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Savior or Helper? Debating short-term volunteer efforts

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’.”

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Sustainable Student Initiatives in Global Health

Trying to repair medical equipment in an area without a guaranteed power source can get frustrating. McCormick junior Aaron Shoemaker knows a lot about dealing with power and infrastructure issues after spending last summer in Tanzania volunteering as a medical technician.

“At the end of the day you could try your hardest to fix a heart monitor and still not have enough electrodes to run it,” he said.

The experience gave Shoemaker the chance to see firsthand the difficulties that clinics in developing countries face. While many Americans might think that the biggest obstacle these clinics encounter is the lack of medical equipment, Shoemaker said that frequently there are two problems: a lack of disposable pieces needed for large equipment and a lack of qualified personnel to run and service the machines. That, and a strong infrastructure to support many types of service, he said.

Shoemaker shared his experience last week as part of a sustainability panel hosted by AIESEC, Engineering World Health and Project RISHI. More than 30 Northwestern undergraduate student groups volunteer in health settings and work with health initiatives, many of which they implement abroad. The panel discussed the best ways for student groups to support health missions around the world.

Northwestern Engineering Global Brigades students assist with in-home infrastructure projects as well as provide health education and engage community members during their trips to Panama, Nicaragua and Honduras. (Photo by Northwestern Global Brigades)

Student representatives from four organizations, including Shoemaker, McCormick junior Ian Su, Weinberg junior Kyle Chan and Weinberg junior Rohit Allada, each spoke about their time working with Engineering World Health, AIESEC, Global Brigades and Project RISHI, respectively. Professor Peter Locke, current director of Northwestern’s undergraduate studies in global health, and Professor Mark Fisher, a clinical associate professor in Northwestern’s biomedical engineering program, provided their insight into solving global health issues as well.

All of the panelists agreed that sustainability in terms of longevity was essential to providing meaningful results.

“Having a great solution alone is not enough,” said Fisher. “With Northwestern Global Health, a big focus of ours is: how do we make it profitable for somebody in the country to maintain this going forward…[that] somebody is invested in making sure that this continues over time.” 

For Fisher, making a lasting impact requires that global health groups pay attention to details such as the supplies, training, personnel and services necessary to maintain health programs after they implement the projects.

Allada, a member of Project RISHI, knows how difficult it can be to keep a program running. He spoke about some of the initiatives that Project RISHI undertook in the Indian community of Charnia.

“One of the problems we run into a lot is the sustainability issue. For example, we found that a lot of the villagers in the area had anemia, so the initiative that we came up with was giving them iron tablets to help supplement them,” Allada said. “We found it was really hard to get them to continue to take the iron tablets when someone wasn’t there telling them to do it or why it was important. The information wasn’t disseminated as well as it could have been and once the iron tablets ran out [we didn’t know] how we were going to get more for them. That initiative didn’t really work out the way we had planned and we learned from that. So now going forward…we have in mind that we need to work within the limitations of the area.”

While Allada focused on working within limitations, Locke promoted the idea of analyzing limitations to create programs targeting the sources of health problems. In the case of Project RISHI’s anemia initiative, Locke noted that the widespread anemia was likely due to dietary deficiency. To truly fix the problem in a sustainable way, it would be necessary to help the village gain food security.

Image from Charnia, located in Haryana, India. Northwestern’s Project RISHI works with Charnia’s community to solve health challenges facing the rural area. (Photo by Sathwik Nandamuri.)

“What we say in all of our teaching in the global health studies program is that we need to take a much more systemic approach,” Locke said. “We need not just changes in policy structures and paradigms of intervention, we need a cultural change in ideology in how we relate to the rest of the world. We need to stop looking for quick fixes to individual issues and realize that all of these issues are linked.”

Of course, providing support to fix entire systems of health care left in disrepair from political struggles and lack of resources is an enormous challenge. Student groups are unlikely to be able to solve systemic issues on their own. However, many have found ways to benefit health systems on a wider level.

Global Brigades, for example, not only sends students on medical brigades, their national organization also helps fund training opportunities, according to Kyle Chan. By increasing the number of certified workers in these regions they fight chronic problems due to lack of personnel.

In addition to focusing on the longevity of projects, the panel also discussed how to minimize the environmental impact their projects carry. Shoemaker said student groups should consider the carbon footprint of flying students to project sites and determine how well their projects can be adapted to the local area without requiring regular international shipments of supplies.

“Is [the project] repeatable?” Shoemaker asked, “Is it something that can be maintained onsite?”

Fisher advised students to keep the environment in mind, but avoid trying to focus on too many causes at once.

“You can’t do everything, you have to choose your mission,” he said. “Environmental sustainability is one portion of thinking about global health…it’s an important thing but you have to think about it as part of design process as a whole.”

Although global health groups face major challenges in creating and implementing truly sustainable projects, both Locke and Fisher remain optimistic about the positive impact students and professionals can bring when they work with communities. Fisher said it all starts with becoming “aware.” He advised students to focus on understanding systems and the people who work within them. From there, according to Fisher, a strong relationship can grow, delivering lasting solutions.

“Until you’re aware you can’t have empathy,” Fisher said. “You can’t have a solution without empathy.”

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Health Care for All

This Saturday, April 7th, marks the 70th anniversary of the beginning of the World Health Organization. Like any other year, the WHO is celebrating the milestone with World Health Day, a yearly call to action on a specific health issue affecting the globe.

Since the day its constitution first came into effect 70 years ago, the WHO has advocated for improving the health – physical, mental, emotional and spiritual – of individuals around the world. To emphasize this mission and progress closer to “health for all,” the WHO devotes this World Health Day to a campaign for universal health care coverage. 


Universal health care coverage means more than offering care to anyone who can pay for it. The WHO states that countries should strive for health care coverage that makes quality essential health services accessible to all peoples and communities without causing financial difficulty for those seeking services. 


Today, about half of the world’s population cannot obtain essential health services, according to the WHO. Even those who have access to services often struggle to pay for them. More than 800 million people spend at least 10 percent of their household budgets on health expenses, forgoing other potentially necessary items to afford their care. Every year, 100 million are pushed into extreme poverty because of health spending. With universal coverage, fewer people will face the prospect of forgoing preventive practices and treatments because they can’t access them or are unable to pay for them.



Many countries, such as Japan and the United Kingdom, have already adopted universal health care coverage programs. They continue to see improved health outcomes within their populations, which in turn benefits the countries themselves. According to the WHO, universal health coverage also provides social and economic benefits for the countries that implement this program including protection from epidemics, enhanced gender equality, decreased risks for poverty and hunger, creation of jobs and increased economic growth. 

Despite these potential benefits, the United States remains one of the few developed nations to not adopt a universal health program. The issue of health care coverage has come to the forefront of debates in recent years with the introduction of the Affordable Care Act and continued coverage of such crises as opioid addiction and rising obesity rates.

Critics of universal health coverage have argued that the program would cost too much and potentially limit individuals’ ability to choose what care they receive and when. However, as Northwestern Global Health professor Noelle Sullivan notes in her May 2017 article for truthout, the United States actually spends much more than other countries that have adopted universal health coverage. Furthermore, the WHO encourages individuals to see health coverage as a right, rather than a privilege and states that there can be multiple ways for countries to progress towards the universal goal while keeping other values in mind. 


To support increased health coverage and support of communities, the WHO invites concerned individuals to take action. Through communicating opinions and expectations to local leaders, voicing community health needs and sharing the stories of affected patients members of the Northwestern community can push important insights to the front of health coverage dialogues. Additionally, students and Northwestern affiliates can research health problems and successful health coverage interventions to better inform themselves about this crucial topic. Organizing events around health care coverage such as policy debates, marches and interviews can bring more attention to this topic and push for change locally and nationally. 


World Health Day challenges people throughout the globe to more thoughtfully consider their health and the health of the global community. Through education and action, the Northwestern community can observe World Health Day and advocate for a better world.

Images courtesy of Wikimedia Commons and the World Health Organization.

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Making a Difference with Mabie

Not sure what to do this summer? For any undergraduate student interested in making a difference, opportunities abound.

March is here, which means the deadline to apply for the John and Martha Mabie Public Health Fellowship is fast approaching. The grant offers undergraduate students a chance to research global health issues, both in America and abroad. Past research topics have ranged from studying public health awareness through academic arts in Chicago to the way Algerian women view hypertension to LGBTQ health disparities in hospice care in Nepal.

This past summer, two Mabie fellows used the grant to study of the most important resources for health around the world: access to clean water. Weinberg senior Julia Yeam and School of Education and Social Policy senior Tracy Guo assisted with research efforts to design a scale that will help researchers analyze water insecurity.

(Photo courtesy of Julia Yeam)

“As a research group we are working on developing a scale, a cross-cultural scale, that will measure water insecurity at the household level— something that doesn’t exist at the moment.” says Julia Yeam, a biological sciences and global health major.

The Mabie grant gave Yeam a chance to extend her work with her research group, keeping her in Evanston during the summer break to analyze data.

“It wasn’t just me individually doing this project, [but] I played a role in it and there were parts that were distinctly mine,” Yeam says of her work over the summer. “I was doing a combination of data cleaning, looking at some of our preliminary data and doing analysis.”

She performed all these tasks in Evanston, but her data set came from 11 different countries, including Ghana, Uganda, Tajikistan, Ethiopia, and Colombia. The number has only grown since then.

“We partnered with a lot of other researchers – both in the US and outside – and we asked them if they were interested in our project,” Yeam says. “If they were, then [we asked if they] would like to partner with us and conduct our survey at their research site. Some researchers have multiple research sites in different countries.”

Ultimately, the research collaboration wants to design a short survey with a set of seven to eight questions that can quantify a household’s water insecurity, regardless of where they live.

“We started off with a list of 32 questions…we condensed it to 27 or 28,” Yeam says. “We’re seeing, based on different models and statistics and regressions, how well do these questions actually capture water insecurity experiences. By measuring the strength of each of these questions we will be able to see which of the questions we ultimately want to keep in this final survey.”

The project isn’t done yet— the number of sites continues to grow, adding more data for the research group to consider. However, Yeam is far from disappointed with her Mabie experience. She says her favorite part of the summer of research was preparing and attending a conference held in Northwestern to discuss progress on the study. Many of the international partners and experts in water insecurity came, which made the atmosphere exciting for Yeam.

(Photo courtesy of Julia Yeam)

“I was the only undergraduate on this project over the summer, so being a part of this conference was very intimidating because there were all of these big names that I had been reading about— people who are absolutely giants in the world of food and water insecurity already,” Yeam says. “I was thinking, ‘who am I to present data to you, this is insane!’”

However, Yeam says she not only presented the descriptives she had generated during the summer, she also joined in the conversations the attendees had about water insecurity. While the summer gave her a chance to learn some important research skills, the most important lesson she learned came from the conference: the necessity of teamwork.

(Photo courtesy of Julia Yeam)

“In terms of actually conducting research work, I learned a lot about how to do quantitative data analysis which was really cool, and I think a useful skill,” Yeam says. “On a more grander level, I really got to see how important collaboration is when trying to make something as significant as a scale that doesn’t exist yet, especially one that’s cross cultural and can be applied to any cultural context and any socio-economic context as well.”

Yeam says she feels grateful to have an eye-opening experience through her Mabie grant and recommends that any global health-minded undergraduate student to think about the fellowship and others like it.

Any students interested in applying for the John and Martha Mabie Public Health Fellowship can apply at this link and contact Micki Burton at micki.burton@northwestern.edu with questions. The deadline for applications is March 19th.

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Interning at Médicos del Mundo: insights from working globally

I spent last fall in Barcelona, interning at Catalonia’s branch of Médicos del Mundo – or translated in English, Doctors of the World. This is an international human rights organization that empowers and provides health services for vulnerable populations. Today, 400 programs exist in over 80 countries, and the programs are largely spearheaded by local teams.

I got to join one of these local alliances: I worked with six women in an office tucked in the non-gentrified half of El Raval, a historically immigrant neighborhood of Barcelona. The office was about the size of a large bedroom, six desks lined the walls and a square window overlooked the narrow street outside. Dense files, packets and large colorful posters were scattered all around the room. When I arrived around noon, the office was always a full house with local volunteers were constantly rushing in-and-out the door. This community was like a family. Laughter and banter – mostly in Catalan, the regional language of Catalonia – filled the room, while a sense of determination united each and every employee.

Three women lead a panel discussion in Transgenerant, an annual event that promotes transgender awareness in Barcelona.

But no matter the size of the office or staff, it was truly astounding how much work they did for Barcelona’s most vulnerable populations. Luckily, I got to engage with some of their initiatives. I designed promotional materials for their annual transgender awareness day, facilitated a roundtable about female genital mutilation in Barcelona’s African migrant community and assisted with a high school course on health inequality. What really put me out of my comfort zone was leading an empowerment workshop for a group of twelve transgender women – entirely in Spanish.

Thinking back on these experiences, I can explain how meaningful they were to me using two big reasons. First, it opened my eyes to another Barcelona, one that is more real, less perfect and ridden with a deep history of inequality. In this Barcelona, systemic processes like stigmatization and hierarchization perpetuate poor health outcomes in disadvantaged populations.

Second, and perhaps most importantly, Médicos del Mundo showed me firsthand how a small local alliance can make hugely influential differences. In 2016, this team designed and launched a docu-web to make visible human rights violations among refugees; they initiated training programs and educational services to teach high school youth about cultural diversity and health inequality. These platforms for social inclusion gave me a kind of optimism that I will bring to my future work in global health, a field that more often than not feels like a collection of problems rather than a discipline. That said, joining this team of passionate individuals who dedicate their lives to advancing health equality was an invaluable experience.

Working abroad in a foreign language was undeniably challenging, but the ability to better understand local contexts and narratives was indispensable to my growth as a global health thinker.

My friend (left) and I (right) strolling through the Gothic Quarters, Barcelona’s oldest neighborhood.

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