Nurse midwives and their students are among the hundreds of thousands of people from wealthy parts of the world who travel abroad every year to participate in short-term programs intended to improve the health and well-being of people in poor countries. Considering the horrific toll of maternal and infant mortality in so many countries, the potential for improving health and quality of life draws students and professionals who want to alleviate suffering as well as learn about the world.
Short-term medical missions (STMMs) have been praised for the dedication of volunteers and their valuable impact in poor communities. At the same time, these trips have increasingly been subject to severe criticism for promoting ‘drive-by humanitarianism’ and as a new form of colonialism. North American medical faculty have expressed increasing concern about untrained and unlicensed students “practicing” medicine in ways they cannot (and should not) do at home. And many well-intentioned volunteers return from their trips wondering whether they made a difference. So how valuable are STMMs, either to the volunteers or to the communities they visit?
Both critics and supporters rely mostly on anecdotes to illustrate their particular position. Indeed, there is rarely any systematic evaluation of these programs to assess their value either for host communities or for volunteers. For my own research*, I surveyed and interviewed STMM sponsors in the U.S. and interviewed host community staff that work with volunteers in four countries. I wanted to use some systematic evidence in order to take another look at this growing multi-billion-dollar phenomenon.
In doing so, I was able to identify common practices and contrast them with what host staff prefer from volunteers. The gap is significant on several fronts—the length of trips (too short), the selection of volunteers (too lax), preparation of volunteers (very insufficient), and active engagement of host communities in determining needs and evaluating impact (often non-existent).
I conclude the book with nine principles for maximizing the value of STMMs. Not all trips can incorporate every principle, but most should be considered essential.
- Foster Mutuality between sponsor organizations and host country partners
- Maintain Continuity of programming
- Conduct substantive needs Assessment, with host community involvement
- Evaluate process and outcomes and incorporate the results into improvements
- Focus on Prevention
- Integrate diverse types of health services
- Build local Capacity
- Strengthen volunteer Preparation
- Have volunteers stay Longer
It is safe to say, based on the research, that most STMMs do not follow most of these principles. Here is an anecdote illustrating this: one of my students accompanied a trip to Ghana whose purpose was to train professional and lay midwives. Their goal was a grand one—to reduce maternal mortality in a remote region. They spent a lot of money and time preparing for the trip. But during the first day of training, the professional midwives objected that they were being taught the very basics they had already learned in school and had indeed practiced for years. The volunteers had assumed that they did not know anything about their field. It was insulting, and a waste of precious time and resources on everyone’s part. Fortunately, the volunteers were able to re-tool quickly and improve what they could offer in the subsequent days. “Birth kits”, distributed to lay midwives, were appreciated and used, except that a follow-up a year later revealed that the flashlights were difficult to operate and supplies were quickly depleted.
A thorough needs assessment beforehand might have improved the program, continuity might have produced a plan for restocking the kits, and a good evaluation afterward could have informed the sponsors whether their investment had indeed made a difference. However, these were not priorities for the organization, which was pleased with the good public relations created and the likelihood that they had made a small difference. And since they were donating money and equipment to the regional health center, the local partners were not likely to provide negative feedback.
Better examples do exist, where professionals from sponsoring and host countries work together to solve problems on an ongoing basis. Host country staff repeatedly said that volunteers are appreciated when they work hard, have needed skills to offer, and are respectful and willing to learn from their hosts.
Organizations that want to have the most impact would do well to extend the length of trips, improve volunteer preparation, and focus on needs defined by community partners. The really good news is that research suggests that following these principles makes for a better experience for volunteers as well as for host communities.
*“Hoping to Help; the Promises and Pitfalls of Global Health Volunteering”, Cornell U. Press, 2016.