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Barbie Saviour is funny and all but now what?

As a healthcare professional, I've been trained to think pragmatically -problem, assessment, solution and reflection. My Tanzanian colleagues and I had to delve a little bit deeper in conversation and ask ourselves what we were trying to achieve exactly. A question everyone needs to now ask themselves.


We've all seen the hilarious Barbie Saviour and the essays written on the questionable impacts of volunteering. A strange new horizon is ahead of medical volunteering. A strange duality that exists between the travel industry and relief work-contemporarily known as volunteering. This odd hybrid that has now become known as voluntourism has painted negative brush strokes across what was briefly an unadulterated area of goodwill.

At the very head of the pyramid should remain, not simply a blanket "good" outcome for all, but a focused interest in improving and protecting the lives of locals who volunteers may come across.

Aside from volunteering, goodwill in itself has on the flip side a negative backtrail, leaving a lot to be desired in the areas of "Aid" "charity" and "NGO" work where various informal, unstructured or unqualified attempts at assistance has left long term damage to the very recipients and their community. We can argue this back to whether or not altruism truly exists. However, without solutions, the criticism is simply futile; purposeless in it's attempt to gravitise those who would dare publicise their "goodwill" in the Global South.

So where does Medical Volunteering fit into all of this? Arguably in a dichotomous limbo. Practical in its nature, qualified volunteers are able to use far more impactful skills in social assistance than any other types of volunteering. However it remains within the volunteering realm, does it not? Well, it can be argued that the question of sustainability is somewhat idle here. As medical care is continuous by its very nature a steady stream of qualified volunteers would provide more solution than anywhere else. In short, the volunteers and their colleagues are professionally at equal levels here, in tandem and doing the same thing. The obvious difference being in environment and backdrop. Healthcare really does encompass universal principles cross-culturally.

This does not take away from the arguments about the negatives of voluntourism in its current form, not in the least. However we need to consider that this is also a result of current globalism and the availability of travel to a wider, more outward looking generation.

Perhaps a remedy for those of us within the medical volunteer realm is to look inwards and back to our basics. Interweaving strong ethical codes and guidelines at the heart of the mission should be a part of the entire process. At the very head of the pyramid should remain, not simply a blanket "good" outcome for all, but a focused interest in improving and protecting the lives of locals who volunteers may come across.

With the most altruistic of motives, then, global medical researchers may find themselves slipping across a line that prohibits treating patients as means to an end. When that line is crossed, there is very little left to protect patients from a callous disregard of their welfare for the sake of research goals. Even informed consent, important though it is, is not protection enough, because of the asymmetry in knowledge and authority between medical researchers and their subjects (Angell, 1997).

At it's conception Medi Trip was outlined as a way for colleagues from around the world to exchange ideas and share areas of mutual concern. Meeting on neutral ground with a strong emphasis on learning from both sides. However, we need to start being more straightforward with who is driving the industry. For the most part it is not locals. An overwhelming majority of the drivers of volunteering are western foreigners and we need to be more inclusive in leadership if we want to see real impact. Partnering with local leaders is a step, however it is naive to believe that this partnership has equal footing. There is a still a large gap in power usually belonging to those that have more financial power-usually the westerners. Thus finding ourselves back to where we started.

There should be a very clear, specific and non negotiable drive to place the voices and interests of the local communities first. Clarity begins with understanding what the community actually want and have asked for in the first place. Organisations may not always like the answers, but the answers should be respected. We often forget these are communities made up of individuals with competing agendas and varying goals and aspirations. No one can enforce on them their idealisation of what "better" means for them. We first need to listen and understand. And although charity is great, social enterprise is where we begin to see real promise. Social enterprise meaning, including marginalised people within viable businesses that have socially beneficial outcomes. What does this have to do with Medical Volunteering? Well, there is a strong positive correlation between socioeconomic status and health (Gornick, 200). Allowing marginalised people to economically empower themselves and drive their own agenda should be the mission. Ultimately, communities should begin setting the agenda on what they need making for a far more impactful cultural exchange. Hopefully we can then finally be rid of Barbie and her saviour complex once and for all!


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