6 Tips for Students Against Ethically Iffy Global Health Field Placements

James Fitzgibbons explores rural Bolivia on a global health education program that promotes cross-cultural learning at the community level. Image courtesy of Child Family Health International
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James Fitzgibbons explores rural Bolivia on a global health education program that promotes cross-cultural learning at the community level. Image courtesy of Child Family Health International

With spring approaching, many students are considering summer global health opportunities. Before you sign up, here are 6 essential things to keep in mind to ensure your experience is safe and ethical.

1. If it looks like your destination has no health care system ... look again.

“Where we’re going, they have nothing. No health care, no medical services whatsoever.” Have you ever said this or heard someone else say it about a global health experience? In fact, it’s extremely rare for a community to have no health care system; it just may look different than what you are used to seeing. Networks of formal or informal community health workers or midwives and small, primary care clinics proliferate in remote and rural communities. (This is also true in the US!)

2. Avoid participating in the temporary health clinic model.

It’s better to connect to existing health care systems and collaborate with local experts and leaders than to set up parallel, temporary health care clinics. That way we help ensure that patients are able to get local referrals and follow up about medical complications after we leave—and we bolster local expertise rather than undermining it. Be wary of any global health program that says that you will be providing care where none exists locally.

3. Never practice beyond your training and education.

Doing this has been shown to endanger patients and undermine local health care systems and practitioners. Something as simple as an incorrect blood pressure reading can have lasting consequences on a patient’s care. (You can also put yourself at risk for needle stick accidents and other injuries.) It’s best to connect to organizations that don’t offer visiting students opportunities to practice direct patient care  and instead focus on shadowing, locally led capacity-building, training and quality improvement efforts. If one of your goals for a global health experience is to help the host community you’re visiting, then be sure to select a program that would never allow you to unintentionally harm a patient.

4. Look for programs where your primary task is learning—and then making properly supervised contributions.

As a visiting student, you are most likely not an expert in the local health care realities, burden of disease, culture, language or geopolitical realities. This doesn’t mean that you don’t have skills and training, just that they aren’t honed for this new setting. Instead, look for a program that is set up according to Fair Trade Learning principles and engaged in a long-term, reciprocal partnership with the local host community. Days of observing and discussing cases with local professionals rather than providing direct patient care or professional services is time well spent. You’ll dramatically increase your understanding of health care and social systems and deepen your appreciation for the “upstream” factors that lead to health crises. This will make you a better doctor, nurse, researcher, administrator or public health professional down the road.

5. Think before sharing a post on social media.

It can seem like a single post isn’t a big deal, but social media posts can have major impacts. Avoid posting pictures of patients (their faces, or any identifying pathologies) since patient consent in these settings isn’t meaningful. (Patients may give consent because because they may worry that care could be withheld if they refuse.) Beware, too, of the widely criticized “white savior” style photos that depict visitors from the Global North “saving” a less richly resourced community. Portraying your host communities as extremely poor, in need of saving, or in other paternalistic terms does nothing to help and instead perpetuates colonial approaches to the Global South.

6. Consider what future academic programs really want to see on your résumé.

While many medical and health professions schools expect succsesful applicants will have “direct patient contact hours,” schools are increasingly screening for ethically questionable global activities. Some even report rejecting students who practiced medicine inappropriately. So yes, seek out a global health experience, but make sure that you are building the right skills and competencies (flexibility, humility, professionalism, as well as an understanding of local culture, health care realities and burden of disease)—without endangering patients, undermining the local health care system and leaders, or practicing beyond your training.

If all of this seems like a lot to think about and you want help selecting a global health experience, use this helpful checklist developed by Child Family Health International and Medsin-UK.

Plan your global health education experience so that your experience is enriching—but respects the expertise and dignity of your host community.

 

Robin Young, MBA, is managing director for Child Family Health International, a San Francisco-based nonprofit organization offering global health education programs to students and professionals.

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