bracelet they had received the day prior. The voluntourists left thinking they gave the kids something they didn’t have before (and with bragging rights for life). But the kids didn’t care, because what they really wanted was school uniforms, their school fees to be paid, guaranteed meals, basic healthcare, and the like — the basics.
Worse, they can even be harmful to children who struggle with abandonment issues. This should not be understated; have you ever considered the negative impact it routinely has on kids after they bond with someone for a week, and then that person disappears from their life? If your justification for going on these trips is “seeing the smiles on the kids’ faces”, then you’re part of the problem.
7 Reasons Why Your Two Week Trip To Haiti Doesn’t Matter: Calling Bull on “Service Trips” - The Almost Doctor’s Channel (via shinyandloud)
Oh god, yes… It’s all very well flying in and setting up a temporary clinic in the middle of nowhere for a couple of weeks but:
1) You’re an outsider, you may not understand the cultural, social and political context of your patients and their presentations. Therefore, you may be ineffective or even detrimental to the long-term health of your patients and their community.
2) Hell, are you sure you’re even focusing on the right aspect of healthcare? You may not be angled towards what is most important to the people you’re treating. It’s all very well opening a sleeping sickness clinic in the DRC but when there are only 7000 reported cases globally each year, you’d better make sure you’re equipped to treat the boring deadly stuff like Gram-negative sepsis too.
2) Your service does not feed into, enhance or supplement any pre-existing services within the local healthcare infrastructure. You are not giving anything back to the health system that is providing you with experience.
3) And as a consequence you may be plugging a hole that the national or regional government are not motivated to plug themselves, thereby giving them even less reason to redirect funds or tackle inefficiency, corruption, training and infrastructure problems.
4) Patients often need follow-up. Fly-in-fly-out works for very few conditions, especially when you’re not addressing the wider context in which they occur.
5) You’re taking on experiences and filling roles that could be otherwise filled by local doctors. The majority of the time without providing training or building an integrated and sustainable system that can exist after the mzungu doctors disappear…
Choose your volunteer projects carefully people!
There’s a lot to be said about the ‘saviour complex’ side of gap year projects and even some medical electives. And that’s partly why electives should be focused on learning from those who do deal with these problems every day, and not any kind of ‘service provision’ that you wouldn’t be considered competent to do here. There are definitely experiences to be gained; many illnesses we do not see as often in the UK, but do come in through tourism and immigration are much more common in the countries favoured for electives. You could grain relevant clinical experience from experienced practicioners, and also be mutually useful to them by helping out within your remit, so long as you come as a colleague and a student, not a saviour.
The healthcare problems in every country (even the UK) are nowhere near being solved by bright but misguided students or juniors dedicating a couple of weeks to helping a little, so it is important that the companies organising these experiences prepare their proteges for the reality of their experience. I do think medical electives tend to be a bit better than your usual gap year tourism in that they are usually paired with departments in existing hospitals and universities under the guidance of existing clinicians, but there are obviously a lot of projects out there that are randomly popping up and not part of the local healthcare infrastructure, and which as a result are much less useful to local patients or in the longterm. Part of that appears to be that where it used to just be the odd student going to existing clinics to shadow a doctor, now there are many more companies who organise these projects to give their customers (the volunteers) something interesting to do, an experience. But true voluntary work shouldn’t be framed around the holiday experience of the volunteer, but around the needs of the community they are going to serve. And I think that is what is increasingly sidelined.
From others’ experiences, I know that it is very easy to fall into elective placements where you are left to do things far, far outside your remit, perhaps because there is nobody else, hopefully not just because you know nobody cares there. But the rules and laws you must abide by are the ones of the GMC which registers you; i.e. to stick strictly within your competencies.
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