Linnea Rothi ’23 is neuroscience and biology double major with a minor in public health at Santa Clara University and a 2021-22 health care ethics intern at the Markkula Center for Applied Ethics. Views are her own.
So you’re considering doing overseas volunteer medical work? With an estimated 1.6 million people who annually volunteer abroad, international medical volunteering is a growing industry. International medical volunteering (IMV) refers to when individuals with health care training volunteer their time to work in a different country. This practice has also often been described as “medical voluntourism” where seemingly altruistic volunteering is paired with an exotic vacation. Medical voluntourism is generally characterized by short-term programs that send large groups of people abroad to low-resource communities with the goals of providing voluntary medical care (volunteering) and vacationing (tourism). Under the IMV umbrella, there are a diverse range of programs, with some programs leaning more heavily towards the voluntourism side than others. While there are numerous benefits to volunteering abroad, IMV is a complex issue with many facets; therefore, it is essential to consider the ethics and implications involved, such as the ethical need to have a deep understanding of the community you’re serving and your role in the process.
The Benefits
International medical volunteering provides many benefits, both for the individual participating and for the impacted community. On the surface, these programs provide a hands-on experience in health care, which can help boost a student’s medical school application and resume. On a deeper level, IMV programs are an opportunity for self-exploration and transformation, such as reaffirming and/or discovering a deeper commitment to medicine and health care. Furthermore, participants will often learn new technical skills and gain practice in a real-world setting serving a diverse population.
The community also benefits directly from immediate patient care–generally free or at a very low cost to the patient. There are also indirect benefits and effects of IMV ranging from having very little impact to saving an individual’s life, and the strength of the impact depends heavily upon the volunteering work completed. For example, if your role on the trip is to simply measure blood pressure, that can help the patient by providing information, yet this information would have little value if subsequent treatment/care is not provided/available. This level of impact is significantly less than say an ophthalmologist removing cataracts to restore a person’s sight and as an indirect result, their agency.
The Ethics
To start, let’s already assume that your motivation and purpose for participating in IMV is to help address a pressing health care issue. Everyone may have good intentions, but intentions are not enough; everyone has the responsibility to be informed participants, which involves considering the ethics involved in doing international medical volunteering. Several ethical ideas to consider relate to the ethical principles of justice, beneficence, and non-maleficence. Specifically, you must focus on these principles as they relate to understanding (1) your role, (2) your impact, and (3) the country, culture, and context of the community in which you are volunteering.
(1) Your Role
Understanding the role you play and your motivations for participating is critical. Even though many of these IMV programs actively work to not be voluntourism, the way the programs advertise themselves leans heavily on what the participants gain through the experience as opposed to focusing on the actual impact they leave on communities. One international volunteering program advertises, “You can make a positive impact within local communities! You can help save animals and conserve planet earth! You can learn more about how to contribute to a better world while traveling the world!”
Though this may all be true, to some extent, it is clear that advertising focuses more on the experience of the participants as a selling point. As a result, individuals often sign up for these programs focused mostly on the benefits they themselves will gain when instead the priority should be more on the community.
This now becomes a harder question of who benefits and how–it’s a balance between your own benefits and the community’s benefits. Are your motivations for participating mostly for your own benefit or for the benefit of the community? How are your actions producing value, and who is getting the most value out of this exchange?
(2) Your Impact
The value of your actions is determined by their impact more than by their intent. As current and/or future health care professionals, we are governed by the basic principle of “first do no harm,” and you can only ensure this by thoroughly examining your actions and impact on the community.
Even if your heart and intentions are pure, perverse outcomes can still occur–previous research has actually found that IMV can cause harm to patients and their communities, without the volunteers even realizing the damage. Furthermore, volunteers often overestimate their positive impact on the community. For example, one of the main benefits of IMV is that medical care is often more affordable, if not free, for the patients. So while you treat your patients and do not directly cause harm, these IMV programs and clinics may put the local health clinics out of business, which harms the community at the systems-level scale. Another aspect to think about is the sustainability of the volunteering. The majority of IMV trips are short-term and only range from a week to several months, which can leave patients without long-term treatment plans once the trip is over. What will happen after you leave? What are the more probable long-term impacts of your actions? Will the community be damaged by or benefit from your interventions?
(3) Country, Culture, and Context
Ensuring you have adequate foundational knowledge of the community you are volunteering in relates to understanding your impact. Oftentimes, ignorance and ill-preparedness can harm the intended beneficiaries, and to help avoid that, you can educate yourself on the country, culture, and context of the place in which you’ll work. It’s not simply about not offending someone, it’s about understanding how your actions fit in the cultural context and then acting in a way that is respectful. How much do you know about the community where you are volunteering? How can you be sure that your actions will be interpreted by the community as appropriate and beneficial?
These ethical considerations can serve to highlight several concerns with international medical volunteering and can be used to improve and elevate existing programs. If you are interested in doing global health work and/or participating in an international medical volunteering program, consider these questions:
- What are your motivations for doing international medical volunteering?
- Are you confident that your presence will not cause harm to the community?
- How can you ensure that your volunteering truly benefits the community?
- Is your understanding of the country, culture, and context in which you will work sufficiently strong that you can be sure that the local community will feel respected and benefited from your actions?
While I’m not suggesting that international medical volunteering should not occur, the reality is that many such trips cause more harm than good. Therefore, I strongly urge you to step back and reflect on these questions. If you go, do your homework to become familiar with the culture that is hosting you. Check your self-interest and focus more on immersion, solidarity, social justice, and equality–be confident that you are prepared to practice ethical health care within the community. We have a responsibility to consider these complex ethical issues now as students and as we move into our careers in healthcare.