Thousands
of global health volunteers, most from the United States, travel to Africa every
year. These volunteers come from diverse backgrounds and have varying
levels of experience. They include surgeons, anaesthesiologists, nurses and
medical students. They arrive with the ambition to improve health outcomes in
Africa and learn about "global health".
In
my research I have studied the impact of these volunteers in Zambia. Between
2014 and 2016, I conducted research at a rural hospital where medical
volunteers from the US provided various forms of medical care, including eye
surgeries, caesarian sections, and treatments for malaria, tuberculosis and
HIV.
In
my latest research
paper I examine how the presence of these volunteers affected the lives and
relationships of people in Zambia.
My
key finding is that the presence of medical volunteers caused damage to the
relationships between Zambian health professionals and patients.
identify
this as a kind of "relational harm".
These
findings are important because relationships are central to the delivery of
effective healthcare. Clinical care requires material infrastructure: power,
water, hospital beds, medical gloves and technical devices. But it also
requires strong relationships of cooperation, trust and mutual recognition.
I
conclude from my findings that academics, volunteers, and global health
organisations should pay more attention to the "relational harm" that
volunteering can cause in under-resourced settings where privileged volunteers
work amid extreme inequality.
The impact
Drawing
on long-term ethnographic research and interviews with Zambian health workers
and patients, I found that local opinions about global health volunteers were
divided.
At the
hospital where I conducted my research, patients were often enthusiastic about
their presence while many Zambian health professionals were critical.
Patients
regularly praised volunteers and described positive encounters with them. One
Zambian patient described a medical volunteer as having "a heart for
patients ... he doesn't look at who he is dealing with ... he can be there for
anyone."
To
many patients, it seemed that volunteers often provided a higher quality of
care than Zambian staff members.
But
this was, in part, due to differences in wealth, status and privilege between
American volunteers and Zambian health workers.
While
American volunteers could focus entirely on their hospital work, Zambian staff
members had families to support, social events to attend, and school bills to
pay. This meant that they could not spend as much time at the hospital or offer
patients gifts, including small payments (known as "transport
money"), that volunteers often offered to patients.
This was
noted by Zambian health workers, such as Matthew, who told me the following:
Most
{patients} will say that {the volunteers} will help with transport money and
{the patients} get back home and then they share with their friends that they
got transport money. But sometimes this is at the expense of local staff who
then get called bad.
In
addition, Zambian health workers felt that their hard work and expertise were
being overlooked. As another staff member explained:
These
international {volunteers} ... they really look like they are better and even
patients start to see a big gap. But it is not that Zambians are worse.
This
staff member was pointing out that volunteers were often able to provide care
that appeared to be "better" because they could work for longer
hours, offer transport money, or even use newer technologies and medical
devices.
In
this context, staff members felt that they were judged negatively by patients
because of the presence of volunteers.
When
patients expressed a preference for white volunteers - particularly those with
less expertise - it often negatively affected Zambian health workers. As an
experienced Zambian health professional told me:
When
somebody comes in and says they want to be treated by a white student, then you
feel like a stranger in your own country.
The
presence of volunteers therefore strained the relationships between staff
members and patients, creating new forms of anxiety, resentment, and division.
Staff
members and patients were concerned that these tensions would continue to
affect their relationships in the future - even in the absence of volunteers.
What can be done
These
findings can contribute to growing debates about the benefits and risks of
global health volunteering.
Critics
have argued that medical volunteering reinforces inequality and paternalism, as
well as causing direct harm through medical negligence. Supporters of medical
volunteering argue that these risks can be overcome when medical volunteers are
responsible and informed.
Focusing
on the impact of medical volunteering on local relationships offers a new
perspective.
In
the future, global health volunteers and the organisations that promote
volunteering should reflect on whether their work is damaging relationships in
healthcare settings. In under-resourced contexts, these relationships are often
particularly fragile, as researchers working in Sierra Leone in the aftermath
of Ebola have shown.
Those
who decide to volunteer should consider whether they are leaving these
relationships in a better or a worse condition than they found them. If their
aim is to improve health outcomes, they should ask how they might use their
resources to strengthen these relationships instead of undermining them.
James
Wintrup, Senior Researcher, Chr. Michelsen Institute
This article is republished
from The Conversation Africa under a
Creative Commons license. Read the original article.