"The onus lies on medical schools and healthcare bodies endorsing international electives to ensure that individuals are appropriately prepared..."

Int J Surg. 2017 Apr 19. pii: S1743-9191(17)30331-X. doi: 10.1016/j.ijsu.2017.04.020. [Epub ahead of print]

Surgical volunteerism or voluntourism - Are we doing more harm than good?

Ahmed F1, Grade M2, Malm C3, Michelen S4, Ahmed N5.

Author information

1

NHS England, UK; London School of Hygiene and Tropical Medicine, UK. Electronic address: faheem.ahmed@doctors.org.uk.

2

Stanford Medical School, USA. Electronic address: madelinegrade@gmail.com.

3

Harvard Medical School, USA. Electronic address: carl_malm@hms.harvard.edu.

4

Harvard Medical School, USA; London School of Hygiene and Tropical Medicine, UK. Electronic address: sophia_michelen@hms.harvard.edu.

5

St George's Hospital, UK. Electronic address: naeem.ahmed@nhs.net.

Abstract

The significant rise in the number of international health electives undertaken by medical students and doctors in the US, Canada and UK reflects acknowledgement of the inter-connected nature of these challenges to health systems and the drive to help solve them. However, the next generation of international volunteers often operate under a conflicting duality: whilst many of their role models have devoted their lives to global health following a similar volunteering experience, there are pervasive ethical problems associated with short-term global health work that must be identified and addressed to ensure positive outcomes for all parties involved. The general shortage of healthcare staff in resource-poor countries has significantly contributed to the disparities between need and provision.1 The majority of populations served by shortterm surgical volunteer trips are vulnerable communities; this raises ethical questions such as the lack of informed consent, use of unauthorised photos for marketing, and practicing new procedural techniques. 2 Whilst there exist various models that can be used to facilitate effective international health electives, there is a lack of stringent monitoring and enforcement both on the part of healthcare institutions deploying volunteers as well as recipient bodies in LMICS. Well-organised programmes prevent cases of 'poor care given to poor people' as medical students and doctors are expected to act in their patients' best interests as they would do in their home country. As clinician interest in global health projects continue to rise, too-common trainee naivety - while rooted in goodwill - must be supplanted by adequate training, ethical coherence, and cultural fluency. The onus lies on medical schools and healthcare bodies endorsing international electives to ensure that individuals are appropriately prepared and only travel through programmes that are able to demonstrate that they meet the necessary requirements and follow guidelines to avoid doing more harm than good.