Thousands of world health volunteers, most of them from the United States, travel to Africa every year. These volunteers come from quite a lot of backgrounds and have various levels of experience. They include surgeons, anesthesiologists, nurses and medical students. They include the ambition to enhance health outcomes in Africa and understand “global health.”
In my research, I investigated the impact of those volunteers in Zambia. From 2014 to 2016, I conducted research in a rural hospital where U.S. medical volunteers provided various types of medical care, including eye surgery, cesarean sections, and treatment for malaria, tuberculosis, and HIV.
In my newest one research article I explore how the presence of those volunteers influenced the lives and relationships of individuals in Zambia.
My most vital conclusion is that the presence of medical volunteers has caused damage to the relationships between Zambian medical experts and patients.
I consult with this as a form of “relational harm.”
These findings are essential because relationships are critical to providing effective health care. Clinical care requires material infrastructure: electricity, water, hospital beds, medical gloves and technical equipment. However, it also requires strong relationships of cooperation, trust and mutual recognition.
My findings suggest that researchers, volunteers, and global health organizations should pay more attention to the “relationship damage” that will be brought on by volunteering in under-resourced settings, where privileged volunteers work in conditions of maximum inequality.
Influence
Drawing on long-term ethnographic research and interviews with Zambian healthcare staff and patients, I discovered that local opinions about healthcare volunteers all over the world are divided.
In the hospital where I conducted research, patients were often obsessed with their presence, while many Zambian medical experts were critical.
Patients repeatedly praised volunteers and described positive encounters with them. One patient from Zambia described a medical volunteer as someone who had “a heart for patients… he doesn’t care about who he’s dealing with… he can be there for everyone.”
Many patients felt that volunteers often provided the next quality of care than Zambian staff.
However, this was partly as a result of differences in wealth, status, and privilege between American volunteers and Zambian health care staff.
While the American volunteers could focus entirely on their work on the hospital, the Zambian staff had families to support, attended social events, and needed to pay school bills. This meant they couldn’t spend as much time within the hospital or offer gifts to patients, including the small payments (called “transport money”) that volunteers often offered to patients.
This has been noticed by healthcare staff in Zambia like Matthew, who told me the next:
Most {patients} will say that {volunteers} will help with money for transportation and {patients} will go home, after which they’ll tell their friends that they got money for transportation. However, sometimes this comes on the expense of local staff who’re then labeled bad.
Additionally, Zambian medical experts felt that their exertions and expertise were being missed. As one other worker explained:
These international {volunteers}… really appear to be they’re convalescing and even the patients are beginning to notice an enormous difference. But it is not that Zambians are inferior.
This worker identified that volunteers were often in a position to provide care that seemed “better” because they might work longer hours, offer money for transportation, and even use newer technology and medical devices.
In this context, staff felt that they were negatively assessed by patients as a result of the presence of volunteers.
When patients preferred white volunteers – especially those with less knowledge – this often reflected negatively on Zambian healthcare staff. As an experienced healthcare employee in Zambia told me:
When someone comes and says they wish to be treated by a white student, you are feeling like a stranger in your individual country.
Therefore, the presence of volunteers strained relationships between staff and patients, creating latest forms of hysteria, resentment, and division.
Staff and patients feared that these tensions would proceed to affect their relationships in the longer term – even within the absence of volunteers.
What will be done
These findings may contribute to increasing debate in regards to the advantages and risks of health volunteering worldwide.
Critics have argued that medical volunteering reinforces inequality and paternalism, in addition to causing direct harm through medical negligence. Advocates of medical volunteering argue that these risks will be overcome if medical volunteers are responsible and informed.
Focusing on the impact of medical volunteering on local relations opens a brand new perspective.
Going forward, global health volunteers and organizations promoting volunteering should consider whether their work harms relationships in health care settings. In contexts of scarce resources, these relationships are sometimes particularly fragile, as researchers working in Sierra Leone within the wake of Ebola have demonstrated shown.
Those who decide to volunteer should consider whether or not they are leaving these relationships higher or worse than they found them. If their goal is to enhance health outcomes, they need to ask themselves how they might use their resources to strengthen these relationships somewhat than undermine them.