"I saw an 18-year-old British high school graduate wielding a saw, at a patient’s side."
This is an actual nurse treating children in Haiti. Image: U.S. Navy/Wikimedia
In the same week the US presidential election dominated headlines, at the International Association for Volunteer Effort conference in Mexico City, Shalil Shetty, Secretary General of Amnesty International, addressed the crowd, saying, "in the ecosystem of social good, there is room for every type of approach. As long as we share some common values and are working towards positive social good." Volunteerism is important and, properly channeled, can be beneficial.
Frequently, we consider poor and vulnerable populations so needy they're thankful for any help they can get. However, in the realm of international medical volunteering, there are nuances and complexities overlooked when we make room for "every type of approach" without taking seriously the tremendous responsibility that should accompany the desire to help. Unskilled volunteers should do unskilled labor, not professional work that, done wrong, could cause harm.
In June 2013, in northern Tanzania, as I walked into an operating room for minor procedures of the government hospital where I'd been doing research, I saw an 18-year-old British high school graduate wielding a saw, at a patient's side. He was preparing to amputate the leg of an unconscious motorcycle accident victim. He was a foreign volunteer, with no medical training.
Had I walked from the surgical theater to the maternity ward, I would have observed a similarly-upsetting yet all-too-common scene in Tanzanian health facilities: Foreign high schoolers or undergraduates delivering babies, lacking adequate medical training, the mothers unaware that these foreigners in white coats possess no credentials whatsoever.
In Tanzania, high school graduates amputating limbs is exceptional; untrained volunteers assisting in births and surgeries is not.
As faculty in the Global Health Studies program at Northwestern University, I encounter many students hoping to access short-term international volunteering experiences to be helpful, but simultaneously to gain "clinical experience," to help them get into medical school. Medical missions, medical brigades, volunteering through a private company—the possibilities are endless.
In Tanzania, high school graduates amputating limbs is exceptional; untrained volunteers assisting in births and surgeries is not. Often, outgoing and uneducated volunteers train incoming foreigners to do procedures. Foreign medical, nursing and midwifery students coach volunteers also, regularly surpassing their training and violating professional standards and best practices. Such activities are strictly prohibited at home without supervision. In Tanzania, health facilities are too short-staffed to supervise the deluge of foreign volunteers.
Meanwhile, volunteers regularly usurp Tanzanian professionals, who could do their job more efficiently without foreigners crowding them out. In one facility I've observed, foreigners outnumbered Tanzanian health professionals 2 to 1, and frequently outnumbered patients.
Tanzanian health professionals rarely voice protest. Volunteer placement organizations provide facilities with modest monetary compensation for hosting, which, in a cash-strapped health system, can do some good. Hosting facilities see volunteers not as hands-on helpers, but rather as prospective sources of funding. Money is helpful.
In most contexts, there are skilled locals on the front lines. We don't see them. If low-income countries needed unskilled strangers to help in healthcare, nearly anyone off the street would be better equipped than we would. Locals know the language, the culture, and the health system. Foreign volunteers lack most of these critical skills. Indeed, in Tanzania as elsewhere, patients' relatives are frequently asked to assist health professionals with minor tasks. Tanzanian volunteers fold gauze and assist in pharmacies.
For students, the desire to be helpful is often coupled with a hope that volunteering will help get them into medical school. The majority of medical schools require applicants demonstrate "clinical experience." Few define what "clinical experience" means, or list activities prospective applicants should not do.
In most contexts, there are skilled locals on the front lines. We don't see them.
HIPPA laws protect patient safety and confidentiality. It is illegal for unlicensed people to provide health care here; violators are subject to arrest. The combined need to acquire "clinical experience" and stiff patient protection laws have generated a multi-billion-dollar market for international volunteering. Just google it: "volunteer" with where you want to go. For-profit volunteer placement organizations stand by to provide you with any number of short term volunteering packages, medical or otherwise.
Volunteers can and do endanger patients' lives. They also undermine local health professionals' ability to do their job, compromising quality of care.
The volunteers I've encountered have laudable intentions. We might critique their desire to get something for themselves out of volunteering, but to do so would be to ignore the systematic conditions that propel this industry. Would you allow a Tanzanian undergraduate to deliver your baby? What about a high schooler to amputate your limb? These question seem preposterous when applied to us.
Unskilled labor can be tremendously helpful in particular scenarios: clean-up efforts after natural disasters, soup kitchens, delivering food. However, while volunteerism is worthy, it carries responsibilities good intentions often overlook. In short, if a volunteer wouldn't be permitted to do a particular job here, they shouldn't do it elsewhere, either.
Noelle Sullivan is an Assistant Professor of Instruction in Global Health Studies and Anthropology at Northwestern University and a Public Voices Fellow. Reach her on Twitter at @ncsullivan.