SHOW / EPISODE

Short Term Medical Missions in Rural Guatemala

15m | Jan 19, 2022

Short Term Medical Missions In Rural Guatemala 


James [00:00:00] When you give something to someone and you say it's a gift. That may not be a gift that may again put them in a position where they're actually in a weaker position rather than a stronger position. 


Colby [00:00:25] Many people would consider medical mission trips to underserved countries a helpful asset. But what if I told you that these trips may contribute to a lack of resources and raise cultural and ethical concerns? Medical missions use many funds and resources, are volunteer trips really necessary? What is a good balance between conducting these trips and contributing to existing health care infrastructure? Short term medical missions are a form of unregulated medical service aid. These trips are usually taken by a team of medical professionals or volunteers from wealthy countries, with the United States having the highest participation in short term medical mission activity. The overall goal of these missions is to provide direct medical care to people of low and middle income countries. We will be focusing on the short term medical missions taking place in rural areas of Guatemala. I interviewed James Mulholland, executive director of Companion Community Developmental Alternatives, better known as CoCoDa. CoCoDa focuses their missions on communities in Central America, providing services such as water systems, rebuilding schools, and they work with projects geared towards public health. Kokoda strives to build strong and long lasting relationships within communities in Central America, with the overall goal being people over projects, which is particularly interesting considering that many missions fail to make building relationships a priority. 


James [00:02:10] Well, one of the things that we know from the research is that about two and a half million people from the United States travel to do international volunteering every year. We know that that's about a hundred and seventy five billion dollar industry. And we know that about 80 percent of the people who go have no recognizable or helpful skill or expertise. So, I mean, it automatically creates some some real issues. 


Colby [00:02:48] Short term medical missions are expensive and may waste valuable resources. There is evidence suggesting that short term medical missions are contributing to the lack of public health infrastructure in rural Guatemala. The real problem in these areas is not due to lack of physicians or medical personnel. It is due to lack of resources. Because of this, there are few clinics, hospitals and necessary medical supplies in these rural areas. And natives are relying on these volunteer trips instead of Guatemalan services for medical care. Global health scholar Paul Farmer has made issues like these known. 


James [00:03:32] There are some very serious risks when we do interventions. I remember Paul Farmer talking about after the Haitian earthquake, you had thousands of medical volunteers come to Haiti. Well intentioned. But what happened was if I'm a Haitian with a medical condition and suddenly everybody there is offer me free service, I'm going to go to where there's free service. Well, what it basically did over six or nine months, it completely destroyed all of the private health care system. 


Colby [00:04:15] Within medical missions and rural Guatemala, language and cultural barriers exist. A cultural and language barrier adds to the already difficult task of providing effective medical care. Short term trips also carry the risk of stereotypical views and attitudes. How can a volunteer understand a new culture in a week with the typical mission only lasting five to seven days? It is difficult, if not impossible, to get acquainted with rural Guatemalan culture, making it hard to provide effective health care. Judith Lascar, who has experience with global health volunteering and is a prominent voice in medical sociology, provides insights to these concerns. 


James [00:05:02] One of the things that we learned from the research of Judith Lasker in her book, Hoping to Help, is that short term volunteering often reinforces negative stereotypes rather than challenging them. You know, how can you possibly understand another culture if you go for a week? How do you really understand their context and that you're going to bring your assumptions to that visit and largely through confirmation bias. You're going to see what you want to see and you're not going to see what may be the real reality. So I think that's really important, is helping people understand that you you are not going to be a critic or an expert in a short term volunteering experience. When you engage in a culture, if you're doing that from a hotel or hostel and then dropping in, get the likelihood that she'll do harm is is much higher. Whereas if you're actually living in a community, living with people, there's a whole different kind of dynamic in relationships. So that becomes really, really important. 


Colby [00:06:10] There is concern volunteers are focused on seeing as many patients as possible, which could result in higher rates and misdiagnosis and complications. Since these trips are short term, there is also concern about follow up treatment of patients. Which brings into question are these trips ethical? 


James [00:06:30] I think this is especially problematic with groups wanting to do medical brigades, which we do not do. We do not do medical brigades simply because I think those have tremendous potential for doing harm. It's people who often don't speak the language. They're coming down for a very short term visit. They're probably bringing medications that aren't available in that country. They may be doing diagnosis that doesn't understand the context and they may not be connected with any continuity of care. So when they leave, whatever that person's ailment may be has not really been addressed. 


Colby [00:07:22] There are many ways current medical missions contribute to harm and may weaken an already weak system. For instance, primary care and financial resources are limited in rural Guatemala, and short term medical missions do little to address these issues. Not only are proper needs not being met, there is a potential to leave target communities dependent upon outside help. 


James [00:07:46] I think one of the questions comes and Farmer talks a lot about this and his work is, is what you're doing building capacity or dependency? And and those are a key questions. So the question is when I leave, will the people I leave behind be in a better position to take care of whatever the issue we're trying to address? Or will they be in a weaker position? 


Colby [00:08:14] When considering infrastructure, free care can be harmful.


James [00:08:19] When you give something to someone and you say it's a gift,that may not be a gift that may again put them in a position where they're actually in a weaker position rather than a stronger position after you leave. And again, I've seen so often where people come down and they say we want to give people free water so they build a water system and give it to people free. And those systems usually last less than a year. The water systems we do. There is a community fee, everybody who's connect to the water system pays a fee into a community fund that then pays for repairs, maintenance, chlorination, whatever the costs are for a water system. So the water is not free. I mean, everybody that community is going to pay to support that system. 


Colby [00:09:21] Clearly, these short term missions carry many risks, which begs the question, are these volunteer trips really necessary? 


James [00:09:30] The volunteers come and they slow it down and make it more expensive. We're very honest with the volunteers and say that's what you're doing. You're going to slow this down, make it more expensive. And if they will probably have to fix some things that you as a volunteer do. 


Colby [00:09:44] Since these ships are expensive, would the exclusion of volunteers be practical considering the ethical risks, would soliciting funds alone be a better option? Funds would certainly help, but how easy would it be to solicit funds without offering a personal experience? 


James [00:10:02] We didn't set out to be a group that use volunteers, but what we discovered is if you want to raise money, if you want to do projects, that it's very difficult to do that just by soliciting funds. That's one of the things most organizations have to do, is take people to the countries, let them see what's happening and get them excited. And then those people return to the United States and become champions for for your efforts. We also recognize that people want to help and people want to to see different parts of the world and see how they can engage. And that's that's not a negative thing. So I think all organizations, whether it's universities or nonprofits, all struggle with balancing that. How do you respond to this desire to help but do it in a way that's ethically responsible and actually doesn't do harm? 


Colby [00:11:14] There are many steps volunteers can take to ensure ethical and effective trips. 


[00:11:21] Well, in terms of short term trips, I think there might be a couple exceptions where we can be helpful. For instance, if we're going in to do specific kind of surgery, that may be rare or difficult in a region, for instance, cleft palate repairs or some kind of thing with eyesight or something like that, where there really can be a an intervention that that makes a significant difference and requires very little follow up. I think those can actually be a helpful thing. If there are physicians and nurses and volunteers in the United States who who want to to engage, they should be engaging in specific communities with specific health care providers. And then they need to make a commitment to support those endeavors, not just during their visit, but in going home and raising resources and raising support and providing medications or equipment. 


Colby [00:12:33] There are also a few things to avoid when considering a short term medical mission. 


James [00:12:40] I think what we have to stop doing is going down and doing primary care. Frankly, we just say that since to stop all over the world, that just needs to stop. What we absolutely need to stop doing is volunteer tourism, where I'm a doctor and I'm going to go to Haiti this year and do my thing in the next year, I'm going to the Dominican and then I'm going to go to Latin America. And then Asia, that's just got to stop. I mean, that that is absolutely exploitative. And we're just pretending that we're doing something for other people. It's just a way to justify or fundraise to do those kinds of trips. 


Colby [00:13:21] It's important to note that this is not just the opinion of one person, but many global health professionals as well. For instance, Judith Lasker says that if short term medical trips were the best way to handle health care, then why don't you and I rely on trips such as these? 


Colby [00:13:39] How do we avoid exploitation of those in need? What did the people of rural Guatemala and other countries ultimately need? Judith Lasker again provides helpful insight to these concerns. 


James [00:13:53] So she did a lot of work with host communities and host organizations and basically went to them and asked, do you realize that you're being exploited? And the. Almost universal response was yes. Which is very odd to think about, so we have all these these organizations in in developing countries, the North Americans come and they know they're being exploited to some extent. So the question she asked is, well, why do you keep doing it? And their response was the hope of future support. And I think that's very interesting because when I talk to people who are traveling. Develop a relationship with them and become an advocate. So I think there's a big disconnect between what people in the developed world are hoping for. And what people in North America and Europe are offering, there's this kind of huge disconnect. And I think being aware of that is really important. 


Colby [00:15:00] Avoiding the exploitation of communities is a must. Going to an underserved community and helping effectively is a wonderful thing, but not if the only takeaway is a picture that is posted to social media. There is a need for a long lasting relationship within these communities. Above all else, we need to make sure that short term medical missions to Guatemala and other countries are ethical, culturally aware and ultimately effective. My name is Colby Hinkle. This podcast was produced for the Spring 2020 Global Health Course at Guilford College. 

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