Playing Doctor… Abroad!

“When I give food to the poor, they call me a saint. When I ask why the poor have no food, they call me a communist.”  – Hélder Câmara

As summer comes to a close and school resumes, thousands of college students are returning from trips to developing countries where they have been playing doctor or nurse for a few short weeks (DON’T PANIC! You didn’t miss anything! Go to their blogs and Facebook posts for a recap of their trip).  These trips, termed short-term medical missions, generally involve premed or nursing students travelling to impoverished areas and providing medical care.  Frequently, these students lack the appropriate training and perform tasks that would never be permitted in their country of origin, such as pap smears and injections.  (Caveat: Medicine has a very recent history of having medical students “practice” skills such as pelvic exams on anesthetized women without their consent even in the United States).  Fortunately (for the wannabe doctors and nurses… sentences referring to the impoverished recipients “served” generally will start with “unfortunately”), groups that market these short-term medical missions help participants skate around these blatant ethical dilemmas with rhetoric such as, “With small health clinics and understaffed hospitals serving low-income communities, volunteers support the over-worked staff, adding to their efficiency and allowing more people in need to be served.”  Participants are made to think, “Sure, I may not be adequately trained, I may not speak the language, I may only be there for 2 weeks… but it is better than nothing!”  (It isn’t).

All these ethical landmines aside, many organizations play to the white savior complex and are marketed to and perceived by participants to be humanitarian or “service” work.  “Volunteers” are told, “As an international volunteer you can effect positive change for people around the world.”  Aside from the fact that research has shown that this is not true, this is an obscenely oversimplified view that discourages rather than encourages critical thinking (possibly a trait we should try and nurture in future health care workers?).  Rather than asking, “What structural forces are at work leading to such poorly funded health systems and abject poverty?  Why are people drinking dirty water when they know there is a cholera outbreak?” these programs sell a prepackaged altruistic identity and make participants think, “Gee, let’s go help those poor, helpless Africans… and go on a safari!”  This downstream approach is unsurprising given the health care system in the United States profits from treating rather than preventing disease.

As a testament to the fact that health services are severely underfunded, one organization states on its website that there are only 74 doctors per 100,000 people in South Africa.  However, they conveniently fail to mention that austerity measures imposed on South Africa by the DC-based IMF and World Bank force spending cuts to health services.  This form of coercion goes under the benign name of “structural adjustment programs” (maybe if we sent aspiring chiropractors to implement spinal adjustment programs we wouldn’t have this problem).

It also conveniently leaves out the unfortunate (I told you) fact that Sub-Saharan African countries have lost over 2 billion dollars spent on training doctors.  Where do they go?  Fortunately (again, for the first world) mostly Britain and the US.  These countries have saved an estimated 2.7 billion dollars (Britain) and 846 million dollars (US) by poaching doctors trained in Sub-Saharan Africa (I don’t mean to sell us short; we steal doctors from other countries as well… 1:4 doctors in the United States was trained overseas).

Other medical mission trip organizations discuss the increase in cholera and lack of clean water in South Africa, but fail to mention the role of water privatization (again, forced by the IMF and World Bank) (Patrick Bond has a great article on this in the book “Sickness and Wealth”).  The list of oversimplifications and contradictions is endless.

       “But what am I supposed to do this summer if not practice (non-existent) medical skills on impoverished individuals or burden communities with too few resources as a means of promoting health?”

As mentioned earlier, policies coming from developed nations are largely responsible for problems in the developing world.  Whether it be global warming leading to droughts and famine in Africa or structural adjustment programs that have, according to the World Health Organization, “slowed down improvements in, or worsened, the health status of people in countries implementing them,” we need to look in the mirror when it comes to culpability for the poor health indicators of many developing nations.  For this reason, the best place to promote health is not travelling abroad to the figurative front lines where the casualties of neoliberalism build, but rather behind enemy lines where political and economic powers undermine health through policy.  Nurses are taking the lead in recognizing the relationship between policy and health and have started protesting institutions like NATO and Wall Street.  Another form of patient advocacy one nurse notes.

I won’t pretend to have all the answers. After all, changing the world is no easy task.  Creating healthier populations is a brave thing to fight for.  Odds are though, if we continue this struggle in a way that isn’t upsetting people and causing conflict, we are treating symptoms of a larger problem at best, and reinforcing the current systems that undermine health at worst.  The chains of oppression will not break without tension.  You don’t need to travel to the other side of the world to make a difference.  But if you do, go abroad to fight for the health of those living in the developing world, stand beside them in solidarity, pick up the chains, and pull.

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