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Markkula Center for Applied Ethics

Global Medical Volunteering: Designing a Sustainable and Ethical Service Model

A person wearing a t-shirt that says

A person wearing a t-shirt that says "Volunteer" holding a small globe in their hands.

Joseph Guasco ‘23

Mikhail Nilov/Pexels

Joseph Guasco is majoring in biology with a minor in public health and is a 2022-23 health care ethics intern at the Markkula Center for Applied Ethics. Views are his own.


In 2022, I volunteered with a global health and development organization in Guatemala where I was exposed to a diverse set of emerging health care and social justice issues.  I volunteered in the Sololá region, providing medical services to several communities that lacked the financial resources to attain clinical attention. Many of our patients went years without medical care. Despite their strength and resilience, many suffered severe forms of treatable diseases. Hypertension, adult-onset diabetes, and urinary tract infections were common, and the community physician explained that poverty and tradition are significant obstacles in Guatemalan healthcare.

Many of our indigenous Mayan patients distrusted Western medicine and often refused to seek help until the last moment. A defining moment of this experience occurred when one of our patients entered our clinic wearing a shirt stitched with the words, "go home colonizer." Among other challenges I faced in this experience, their powerful protest was striking and surprising. They were not the only ones who cautiously approached our humble clinic. In fact, their distrust paralleled others who were comparably reluctant and expressed contempt for our presence. I believed the communities welcomed our initiative, but complex social dynamics, violent histories of colonialism, and decades of abuse sewed mistrust among some of our patients. 

International medical volunteering (IMV) is a growing industry, with increasing interest in its potential to enhance cultural competency, promote global engagement, and build networks among similarly-invested peers. The global volunteering industry is a billion-dollar enterprise, with an estimated 10 million volunteers annually. IMV programs are short-term commitments that cater to undergraduate students interested in gaining clinical experience and a competitive edge in graduate school applications. Many believe volunteering abroad benefits the participants’ professional interests and the communities they serve; however, this is a complex issue with a diverse group of stakeholders. 

Last year, Linnea Rothi discussed the significance of individual decision-making in international medical volunteering. My goal in writing this is not to discourage international volunteering. IMV programs meaningfully impact the lives of many, and their noble effort has helped address global health inequity. Instead, I hope to challenge the current volunteering framework and propose how IMV organizations can make more informed, ethical choices to cultivate sustainable and equitable partnerships with local communities.

Current IMV Landscape

There is a global demand for international medical volunteering initiatives. People in low- and middle-income countries (LMICs) typically have less access to routine healthcare services than those in developed countries. The absence of established health care systems in LMICs provides a favorable environment for non-governmental organizations (NGOs) that advocate for medical humanitarian aid. IMV organizations typically rely on a service exchange model, where communities receive free medical attention, and volunteers gain clinical exposure and cultural knowledge. Unfortunately, this exchange is often one-sided, and ethical concerns arise when organizations are negligent, ill-prepared, or inconsiderate of the urgent community needs.

IMV participants are generally aware that their involvement may perpetuate the adverse outcomes of medical voluntourism. According to one meta-analysis, IMV participants have expressed concern that short-term medical volunteering trips reinforce neocolonialist or exploitative attitudes. This is not an isolated perturbation, either. Others have suggested that poorly executed IMV exemplifies contemporary imperialism. The cornerstone of this association typically rests upon the understanding that the expansion of Western influence into culturally and ethnically distinct regions disregards local tradition, and compliance with medical arrogance neglects autonomy, harms vulnerable populations, and forfeits sustainable partnerships. 

The outcomes of dysfunctional IMV programs are varied and widespread. At its worst, international medical volunteering limits resource availability, undermines established health care outlets, and contributes to an overreliance on foreign aid. According to Jennifer Jacobs, a physician and epidemiologist at the University of Washington School of Medicine, insufficient investment in health care infrastructure can exacerbate health inequity. Although medical volunteering can offer productive assistance, the help provided by volunteers may be superficial and subpar. Occasionally volunteers participate for the wrong reasons. This could be for personal gain or pride; regardless, it is usually at the expense of local communities. Host communities often have little power in deciding where IMV initiatives operate, meaning that IMV efforts are not directed where they are needed most. Whether or not this displaced effort is due to perceived safety concerns or diplomatic agreement, IMV organizations may overlook the communities where their work will have the greatest impact. Further issues arise when medical practice reinforces paternalism, volunteers neglect the urgent community needs, or arrive with inadequate training.  

Next Steps Toward a Sustainable IMV Model

Until now, I have identified some of what can happen when IMV projects are poorly executed. Not all IMV initiatives struggle with the same issues; however, the medical volunteering industry can benefit from making several essential changes that will improve the quality of care and nurture enduring partnerships. Although IMV programs can make many adjustments to their operations, I will suggest four changes to implement in the current framework:

  1. Establish a global health curriculum.
  2. Involve the community in patient care decision-making.
  3. Select volunteers who are conscious of their role and responsibilities as a participant.
  4. Commit to sustained aid and community development.

Implementing culturally competent patient care protocols into IMV experiences requires a departure from ethnocentric practice. This can be achieved by establishing a global health curriculum that educates volunteers about unique health disparities, culture, and foreign health systems. International government agencies like the World Health Organization (WHO) assert that global health curricula are essential in medical school academic programs; these programs can address language and cultural barriers that interfere with respectful care. Inappropriate communication may further offend patients, and it can also contribute to misdiagnoses and distrust. 

IMV organizations can collaborate with local physicians, nurses, administrators, and other health care professionals to ensure that volunteering efforts do not impair established health systems. Native health care workers know how their health system operates, and they speak the language. Leveraging their expertise provides patients with a resource for follow-up appointments. Furthermore, working with community leaders will help develop fair partnerships with local groups, establish trust, and allow local workers who volunteer their time to receive compensation.

It is crucial to select volunteers based on skill and preparedness, cultural sensitivity, and awareness of their privilege. IMV volunteers have a powerful influence on the well-being of the communities they serve. With this in mind, IMV organizations must prepare volunteers for on-site experiences. Infectious disease, crime, and infrastructure problems are frequent concerns, and if volunteers are not prepared for these challenges, the consequences may be traumatic or life-threatening.

Maintaining continuous support is essential to preserving relationships and preventing collapse. IMV organizations should invest in lasting partnerships to establish trust with the communities whom they serve. They should also be receptive to community needs, know their boundaries, and recognize when they have achieved their mission. To avoid undermining the established health care system, organizations must consistently re-evaluate their impact. Committing to sustained aid provides patients with continued access to affordable health care, aftercare, and future consultation. 

Future Directions

Foreign communities and underserved populations are vulnerable to malpractice, ineffective patient care, and cultural insensitivity. Failure to uphold fair and equitable partnerships sacrifices patient autonomy and allows companies to profit from their misfortune. Thus, IMV organizations have an ethical responsibility to protect communities from harm while also striving to ensure patient welfare. I have identified several actions IMV organizations can take to improve their operations. If these initiatives intend to be consistent with their mission to create sustainable change, deliver high-quality medical care, and prioritize patient interests, they must reassess how they provide care. IMV organizations bear direct responsibility for the well-being of their patients, volunteers, and the functioning of the larger health care environment. They must recognize their role, reassess their impact, and hold themselves accountable. Confronting these challenges will be a productive means of addressing global medical engagement and international medical volunteering issues.


Apr 24, 2023

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