Author Urges a Rethink About Medical Volunteerism Abroad

Chronicle photo by Ron Coddington

Every year, thousands of college students, church members, and medical professionals provide health care in other countries through short-term volunteer trips. But do they actually improve the lives of the people they aim to help?

Judith N. Lasker, a sociology professor at Lehigh University, explores this question in her new book, Hoping to Help: The Promises and Pitfalls of Global Health Volunteering. Lasker participated in several such trips and interviewed organizers, volunteers, and community members in host countries.

What inspired you to tackle this topic?

I’ve always been interested in health in the less well-off parts of the world. I did my Ph.D. dissertation on the health system in the Ivory Coast in West Africa. I’ve taught global health as a course.

But also, I worked with students who were doing short-term volunteer trips, and they would sometimes come back saying, I don’t know if that was helpful but it sure was a wonderful experience.

Given the increased number of people going on these trips, what can we learn about how they actually operate? What kind of evaluations are being done? How do we assess the value for host communities as well as for the volunteers?

What conditions led to this phenomenon?

Through the Internet, people are seeing a lot more information about conditions abroad and hearing much more about the experiences of others who go. People post their adventures on social media, and it generates interest.

Interest in public health has grown exponentially at universities in this country. Many colleges now have an undergraduate public-health degree, and that’s a fairly new phenomenon. So more and more students are interested in public health and see spending time in other countries in a health clinic as exciting and a good learning experience.

But the biggest group that goes is church groups — and that’s a different set of circumstances.

Lehigh University

With the input of very visible celebrities, people like [Bill] Gates and the Gates Foundation putting money into the field, and the greater publicity around AIDS and Zika and Ebola, there’s a much greater awareness around problems in global health.

Also there’s been an increase in service generally. High schools sometimes require it as part of graduation. People who are applying to jobs or schools, undergraduate and graduate, see service as a credential that is almost essential.

The greater demand generates more businesses, churches, and schools offering programs that make these trips possible for more people.

You outline three parties that potentially stand to benefit from these trips: the volunteers, trip organizers, and host communities. Which groups tend to benefit most, and which do you think should benefit most?

I think it’s unclear; that’s what I tried to show in the book. A well-designed program would benefit all three groups. A poorly designed program doesn’t benefit any of them very much, except perhaps an organization that is really just looking to make money or recruit more people and show off that they’re doing something.

Even the issue of what do we mean by “benefit” is not clear. Volunteers may benefit from an opportunity to travel to places they’ve never been, but maybe the benefit for them is to learn that the answers to all the world’s problems are not to be found in Americans with money, that there are better ways to do things sometimes. And countries that are stereotyped as full of ignorance, poverty, and hunger are actually places with dynamic communities and leaders and people and economic development and good ideas and experience.

In my mind, clearly the host community should be the primary beneficiary. You cannot go into something like this and say it doesn’t matter whether the host community benefits or not. That to me is kind of dishonest, unless you accompany it with a clear statement that the host community is not the beneficiary but is the actual donor of good experiences and education to Americans. And if they are the donors, then they should be compensated for the skills, experiences, and knowledge that they are giving to travelers.

What are some of the common pitfalls of these trips?

If a program is designed to suit the schedules and the skills of the volunteers, and it’s a one-off drop-in in some village, and they say, Here we are, we’ve got this stuff with us, and we’ll be here for a day or two and then go onto another village for a day or two, and then we go home and we will never be back again — that’s lousy medical care. It means that you can’t treat people for anything beyond an immediate, acute situation. You cannot follow people up to make sure that you didn’t do something that caused problems.

To bring stuff to a community on a once-and-done basis is a disservice. For the most part, the impact on the community is nil or very small and potentially even harmful.

The other pitfall, from the point of view of the volunteer, is to go with very little preparation, no knowledge of the community, the nation, the culture, or the language. To be thrown into a completely strange setting and then go home after a week — I don’t think that’s a good learning experience.

You suggest that some organizations know volunteers don’t provide much benefit but use them anyway because they provide financial support later. Why is the idea that people should “just send the money” an “unrealistic alternative” to these trips, as you say in the book?

It’s very hard to raise funds from young people who don’t have much money, or even from adults who may give small amounts to different organizations. It’s unlikely they’re going to send a check for $2,000 for health care in Guatemala.

I don’t think the fundraising would occur if volunteers don’t go. The people I interviewed who said it’s really about creating donors, they’re talking about a longer-term commitment. They want, reasonably so, for potential donors to see what they’re doing, to appreciate it in person, and then be motivated to continue to support them. I continue to support some of the organizations I traveled with because I saw they were doing good work, and if I had not gone I wouldn’t do that.

Of course, if you took away the money that goes to paying the airlines and that goes to paying administrative costs, it wouldn’t be as much. If you actually figured out how much goes to the host community, it’s maybe a quarter or a third.

What the organizations rightfully understand is that people want the experience and they like to be able to be able to talk about it afterwards. It is exciting to go to another country. People feel they can justify the expenditure, even if they don’t have much money, because it’s perceived as philanthropy.

The book contrasts “New Colonialism” with “Fair Trade Learning.” Can you define those terms and explain how they differ?

There are many people who accuse volunteers of being “colonial” in exploiting poor people for rich people’s benefit. There is a sense in which it is about people in the richer countries extracting benefits from their interactions with people in the poor countries. They get resume building, they get experiences, they get contacts, social capital of various kinds.

We need to consider what that means, that there is so much benefit coming from an unequal relationship in which the outsiders are perceived as experts, whether they are or not, and they go home and get applauded and praised and get opportunities whether they’ve done anything good or not.

The Fair Trade Learning approach was developed by Amizade, an organization based in Pittsburgh. They still want to give American students opportunities, but they do it only in places where they have a local partner who has a lot of say how the programs are run and where the local partner gets financial benefits and educational benefits. This is an exchange, and if it’s going to be a benefit to the volunteers, there should be an equivalent benefit to local communities.

In the book, you say that “healing bodies as a pretext for saving souls” is “deceptive and potentially coercive.” What does that mean for religious medical-mission trips?

Throughout the world, there are many, many places that get excellent, dedicated medical care from church-group missionaries. I don’t want to diminish that. I don’t want to neglect that.

But if you have to listen to a sermon or go to a movie or pray before you can get treated, I have a real problem with that. There are groups that operate that way. Many faith-based groups urge people to go through some kind of religious practice as part of getting medical care, and that I think is coercive, and it’s deceptive if they present themselves as strictly providing medical care.

My impression is that most faith-based groups do not do that. Many faith-based groups and people that I’ve talked with strongly oppose doing that. They feel their religious faith motivates them to make the world a better place and serve the poor.

Why is there resistance to scientific evaluation of short volunteer medical trips?

I do believe evaluation can be done, but it’s difficult and expensive. If people believe they are doing good, they don’t really see it as necessarily that important. Unless people have a good incentive to be able to show benefits, it’s not going to be first priority.

Why is it important to involve host communities in evaluation?

First of all, it’s important to involve them in the assessment process. Start by figuring out what people need and work with them to make sure that what you are doing is appropriate and useful. Don’t train people to do surgery where there are no operating rooms. Don’t train people at a level too low for them. Don’t assume that people don’t know anything.

If you actually do that, you still need to know whether it works. Is there a follow-up?

I would like to see people use their time and their effort and their money and their goodwill as wisely and effectively as possible. In any social-service setting, you can’t do that without some kind of ongoing collaboration with communities who can say, This is what we need and this is what’s working and this is what’s not working and here’s how we can revise it to make it better.

Ideally, would volunteers be involved at all in overseas medical care?

There are folks who think that this is completely wrongheaded and should be stopped. I’m not one of them. I think there are enough problems that it needs to be rethought in a lot of ways.

If a student comes to me and says, “I have this opportunity to go on a trip for a week,” I would counsel them not to do it. I would counsel them to find out much more about the organization, what they’d be doing, what the track record is, and to go for longer for a week. The people I interviewed who are staff in host communities said quite strongly that they want people to come for three weeks because then they can finally start to get used to the place and learn something and be able to accomplish something.

There’s a great deal of problem with people being dressed up in medical gear, in scrubs, acting as if they are doctors when they are undergraduates with no medical training.

They should be much better monitored and regulated. We need some way to make clearer to people who are looking that there are criteria that would identify good trips from bad trips, or useful from not useful. And useful, like I said at the beginning, for everybody.

This interview has been edited for brevity and clarity.