Wednesday, September 24, 2008

The Ethics of Being a Student in Global Health

Here is an excellent article in this weeks Journal of the American Medical Association titled: Ethical Considerations for Short Experiences by Trainees in Global Health. (You may have to log in through your institution's library or purchase to read) In it they discuss the ethical implications of sending inexperienced students to places of poverty to gain experience as part of a global health training program. I thought that this was especially poignant since my recent post about the explosion of global health programs at undergraduate campuses across the US.

Money Quote:
"...sending institutions have a moral obligation to ensure that the patients and host institutions in which these programs take place are at minimum not left worse off as a result of this collaboration, but they arguably also have a moral obligation to help improve care and service delivery. Mutual and reciprocal benefit should be the goal."
The authors identify five ways in which sending institutions and students benefit from these short-term global health experiences:
  1. Institutions are better able to draw attention to issues of global health disparity.
  2. For some students, the experience may form the foundation for a career in global health work.
  3. The training experience may allow the sending institution to recruit the most talented trainees who are interested in global health experience.
  4. The experience may allow students to gain cultural and health related experiences in ways that may be impossible at home.
  5. Sending institutions may benefit financially from the interests of philanthropists
The bottom line however for the authors:
"The benefits [to the sending institution] should not trump responsibilities for ensuring that these training programs are beneficial to the relevant stakeholders."
I have thought a lot about the ethics students engaging in medical volunteerism in poor countries. I've linked to them before in this blog, but check out two other short articles that have shaped my thinking about this issue: To Hell with Good Intentions, by Ivan Illich and Duffle Bag Medicine, by Maya Roberts.

Fundamentally, as we work as students in global health we must always be critical of our work. We must always think about the potential harm that we (complete unintentionally) may be doing to the communities that we intend to help.

I think that GlobeMed does a very good job mitigating the risk of ethical breaches by creating partnerships with grassroots, community-driven organizations and institutions. We are not students completely on our own, practicing vigilante global health, nor are we a massive foreign institution coming in with our own agenda and motives. Instead, hopefully we can practically address health issues in poor communities by connecting the assets that we have as students to community-driven institutions working to build the health systems necessary to guarantee health equity.

1 comment:

Christine Gorman said...

I'm sorry JAMA didn't make the contents of this editorial free to all since this is such an important topic.

On the other hand, the writing is so academic that I fear no one will get the point.