It’s a typical image you might find in your Facebook feed. There’s a tall white man or woman, perhaps dressed in scrubs, surrounded by a group of smiling children in some remote part of Uganda or India. Maybe the individual is handing out some vitamins, or bandages, but it is clear that they are helping the impoverished children near them in a kind, selfless act.
Every year, tens of thousands of Americans travel abroad to take part in volunteer opportunities in medical facilities in the global South, coming home to post special Facebook photos like the one above and talk about how much they learned about living in poverty. For many, this type of medical volunteering seems like an enormous service. However,several questions and problems arise when dealing with short-term medical volunteering. Dr. Noelle Sullivan and Dr. Judith Lasker spoke Thursday night about many of the issues that come with the recent trend in “voluntourism,” asking whether volunteers are truly selfless “saviors” or “helpers.”
Lasker has been studying short-term global health initiatives for some time and recently published a book about her research, entitled Hoping to Help. In the text, she notes some of the problems that often come along with these short-term global health initiatives. For one, these short-term trips tend to reinforce stereotypes about developing countries. Lasker noted that many volunteers believe they are going to places of poverty, illness and ignorance.
“If you start with those stereotypes of ‘they have nothing and we have everything’ or ‘we know everything’ then of course you’re going to assume that if you go on a short trip, you’re going to be helping people,” Lasker said. “You are bringing something to people who have nothing – it must be helpful.”
Many Americans go to these countries believing that they can change the lives of the people there, promoting the concept of the “white savior” so ingrained in Facebook feeds and blog posts. In reality, most trips are so short that volunteers spend more time getting oriented to the facilities than they spend helping the people there. Certainly, these volunteers are not “saviors.”
Because they are unfamiliar with the spaces, volunteers tend to hinder medical efforts, rather than provide the life-changing medical help they envision themselves giving. Staff at the clinic or hospital must take away some of their time with patients in order to train the newcomers, reducing the care they normally offer patients. In more extreme cases, temporary trips to aid free clinics can take away local physicians’ paying patients, forcing the doctors to move to maintain their livelihood. When the volunteers leave after a few weeks, the area is left without an adequate number of physicians.
Beyond taking away medical staff time, volunteers can actively harm patients by participating in surgeries and other tasks that they are not qualified to perform. Both Sullivan and Lasker shared stories of students who jeopardized patients’ safety and trust, whether by giving health education lectures to adults or delivering babies without any previous medical education.
“Young people – as well-meaning as they are and as well-armed with a computer as they may be –can go to Uganda and teach adults in a language they don’t share, about sex? That’s mind-boggling,” Lasker said. “I try to tell my students, just imagine the reverse. What if someone came into your classroom that does not speak your language, has never been in your country before and knows nothing about you or your country and starts lecturing to you on how to behave…How likely are you to change your behavior because this person told you to?”
The evidence suggests that volunteers cannot even be considered “helpers,” let alone “saviors.” Yet, despite the potential dangers of short-term medical volunteering, the business is growing. In addition to the typical faith-based organizations, schools, private institutions and NGOs that send volunteers, brokers and tourism agencies have started offering trips. Sullivan mentions that when she first started analyzing medical volunteer work in Tanzania, most of the volunteers were medical students on rotation. Now she sees a wide variety of volunteers, some as young as high schoolers, coming to work.
Host countries and facilities are very aware of many of the risks and downsides that come with volunteer trips from the developing world. However, they seldom complain about the behavior of volunteers who break rules or waste professionals’ time. Sullivan had to try very hard to get Tanzanian medical staff to speak about their concerns with the unskilled volunteers coming to assist them.
“I often get asked, ‘why do Tanzanians allow this to go on?’” Sullivan said. “One is that the fees that the volunteers pay, which are $100 to $150 per volunteer regardless of how long they stay… that’s money that they can spend on the repairs they need to do and the equipment that they’re missing. I actually finally got to get a roster on how they spent the volunteer funds and it was on… things like petrol for the ambulance and a filing cabinet – really basic stuff that they don’t have money for in the budget but that they need in order to be able to operate.” Another reason why Tanzanians were hesitant to complain? They didn’t want to be bad hosts.
“They also talk about things in terms of hospitality. The Tanzanian culture is one of hospitality,” Sullivan said. “[They say] ‘if you’re not from my village, it’s my responsibility as a Tanzanian to bring you in and make you have a good experience.’”
Lasker’s research found similar attitudes from other host organizations. Because the volunteer trips also bring money and supplies, many host facilities do not voice their issues with the trips. Doing so could potentially end a relationship with an important institution and stop the provision of needed supplies.
Completely ending the practice of volunteering abroad would also diminish many of the other benefits the projects could potentially bring. According to Lasker, these experiences allow individuals from developed nations to see what poverty looks like and become better advocates for social change. They can also facilitate cultural exchange between volunteers and individuals from the host country.
Instead, Lasker and Sullivan suggested that organizations running volunteer programs allow the host institution to define the needs and goals of the program. They list this principle, along with five others as important elements for volunteers to use to consider potential programs they might join and evaluate trips in which they participate.
To avoid hindering local medical efforts, the organization should carefully recruit potential volunteers to ensure they are capable and should have a long-term sustainability plan. Additionally, all programs and volunteers should respect governing structures in the host countries, as well as the hosts themselves. There should be a sense of learning on both the part of the volunteers and of the host institution.
Learning is perhaps the most important aspect for Lasker and Sullivan, who do not think “helper” or “savior” are accurate terms for volunteers.
“We’re not really sure that it’s ‘helpers’ or ‘saviors,’” Sullivan said. “It’s certainly not ‘saviors’ and not everything is helpful, and sometimes its neither.”
“We had a little conversation about it and concluded that ‘learner’ is the best description,” Lasker said. “Really, the volunteers are not there to save or help and should really think of themselves as ‘learners’.”