International health experiences, and more broadly, any type of overseas volunteerism in the the developing world has become increasingly popular. Amoungst medical students in the US, 5.8% completed such an experience in 1978. In 2003 it jumped to more than 1 in 5; 22.4%.However, in the midst of this growth many tough questions around the ethics and implications of these experience for host communities have been short changed. For example, what are our own intentions when undertaking these experiences? What are the consequences for the local community, good and bad? What are the overarching goals of these experiences?
If you have 5 minutes:
To Hell with Good Intentions - Ivan Illich
Written in 1968, but still relevant today, Illich turns the idea of ‘mission-vacations’ on its head, arguing that these projects are irredeemably mired in hypocrisy. Using his experience with 'voluntourists' in Latin America, he argues:
- Good intentions are meaningless when the result is a ‘do-gooder’ army that offends many Mexicans.
- Volunteers are ultimately selling an American value system and ‘seducing’ the ‘underdeveloped’ with the benefits of their way of life. This value system is a product of American consumerism with little in common with the local community.
- Ultimately, volunteers have no ability for a meaningful dialogue with those they are ‘helping’. Their only meaningful exchanges can be with Latin American versions of themselves, the educated and middle class elite.
Finally Illich urges the volunteers to stay at home and work for change in their own communities, where their work can be understood and have meaningful consequences.
If you have 10 minutes:
Read the full article. Much more powerful then our bullet points and worth the time:
http://www.swaraj.org/illich_hell.htm
For a medical perspective, read this short piece from the BMJ: Medical tourism can do harm
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117889/
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If you have 5 minutes:
Watch this 4 minute video from Free the Children. If extolls the virtues of the type of experience Illich rails against.
http://www.youtube.com/v/0J9ZqW5KyDE?autoplay=1
As physicians where does this leave us? There are clear inequities in health and health care in Canada and overseas. Do we have a role in addressing them? If so, how do we do so responsibly and respect the principle of 'do no 'harm?' If not, what is our role in dealing with health disparities?
After our discussion, we'll post an article that addresses these issues in it's own way.
