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What do you think?

Here are some answers you may have thought of while contemplating this module's reflection question:

1. What are the challenges of medical missions?

Medical missions and other short-term volunteer engagements have challenges and issues related to quality standards, lack of control by host countries, and power dynamics between the volunteers and host countries. They often don't fully consider the needs of communities and host countries, and can even end up causing more harm than good.

Moreover, they may also undermine local community resilience and health systems. The critical issue to consider is who is driving the agenda and is it being addressed in a sustainable, ethical and equitable way.

The article by Lasker et al. (2018) on guidelines for responsible short-term global health activities describes the following challenges:

- "displacement or devaluing of local providers,
- failure to arrange adequate follow-up of medical and surgical treatment,
- visitors carrying out medical procedures without adequate training and/or expertise,
- discordance between local needs and visitor offerings,
- inadequate licensing and credentialing of participants,
- inadequate intercultural aptitude of visitors,
- neocolonial attitudes towards host communities,
- inequitable use of funding,
- creation of dependency on external resources, and
- lack of continuity of services" (page 2)

The article by Stone and Olson (2016) on the ethics of medical volunteerism also describes challenges related to exploitation:

"The communities served by MSTs [short term medical service trips] are inherently vulnerable populations...these populations are at risk of exploitation by MSTs, raising ethical concerns about informed consent, beneficence, coercion, autonomy, and justice. Exploitation may take place in various forms and to varying degrees, from the use of unauthorized patient photos for fundraising and publicity to the extreme of practicing new procedural techniques during MSTs."

2. What are alternatives to short-term medical missions?

While engaging in global health activities, it is critical to focus on mutual partnership with countries and communities, and allowing the local community to define its health needs.

The Brocher Declaration highlights six principles for ethical global health interventions:

Mutual partnership with bidirectional input and learning
Empowered host country and community define needs and activities
Sustainable programs and capacity building
Compliance with applicable laws, ethical standards, and code of conduct
Humility, cultural sensitivity, and respect for all involved
Accountability for actions

In addition, the article by Arora et al. (2018) about pediatrics and global health calls on healthcare providers to especially consider respect for partner perspectives:

"to provide benefit, visiting GCH practitioners must ensure that proposed health activities reflect both the population’s needs and preferences, understand cultural contexts, formulate collaborative and sustainable relationships, and maintain professionalism based on mutual respect" (pages 4-5)

3. How can I get engaged in ethically sound global health activities?

Despite these complex challenges, it is possible to engage in global health activities in an ethical way. It is important to evaluate the organization or provider to ensure they have a model of mutual respect, bi-directional learning, and long term engagement with the host community.

Fair Trade Learning is one emerging model that works to ensure that global service and learning partnerships are aligned across sustainable development values.

It is also crucial to understand and take inventory of how you best fit into the global health system, and where you can be of the most help. What are your skills and capabilities? Is there a need for your particular skillset? Find out where you fit in, and work to become a "global citizen" to support your local and global health communities.