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Voluntourism: the downsides of medical missions



12 June 2012

An increasing number of doctors and other health workers from developed countries - including Australia - are packing up their mosquito nets and scalpels and heading overseas on short trips to provide health services.

These "medical missions" - frequently a week or two in duration - often conduct specialist surgeries for cataracts and cleft lips as well as basic care.

Our recent study of all 230 published accounts of short-term medical missions to poor countries over the last 25 years reveals that there are serious concerns about their sustainability, financial transparency, ethical standards, and appropriateness in meeting the real needs of our neighbours.

We found that the USA, Canada and Australia were the countries that dispatch the most missions, with the most popular destinations for Australian health teams being Papua New Guinea and the Solomon Islands.

The health professionals who went on these missions gained a great deal personally and saw these volunteer experiences as opportunities to reconnect to why they chose to become health workers. And the services provided helped a number of people in need who might not have had access to care otherwise.

While these missions are fundamentally altruistic and led by people who "want to make a difference", there are a number of negative aspects. A number of the rich-world doctors demonstrate a lack of awareness about the realities of health care in developing countries and show a lack of respect for local health workers.

Visiting health workers often make little effort to understand local health needs and culture - often trying to provide health care to individuals without speaking their language or using appropriate interpreters. One report said of visiting health professionals:

They expect to be greeted with warm enthusiasm and are often bearing gifts. They seldom inquire beforehand what is most appropriate for the local needs. The department concerned has not even been told about their forthcoming visit.

Furthermore, insufficient attention is given to critical issues of follow-up and ongoing care - often not knowing the local system well enough, there is a failure to refer patients for ongoing care for their high blood pressure, asthma or epilepsy, or having had surgery for cleft lip, for instance. These volunteer health professionals essentially wash their hands of the patients as they board their plane home, souvenirs in hand.

Short-term medical missions are also not the best use of limited financial and human resources. The costs involved in financing medical missions such as airfares, accommodation, vaccinations, visa costs, customs fees for medicines and medical equipment are considerable.

One mission member, on return to England, asked if the funds spent to fly 10 doctors to Ghana for 10 days would have been better spent building a new wing of the hospital, or up-skilling local doctors over several months, or even providing the annual salary for a Ghanaian doctor.

There were also suggestions that some mission participants were not as altruistic as claimed. Medical missions by Canadian health workers to the Caribbean increase during the cold Canadian winter. Some have accused health workers of categorising brief missions as work travel expenses to gain a tax write-off. Then there is the CV factor - some medical students see time working in developing countries as a "right of passage" for admission into residency.

One report in our review, from 2002, saw patients in developing countries as a "population on which to perfect their surgical skills".

Health work overseas needs to take into account strengthening the health system for the community as a whole and for the long-run, and not just providing immediate bandaid solutions for a handful of individual patients.

Considering their popularity and growth, there is a need to harness the positive power of these medical missions by increasing true partnership with people in developing countries and mentorship over the long-term.

This will help local people increase their own skills to ultimately reduce the need for medical missions. As with most aid work, the ultimate goal has to be to make oneself redundant. More capacity building, more focus on prevention, and more cost-effective use of funds for infrastructure are needed to achieve that goal.

We recognise that many medical missions already adhere to this framework, but it should be all; as privileged citizens of a high income country, we owe it to our neighbours to support their true needs.

Short-term, unconnected medical missions seeking new and exotic diseases are not typically what health professionals in developing countries want. We recall reading the vehement comments by a Nepalese doctor about visiting health volunteers who would set up shop on the trails to Everest to provide "who knows what kind of services" to local people instead of working as registered doctors in Nepal. He asked how we would feel if a Nepalese doctor set up a sign in downtown Sydney and started to provide services.

Dr Alexandra Martiniuk is a senior lecturer and research fellow at the Sydney Medical School. Joel Negin is a senior lecturer in International Public Health at the School of Public Health.


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Media enquiries: Verity Leatherdale, 02 9351 4312, 0403 067 342, verity.leatherdale@sydney.edu.au