The Ethics of the International Development Trip: Medical Electives

Often enough, the West imposes its view of development on to the developing world. This issue extends to the ‘gap year’ and volunteering industries, when the tourist’s needs are places ahead of the communities and environments that they claim to help.

There’s real potential for these international development schemes to do good, yet their sudden increase in popularity has seen many organisations cash in on their popularity, without taking the time to develop a business model that benefits both the volunteer and the host community. Although they are often well-intentioned, these tours can portray a simplistic view of development along with incorrect representation of the ‘developing world’.

One sect of the ‘volunteerism’ market that is becoming increasingly popular is the medical elective. These are undertaken by medical students, usually in their fourth or fifth year of study, either in the UK or internationally. A broader perspective of the medical profession is endorsed by the World Health Organisation (WHO), stating that in order to become a ‘global’ doctor, it is vital to have an awareness of population needs, social factors, illness prevention and public health medicine, amongst other things; all factors that working abroad can help towards.

NGOs with foreign funding are often an attractive option for Health Ministries in the developing world that face limitations such as a lack of funding and workforce shortages. However, there is the danger that students strive for self-progression, rather than the needs of the host country. This scenario can be equally as disconcerting for the medical students whose role is to intervene and ‘see patients’, which has implications on legal grounds and exceeds moral boundaries which students can find distressing. Clearly patients have the right to know they are being cared for by students, and this begins with the relationship that the elective provider has with the medical institution.

In response to the recent increase in NGOs performing health-related aid work and the issues discusses, the Code of Conduct for Health Systems Strengthening was developed by a coalition of health organisations (Health Alliance International; Partners in Health; Health GAP; and Action Aid International). A well run medical elective with a strong ethic towards funding and equality and health education has the power to be a positive tool for development and can help to create great doctors. Like any ‘responsible’ tourism, it should be underpinned by awareness and knowledge, professional advice and ethical integrity. In other words, it’s not just a holiday and shouldn’t be treated as such.

The main principles of the Code are that NGOs:

  • will engage in hiring systems that ensure long term health system sustainability
  • will enact employee compensation practices that strengthen the public sector
  • pledge to create and maintain human resources training and support systems that are good for the countries where they work
  • will minimise the NGO management burden for ministries
  • will support Ministries of Health as they engage with communities
  • will advocate for policies that promote and support the public sector

Clearly the ethics of a medical elective require thought and care before signing up to a provider. It is important to ask questions about the integrity of the funding, and a good start is to look at the criteria in the Fair Trade Volunteering (FTV) website.

If you are a medical student considering a position in the developing world, make sure that you discuss with the placement provider and your supervisor what is expected and how you can be most helpful. Do relevant research and make sure that you have clearly defined objectives so that your contribution is truly helping towards international development.

To see how Adventure Alternative complies with the FTV guidelines, and for a detailed description of our medical elective trips to Kenya and Nepal, visit our website. We have been developing these placements since 2003 and 2004 respectively and we have proudly maintained long-term relationships with the medical institutions in these countries to continually improve the service that they offer, based on their needs.

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