From the DR: Who are we really helping?
I’m spending this semester abroad in the Dominican Republic to do global health research as part of my program at McMaster. I am here with four of my peers and since September, we have been working with the local community and American short-term humanitarian aid teams to improve the health status in the underdeveloped areas surrounding the city of La Romana.
While here, I have observed quite a few instances of “voluntourism”.
On days that we are not doing research, my team and I often accompany the mobile medical teams visiting the underdeveloped areas. While some of these teams are composed of qualified physicians, the majority are formed of students of a variety of competencies – and yet they all function on a similar level, seeing patients and prescribing medications. These teams, from the leaders to the student participants, see little wrong with the quality of care provided.
Take for example a team that we saw a few weeks ago: a couple of nurses supervised a team of first year nursing students, who had not yet been on a clinical rotation. The students were encouraged to preform pap smears on women visiting the clinic. The leaders believed that it was a great learning opportunity. The students believed that “the rules were different here”. All believed that they were helping the local community – because after all, wasn’t doing something better than doing nothing?
Maybe not. Though these pap smears were conducted by students with almost no training, the women believed that they were receiving the best quality of care simply because the students were American. After all, Americans were the ones that supplied medicines and clinics to these underserved and underdeveloped areas, so all Americans shared a reputation of innovation and superior aid. If I were a local woman who had just received a pap smear from an American student (and really, would I be able to tell the difference?), I would believe that I had just received the best care available and probably not to see a more qualified local physician, even if I felt ill. If I were a local physician and most of my patients chose foreign mobile medical clinics, I would be unable to maintain a practice in these underserved areas even though I wished to help my local community. Finally, if I were a foreign medical team, this situation would create a gap in care that I would passionately believe I needed to fill. Rinse and repeat. I am probably exaggerating the story, but I think you get the point – if providing inadequate foreign aid crowds out local and more appropriate care AND perpetuates a cycle of need of dependency, is doing something really better than nothing?
One source of the unseen and unintended implications of foreign aid may be the attitudes of these teams. They genuinely believe that they are helping the less privileged, a belief that acts as the driving force for the whole voluntourism industry. I have heard variations of “it’s for the people” and “let’s do some good” countless times here. But when I truly consider the impact of these teams, it doesn’t seem as if the locals are the ones benefiting. Going back to the pap smear debacle, it could be argued that the students are the ones who really benefit in this scenario. But “let me learn by doing things that would never be acceptable at home” definitely attracts less donors than “bringing medical aid to an underprivileged community”. And so the voluntourism industry trudges on – we give ourselves a pat on the back while someone we “helped” bears the consequences of our “aid”.
This is not to say that all volunteering abroad is harmful. I have also seen teams take the time and effort to align their contributions with local needs. These are also the teams that strive to be aware of their impact on the local community and mitigate unintended negative consequences. And as for students volunteers, the informed and thoughtful ones are usually aware of the boundaries of their capabilities and honest about their own motives, understanding that their primary objective on these trips is to learn and first do no harm. These teams and students are the ones with long-lasting impact, showing that humanitarian aid can be delivered in a better way. And it all starts with awareness of our actions.
These rarely recognized impacts and the underlying paternalistic attitude gives only a glimpse of the ethical nuances associated with foreign aid. In the next few weeks, I will be posting more instances of voluntourism, but for now, here’s some food for thought. What could make these volunteer trips more appropriate and helpful for the local community? Is it so wrong to go on a short-term volunteer trip for learning purposes? What are the unseen and unintended impacts of volunteering, not just abroad, but at home in the local community?