The Ethics of Medical Mission

Over the years, as access has improved and awareness has increased, medical trips abroad have become increasingly popular. What was at one point a “once in a lifetime” opportunity is now much more available to healthcare students and professionals. It is not unusual to take a week to head off to far off places and provide some much needed medical services. These opportunities afford many lessons to be learned and memories to be cherished.

However, it must be reminded that the “rules” still apply when it comes to medical trips abroad. There remain professional boundaries that should not be crossed; just because one is outside the jurisdiction of their professional governing body does not mean that ethical practices do not apply. On the contrary, it would be even more important to continue providing ethical, competent healthcare to those populations that need it most.

The idea of a medical trip abroad is an alluring prospect to many in the healthcare field. The idea of a chance to see countries that are not often visited by tourists, and to make a meaningful difference in the lives of local residents is very appealing. We can see the shift in popularity through the awareness of programs such as Doctors Without Borders, in professional schools offering international rotations, and with the increasing emergence of “voluntourism” programs aimed at pre-professional students. Dr. Joan Paluzzi, a medical anthropologist and former trauma nurse with years of international experiences, highlights the excitement of participating in a healthcare trip abroad: “these are opportunities to witness the challenges of healthcare, and health, in places where profound poverty becomes a major risk factor.”

Maranda Herner, a first year resident in Internal Medicine at UC Denver, expresses a similar sentiment regarding her elective rotation in the country of Malawi, which consisted of a lot of malaria cases in the pediatric ward of the hospital: “I learned the way of life is very different than ours, both troublesome things like rape and droughts, as well as simple things like making a daily fire for cooking and spending more time visiting with people.” She also had to adjust her expectations in regards to the delivery of healthcare. Maranda notes that “unlike in the United States, where we value shared decision making between the physician and the patient, in Malawi, what the physician says is what happens.” In particular, she emphasizes that the attitude towards end of life care is in stark contrast to our own, and that healthcare providers are rarely accused of wrongdoing.

Despite the increase in awareness of these opportunities, there is an educational gap surrounding what should be expected on a healthcare trip abroad. As pre-professional students, as current professional students, or as current healthcare professionals, do we go on these medical trips abroad willing to provide any medical care we deem fit for a certain situation? Alex Anderson, a medical student at Western University of Health Sciences in Lebanon, OR, explains what he expected before his medical trip to help refugees currently residing in Thailand: “At the time, I knew that most patients were refugees, but I didn’t know much about the infrastructure, I just knew that the most common goal was to rectify nutritional deficiencies in our patients.” What often gets lost in the excitement of one of these trips is that although we are in an environment which differs from our normal healthcare duties, the responsibilities to one’s patient remains unchanged. This involves providing compassionate, competent, and most importantly, ethical healthcare.

A proper frame of mind can make for a successful international experience, whether it is for healthcare volunteering or for an elective rotation during a course of study. According to Dr. Paluzzi, “a student will get much more from the experience than they can possibly return to the patients and colleagues they will encounter along the way.” She also mentions that it is helpful to have a grasp of some global issues that may be encountered when abroad. These are often countries where high-tech medical devices and well-stocked pharmacies are not available, so the delivery of healthcare requires different skills and a level  of creativity that is not always expected with healthcare delivery in the United States. As alluded to above, we should remember that ethics are without borders. A medical trip abroad should not be treated as a chance to perform operations or try an unfamiliar treatment that was not provided in healthcare training. Rather, one should use the skills they have already acquired, learn from the people and patients around them, and continue applying sound, ethical practices to their healthcare delivery when abroad.

When we agree to participate in a healthcare experience abroad, many ideas can run through our minds. There is a lot of excitement, but it can also be nerve-wracking to step outside our comfort zone where the standard of healthcare is vastly different than our own. Alex Anderson admits, “At times I did feel a bit uncomfortable (on my trip to Thailand), but only in the sense that our work could at times feel just like a stopgap.” These trips often occur in regions of the world where healthcare services are desperately needed. Despite that need, it is imperative that we not take advantage over vulnerable populations. Dr. Paluzzi encourages students seeking out international experiences to “be humble, learn from the doctors who do the work day in and day out, frequently under impossible circumstances.” We should continue to remember that ethical healthcare practices follow us no matter where we end up serving as members of a healthcare team.  If we remember this, it enables us to have a successful, educating, and fulfilling international experience.

Paul Bluhm is an OMS-II at the Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Northwest

Paul Bluhm is an OMS-II at the Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Northwest