Originally published as an Op-Ed on Feb. 25th 2016 in the Orlando Sentinel, this longer piece provides additional information and links to relevant articles that may be of interest.
On February 18th, 2016, 18-year old Malachi Love-Robinson was arrested for “Posing as a Doctor” in Palm Beach. Practicing medicine without a license is a third-degree felony in Florida. Yet, were Mr. Love-Robinson to fly to Tanzania, Cambodia, Bolivia, Honduras, Senegal, Nepal or any other so-called “developing country”, not only would he be able to practice medicine without a license…his actions would be celebrated.
An expanding and highly lucrative industry has sprung up around international voluntourism. Placements in health facilities are popular. It is mostly health professions students, or aspiring professionals like Mr. Love-Robinson, who pay companies to do these trips. Websites say anyone can offer “first-rate healthcare to people who usually don’t have the regular opportunity to see a doctor”. As a foreigner and a volunteer, regardless of training, you provide “more than hope” by virtue of who you are.
Poor countries are depicted as having few locals with good ideas and a commitment to assist with the pressing problems there. In such places, “any help is better than no help at all.” Nothing could be farther from the truth. Worldwide, foreigners crowd health facilities and orphanages, despite concerned reports and campaigns about problematic ethics of both types of volunteering and the harms that volunteers could unwittingly cause.
Celebratory assertions of “good intentions” echo those that Mr. Love-Robinson draws upon to justify his actions. He meant no harm, his grandfather tells us: “He was out trying to help people.” The “good intentions” argument appears as hubris when applied to vulnerable American patients. Substitute the poor in other countries, and it commonly justifies otherwise unethical actions.
I have been researching foreign clinical volunteering in Tanzania for nearly four years. The health facility receives a paltry donation for each volunteer hosted; staff is expected to volunteer scarce time and resources to volunteers as well as patients. Tanzanian health professionals receive no compensation for hosting foreign volunteers.
Some Tanzanians host volunteers to be hospitable. Some hope volunteers will help them personally or professionally. Some enjoy the deviation from the doldrums of work. While foreign volunteers are often more burden than boon, most Tanzanians are too polite to say anything. In countries with struggling health and education sectors, regulating the actions of several thousand foreigners in clinics is hardly a priority.
When abroad, foreign volunteers routinely supersede Mr. Love-Robinson’s actions in Palm Beach. There is an informal rite of passage amongst foreign volunteers. Departing volunteers tell incoming ones where to go and who to befriend in order to get “hands on” experience. Students teaching students how to do procedures was routine in several of the six hospitals I have researched in Tanzania. One of my interviewees, an American 22-year-old pre-medical student, stated “I’ll be damned if I leave Tanzania and haven’t delivered a baby.” Two days later, after a 15-minute lecture by a British midwifery student volunteer, he delivered a baby, unsupervised by Tanzanians. A former student of mine volunteered in India as a high schooler, where he administered surgical anesthetics. During college, he went to Peru, where he administered shots, performed pre-natal check ups, tested patients for HIV and syphilis, and took blood samples.
Many volunteers are good people, but ill informed. There are systematic problems underlying volunteers’ unethical actions, and meaningful ways to improve best practices. Our society tells young people that they not only can make a difference abroad, but that they should. Doing so is marketable. Clinical volunteering looks good on admissions essays and resumes. In rich countries, “clinical experience” is usually a requirement to get into medical school, but it is rarely defined. While professional health associations have guidelines for ethical practices abroad, students are rarely aware of them.
Universities have to do more to foster awareness, and develop best practices for students’ global engagements. Several organizations are working on this effort, including the Working Group on Global Activities by Students at Pre-Health Levels (GASP), the Global Ambassadors for Patient Safety course, and globalsl.org.
Let Mr. Love-Robinson be a reminder to all of us: if the desire to “help” can’t justify playing doctor at home, it shouldn’t justify it anywhere. We can do better.
Noelle Sullivan is an Assistant Professor of Instruction in Global Health Studies and Anthropology at Northwestern University, in Evanston, Illinois. Her research explores global health priorities, postcolonial governance, market logics and humanitarian sentiment, and their impact on healthcare in countries reliant on foreign assistance.