This is a guest post by experienced nurse and serial volunteer Emily Scott, with some important advice about volunteering overseas in the medical field.
When I started volunteering abroad as a nurse, I used to tell every medical professional I met that they should participate a medical mission. “Go for it!” I’d urge them enthusiastically. “You can make a difference, and it will completely change your life.”
I had personally experienced the damage that unskilled volunteers were causing in developing countries, but I figured the world couldn’t get enough skilled volunteers. Here’s the thing: I was wrong.
A decade later, after countless experiences both at home and abroad, I’ve completely changed my tune. I know that even skilled volunteers can inadvertently cause real harm. Almost daily, a coworker approaches me about going on a medical mission – and now my response is far more complicated. I warn even the most experienced medical professionals that there’s A LOT they need to know before they set foot on a plane. Here are a few guidelines for medical professionals volunteering abroad:
1. Don’t do anything you wouldn’t do at home.
I put this rule first because it’s the one I see broken most often. Consciously or not, medical volunteers feel that when we step into a hospital in a developing country, the rules are somehow different. Because resources are scarce and staff may be limited, we find ourselves doing things that are outside our licensed scope of practice. We don’t worry much about it because no patient in rural Uganda is going to sue us, nor will a manager appear to fire us – after all, we’re volunteers!
For example: As a nursing student, I helped deliver a baby at a clinic in the slums of Nairobi, Kenya. But when I completed my clinical rotation in obstetrics in the US, I was only allowed to observe deliveries. So why did a change in continents make me feel that I was qualified to deliver a baby? Because the assumption that American healthcare providers are inherently better than those in developing countries is deeply ingrained in our culture. And because the same belief (that white foreigners somehow automatically do things better) has often been inculcated in local staff, they’ll often step aside to let us complete any procedure.
When I delivered that baby in Kenya, there was a local nurse available who was certainly far more experienced than I. But she offered to let me step in, and I did so because I wanted the experience. I cringe looking back on that day, because I know I crossed an ethical line. It’s not OK to treat African patients differently than we’d treat American patients, just because we can get away with it. Developing countries aren’t places to practice procedures we don’t see often or aren’t licensed to do at home.
When a patient needs to be stitched up, defer to the local clinician unless you’re licensed and experienced at suturing. If you don’t deliver babies professionally, then get the local birth attendant when a woman shows up in labor. If you’re a doctor who doesn’t know much about tropical diseases, don’t just take your best stab at treating malaria – ask the local physician! The trouble with practicing outside your expertise is that you don’t know what you don’t know – meaning, you may not realize when you’re in over your head, and you might inadvertently cause your patient harm.
Yes, there are exceptions to this rule in cases of life-threatening emergencies. But I have found those situations to be extremely few and far between. Before you step outside your scope of practice, ask yourself honestly if you are the best option available.
2. Do your research first.
All medical missions are not created equal. Some will utilize your skills to genuinely help the local community, while others will leave you feeling frustrated and ineffective. Ask questions of any organization you’re considering volunteering with before you commit. For example:
– Will there be translators? If not, how are you planning to communicate with your patients? After exasperating experiences on programs that didn’t provide translation services, this one is a deal breaker for me.
– Are you legally allowed to practice there? Again, just because it’s a developing country doesn’t mean we throw out the rulebook. I’ve heard of cases in which a gaggle of American nursing students are allowed to treat patients under the license of a single local physician, which strikes me as an incredible risk to that doctor (aside from being questionably legal).
– Where will you get your medications and supplies? I rushed to Nepal after the 2015 earthquake with a disaster response team, only to find that the organizers hadn’t brought the provisions we needed to treat patients. We spent our first day on the ground raiding a local hospital for medications. While there may be scenarios in which buying supplies in-country makes sense and supports the local economy, draining limited resources immediately after a disaster isn’t one of them.
– Can you speak to a previous volunteer? It always helps to get a sense of their experience and whether this program would be a good fit for you.
3. Listen before you act.
On my first medical missions, I used to barge into clinics in developing countries with a plan to “fix” everything. Spoiler alert: That doesn’t work.
There’s probably a reason that local clinicians do things the way they do. And the issues that you want to address may not be the problems that locals really want your help with. Even seemingly damaging local practices may have some relevance, and abruptly changing them can cause unforeseen consequences.
For example, HIV-positive mothers in the US are advised to exclusively feed their babies formula to reduce the risk of transmission. But in many developing countries, the high cost of formula and lack of clean water with which to mix it makes formula feeding dangerous for newborns. So even HIV-positive mothers are urged to breastfeed exclusively in these settings. Remember to proceed with caution even when you think you know what’s best.
Nowadays, I spend the first couple of days (at least) in any new setting just shadowing the local nurses, learning how they work, establishing a friendship, and understanding what they hope to gain from my presence.
4. Think carefully about social media.
HIPAA (patient privacy law in the US) may not be law in many developing countries, but privacy still matters. I’ve watched enthusiastic volunteers wander through hospitals with their cameras, snapping photos of women in labor or children on death’s door. And I constantly see volunteers on social media exposing the HIV status of their patients.
But if I showed up to work in the US and started posting photos of my patients on Instagram, you can bet that I wouldn’t have a job to return to the next day.
I know, we all want to share photos with friends and family and keep memories of our experiences for ourselves. Just do it thoughtfully. I aim for photos of buildings or objects rather than patients, and I frame my shots so that no faces are revealed. Before you share that photo, ask yourself: Would I want a picture taken of myself in the same situation?
Social media is also an opportunity to contradict stereotypes about the countries where you volunteer. Your photos and captions may be the only context that your followers have for learning about these places. Use that power wisely! When I volunteered in refugee health clinics in Northern Uganda, I posted photos and stories about all the amazing local clinicians and translators who worked there (with their permission, of course!). I’d rather share the positive and hopeful aspects of my experience than the same tired old tropes about poverty and disease. I also try to give credit to local staff rather than making myself the hero of the story.
5. Don’t mix religion and medicine.
Here’s where I think the term “medical mission” gets sticky. I use it because it’s the most widely understood term for medical professionals volunteering abroad, but I think the religious connotations it implies are problematic.
I was recently invited on a medical mission and checked out the organization’s website, only to find that they were not only tallying the number of patients treated and surgeries completed, but also the “professions of faith” they had produced. Now, there’s no problem with being motivated by your faith to use your skills to help those less fortunate. But to make spreading your personal faith the intention of your program is a problem.
Obviously, a parent will “convert” to the religion of a visitor who offers to perform an operation to save the life of their child. We all need to be careful not to exploit the power dynamic between caregiver and patient. Again – we don’t use health checkups as an opportunity to proselytize to our American patients, so we shouldn’t feel free to do it in developing countries, either.
Also keep in mind that mixing religion with healthcare may compromise your ability to effectively provide care in communities where your religion is in the minority. It may even put you and your colleagues in danger in some places.
6. Make sure your work is sustainable.
Are you just throwing a band-aid over a mortal wound, or actually addressing the source of the bleeding?
The first medical mission I ever participated in was a three-day free clinic offered by European volunteers in a slum in Nairobi, Kenya. We handed out antibiotics, pulled teeth, and performed health checks on hundreds of people. Even though all I did was sterilize equipment since I wasn’t a medical professional yet, I felt energized and inspired – in fact, those three days are what made me want to be a nurse.
But what happened after we left? Did the people we diagnosed with high blood pressure get follow-up care? Did the kids whose teeth we pulled suddenly have access to better nutrition, clean water, and oral care? Did we leave our patients in the capable hands of local healthcare providers, or did we encourage them to delay checkups and treatment until the next time a group of foreigners arrives?
The vast majority of medical missions I’ve encountered function just like that first one: A few days or weeks of clinics thrown together in a public building, after which the volunteers head home and leave the community exactly as it was before they arrived. Though this might feel good to everyone involved in the moment, these programs don’t address the underlying issues causing the lack of access to healthcare. In fact, they may disempower local care providers and create a dependence on foreign intervention.
Though it may not be as exciting, training local nurses and doctors has a much greater long-term impact than caring for patients ourselves. I spent a month mentoring local nurses at refugee health centers in Northern Uganda, and I have no doubt that I made more difference there than we did at that first clinic in Kenya. Long after I’m back at home in America, the fantastic Ugandan nurses I worked with will still be caring for their own communities and implementing new strategies that we developed together.
In my opinion, the goal of any good medical mission program should be to work itself out of a job. Rather than relying on endless teams of foreign volunteers, we should be striving towards a future in which the community we’ve set out to help stands on its own two feet.
7. Learn from local clinicians!
Local healthcare providers are an invaluable resource. Regardless of how much education and experience you have, they’ve probably forgotten more than you’ll ever know about how to work in their particular context. They’re the experts on treating diseases common to their area, working effectively with their ministry of health, providing care with limited resources, and the cultural aspects of care in their community. While we rely on a bevy of tests to identify an illness, health providers in places without those resources may have such keen assessment skills that they can diagnose an illness without running a single test.
Many skilled volunteers arrive for medical missions with the one-way mindset that they will impart knowledge and locals will receive it; they’re missing out on half the experience. I have learned more from working with nurses in developing countries than I can even begin to quantify. I am a more patient, empathetic, and resourceful nurse thanks to their example. My hope is that I have touched their lives anywhere near as much as they have affected mine.
Looking back on ten years of volunteering abroad as a nurse, the one thing I know for sure is that I’m still learning. I always will be. Although medical training makes for useful volunteers, it’s not enough by itself. We must combine our skills with humility, openness to growth, and commitment to true partnership with local caregivers. I hope to help people avoid the mistakes I made early on, so that we can truly change the world (and ourselves) for the better.
Emily Scott is a Registered Nurse with a background in Peace Studies. She has extensive experience volunteering abroad, including treating Ebola patients during the West African outbreak, training skilled birth attendants in Haiti, and mentoring local nurses at refugee health centers in Northern Uganda. Emily blogs about ethical travel and volunteering at Two Dusty Travelers. She lives in Seattle with her husband and their rescue dog. The main image shows Emily with some nurses that she trained with in Sierra Leone.