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Monday, December 21, 2015

"Hoping to Help" (Judith N. Lasker)

TITLE: Hoping to Help: The Promises and Pitfalls of Global Health Volunteering (Culture and Politics of Health Care Work)
AUTHOR: Judith N. Lasker
PUBLISHER: Ithaca, NY: Cornell University Press, 2016, (256 pages).

One of the growing movements in the helping industry is medical missions. Whether one calls it "voluntourists" or holiday missions, the pattern is familiar. Some group from a rich first world country would organize trips to third-world countries to "contribute" and to do some good for the people there. This is especially so for medical related trips like "medical missions," "health brigades," "flying surgeons," or anything that has medical professionals flown in from the rich to the poor countries. In 2007, researchers have calculated about 1 million Americans have contributed 162 million hours at the cost of $3 billion into third world countries around the world. This figure is just for USA alone. This is not taking into consideration many other private and non-accounted for volunteering by smaller groups. Amid the big impressive figures, there is a growing disquiet among observers looking beyond the nice feeling generated by the huge numbers.
  • About 50% of the money spent are airfares.
  • How much of these money go directly to the third-world countries?
  • Are the third world countries really that poor and dire?
  • Are the people there as needy as the Western media paint them to be?

This is not to belittle the contributions made by these "voluntourists." Inspired by the exchanges of Ossob Mohamud (against) and Sam Blackledge (for), author and researcher Judith Lasker conducted two national surveys of trips made six months or less. Focusing on medical care and global health trips, Lasker asks the questions: "What are the benefits and the costs for host communities? How can the benefits be maximized?" This is especially when many of these groups do not have direct contacts on the ground to help them determine the true local needs. At the same time, many groups spend too little time to understand the contexts of where they want to serve. Collaboration is key. Judith Lasker is NEH Distinguished Professor of Sociology and Anthropology at Lehigh University in Bethlehem, Pennsylvania. Her research interests focus on global and women's health.

It is vital to differentiate the words "benefits" and "purposeful trips" from the perspective of the host communities rather than the groups who are volunteering. In other words, anyone seeking to help must understand the true needs of from the hosts' perspectives. Otherwise, such well-intentioned trips may end up making a difference more for those going rather than those receiving. Lasker notes that the lack of a "clear societal model" to such help activities ends up creating more "individualistic approaches" that benefit individuals going rather than the hosts receiving the help. Thanks to the press and the media, the focus of attention also happens to be on the "voluntourists" more than anything else. Politically, governments look good when they are seen giving and donating stuff. The summary of this is captured as:
"Nations pursuing political and security goals, individuals seeking personal advantages, and companies seeking profits also contribute to the growth of this phenomenon."

Some of the critiques include:
  • Neglecting the true needs of the hosts
  • Providing poor quality work
  • Undercutting locals' employment; (after all, getting something free better than paying a local)
  • Promotion of dependency
  • Reinforcing the superiority of the volunteer groups over the hosts
  • Cultural colonialism that affect local values and local consumption patterns (like using an advanced electronic device that locals don't have)
Apart from interviewing 119 people, including 55 from host countries in four countries in Asia, Latin America, Caribbean, the author has researched 177 US-based organizations and summarized the findings in this book that contains much data and advice for sponsoring organizations, volunteers, and host communities. Sponsoring organizations include both big corporate names as well as private individuals relying on their personal history and connections with the hosts.  The four largest organizations are faith-based, NGOs, educational institutions, and then corporate sponsors. Lasker looks at the history, the origins, the mission, and goals of these organizations in order to understand the rationale for sending these volunteer teams. Faith-based groups are motivated by their love for God, with every major Christian denomination having a mission arm to do just that. While some are unabashedly clear about their identity and evangelism purposes, others are more subdued, choosing to let their actions do the talking. For all the altruism and the generosity, the fears remain that the methods smack of colonial arrogance and cultural show of superiority. NGOs are often not faith-based but are sponsored by rich governments who do not want to give their money to corrupt regimes in the third world. Linda Polman criticizes NGOs for increasing competition rather than cooperation, often complicating the nature of work to be done. Universities are also in the mix, with them requiring medical students to do volunteer hours requirements. Corporate Volunteering makes sponsoring companies look good.

Lasker looks at volunteer groups and looks at the process and result of volunteering. Most groups recruit donors and volunteers located in wealthier countries. They use the Internet. About 60% of the organizations require medical skills training. Cultural adjustments have to be in place for the volunteers when they get to their destinations. Apart from real life eye opening incidents, there is the problem of culture shock and lack of "well-matched experience." Adaptation, fit, and expectations are all factors for both volunteers and hosts. Many individuals come with an attitude of wanting to "give back" something to society, or to find some purpose for their lives. The overriding motivation is self-benefiting. It sure looks good for one's CV, one's career prospects, gaining accreditation, public recognition, and so on. This is confirmed by the feedback from most volunteers who confessed: "I gained more than I gave."

The part on host communities is given a larger coverage than the sponsoring organizations and the volunteers. Rightly so, for without the hosts in the first place, there is no need for any overseas medical missions. This important part focuses on host perspectives of these volunteer programs. They tell of the best experiences like how the locals are impressed with the volunteers' "energy, technical capacities and their eagerness." Good volunteers are those who are open, curious, genuinely interested, humble, respectful, and adaptable. Bad ones are those who are "high maintenance," unwilling to learn, unable to communicate, or have some form of superiority complex. The benefits to host communities include:
  • Having extra manpower to help existing needs
  • Medicinal supplies and equipment
  • Training
  • Patient well being
There are other benefits too, like contribution to the local economy, employment of locals, etc. The key maxim for any volunteer is this: "First, do no harm." Then comes the criticisms. Foreign medical missions unfortunately create problems like
  • Additional burden on host communities to take care of their visitors
  • Untrained and inexperienced volunteers
  • Lack of continuity
  • Competition between local and foreign medical or dental professionals
  • ...
Fortunately, Part Four of the book gives us some good principles to maximize benefits for the hosts. Principles like fostering mutual understanding with all; maintaining continuity and training of programs; conduct detailed assessment of needs; focus on prevention; build local capacity; and so on. Lasker calls mutuality and continuity as the "two pillars of effective programs." More ought to be done on community focused research and to learn to hone any programming more toward host benefits.

A book like this can seem counter-intuitive to all the good that sponsors and volunteers are doing for the poor, the needy, and the ill-equipped. Yet, it reminds us of the truth that even the best efforts and intentions can create negative images and consequences. For every effort, there will be pluses and minuses. The key is not total abandonment of such volunteer trips, but to learn to be more sensitive, more understanding, and more humble when we go to host countries. We need an other-perspective from the mindset of others. We cannot be fixated on "best practices" and ignore "inspiring practices." We must learn to equip and to train the locals as much as possible. Every short term mission trips must be within the context of a long term continuity. I appreciate Lasker for including the "seven sins of humanitarian medicine."
  • Sin No. 1: Leaving a mess behind
  • Sin No. 2: Failing to match technology to local needs and abilities
  • Sin No. 3: Failing of NGOs to cooperate and help each other
  • Sin No. 4: Failing to have a follow-up plan
  • Sin No. 5: Allowing politics, training, or other distracting goals to trump
  • service, while representing the mission as “service”
  • Sin No. 6: Going where we are not wanted or needed and/or being poor
  • guests
  • Sin No. 7: Doing the right thing for the wrong reason
I think this book is a must read for all involved in volunteer medical trips from the top to the bottom. We must bring back into focus that it is not about us, but about them. This means from start to finish, begin with their end and their benefits in mind. Far too often, people start with their own pet ideas of what is needed and how we can help others. The best way is simply to ask with a humble heart before we go. Prepare with willing hearts as we learn the language, the culture, and the contexts of the host communities. Adapt with curiosity and genuine interest as we start our work at the ground level. After that, maintain continuity, communications, and camaraderie, even after the trip is over. See the host communities not as problems to be solved but as people to be loved, to be appreciated, to be served. If there is no long term plan involved, discontinue short term trips.

I recommend this book highly for all volunteers and volunteers to be. This is definitely a must read.

Rating: 5 stars of 5.


This book is provided to me courtesy of ILR Press, an Imprint of Cornell University Press and NetGalley in exchange for an honest review. All opinions offered above are mine unless otherwise stated or implied.

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