Medical Volunteering – First Do No Harm

Lizzie and I (Pat) first met when she came for weekends to Moon&Star guesthouse. She’s an amazing and enthusiastic person and there was an instant click. That weekend Moon&Star was totally occupied with non-Ghanaians working and studying in the medical field. Lizzie enjoyed her time here with the others, they made nice excursions and had fun at a big BBQ-party. We started talking about volunteering abroad, white saviorism and the ethical lines that are there in volunteering and especially in the medical field. After this first weekend Lizzie came back on several occasions and when she was about to leave for Britain I asked her if she would write a blog post for us. Thank you so much Lizzie, hope to see you again!

The first thing I did after being asked to write this blog was to google ‘medical voluntourism’ with a sinking feeling that I was part of this. Phrases like ‘inequitable relationships’ and ‘entrenching paternalism’ were flashing up at me. It was time to question the role of doctors volunteering abroad and also reflect on my own experience in Ghana.

About me and how I made it to Ghana….

I am a GP from Norwich in the UK. After coming to the end of specialist training I did a diploma in tropical medicine. This respite from clinical work was welcomed and I was keen to use my glamorous knowledge of weird and wonderful diseases in the tropics. I found a placement with a small NGO called Foundation Human Nature (FHN). They are a friendly bunch of doctors who run projects in Ghana and Ecuador. I didn’t have much time to consider what I was heading into or my motivation behind this. Before I knew it I had landed in Accra, handbook of tropical diseases poised, dripping with sweat and ready to identify any unusual parasitic illnesses.

Day to day life….

Life in Ghana quickly absorbed me. I made my way to a small village called Boamadumase and was warmly welcomed, meeting the staff who I would live and work along side. Surprisingly, it didn’t take long to adjust to the slower pace of clinical work and life in general. I started picking up ‘small small’ amounts of Twi and learning the basics of Ghanaian cooking. Later I almost got used to the incredible heat and humidity.

As the sole volunteer in the clinic I was guided by the health centre manager, David, who was also my good friend, running partner and general authority on Ghanaian life. He had arranged an induction for me at a local hospital which was a great learning experience for me. Over the first few weeks I found my feet and started weekly teaching sessions on topics selected by staff. Gathering resources with extremely temperamental internet connection and limited books was challenging, I had to trust my own clinical knowledge and skills. Day to day work was officially observing and offering guidance to staff although I also did my own consultations with help interpreting.

I learned a lot from the staff, they had almost intuitive knowledge of malaria and were excellent at managing conditions such as tropical ulcers. I hope that some of my knowledge was helpful to them as well, we covered common topics I see in general practice. We also had some excellent group discussions around issues such as domestic violence, child abuse, alcohol misuse and communication skills, these forums gave us the opportunity to make cultural comparisons and discuss potential areas for development.

Community outreach programme

The community outreach programme allowed us to visit remote villages (some only accessible on foot) with community health volunteers to deliver talks on health topics such as malaria. These also gave us the opportunity to run small clinics and promote the health centre. On some of these visits we encountered seriously unwell people. For example a severely malnourished baby, a woman with terminal liver disease and likely underlying cancer. My clinical skills had to adapt to the resources available and the health beliefs of the local people. It was common to seek treatment from a herbalist or fetish priest before presenting to clinic. It was important to balance the western approach with these traditional beliefs.

volunteering in the medical field

The placement involved so much more

The placement involved so much more – including teaching children in schools about health related issues. The NGO funded numerous bore holes in remote communities and I was able to see some of these being drilled and used in the villages. Furthermore there was a good environmental awareness with community projects on reducing plastic use and establishing a recycling scheme.

bore hole

I was able to explore Ghana on my weekends and at the end of the placement. I did trips with the clinic staff which was great fun. There were some beautiful spots close by – Bobiri Forest and Lake Bosumtwe and of course Banko with the excellent Moon and Star Guest House. This time away from clinic was also great for learning about Ghanaian culture – seeing the different types of farming and industry, comparing the buzz of city living in Kumasi with village life, learning how to negotiate a trotro station, discovering fan yogos! It was such a privilege to be able to see this vibrant beautiful country.

So what does it all mean?

I can honestly say I thoroughly enjoyed myself in Ghana. Being integrated into a community and having a defined role made the experience much more fulfilling than simply visiting as a tourist. But was I part of ‘medical voluntourism’? Well, yes – as a doctor working in a lower resource environment having a great time. However, I think I was lucky enough to have done this through an NGO that respects local culture and runs in a sustainable way. The clinic, although it is funded through the NGO, functions without a volunteer there so there isn’t the problem of a sporadic service that ultimately could be damaging to a community.

medical staff

What was my motivation for volunteering in the medical field?

The question of motivation behind my time in Ghana is still a little vague to me. I can say it’s because I wanted to help those less fortunate than me, this is true, however I can do this at home being a GP as well. Overall I think it’s more complex and it had more to do with my own self development and a desire to experience work in a different health care system.

I maintained my ethical standards and never did a procedure or worked beyond my own remits of safe practice. The NGO only recruits volunteers in the medical field with adequate training. I understand that this is a problem with some placements, personally I feel that having double ethical standards shows disrespect to the people you have chosen to help.

Having an understanding and respect for local culture underpins a successful volunteering in the medical field placement.

I can see that assuming that a western approach is superior or using a didactic, authoritative stance will simply be a barrier to any meaningful intervention. I admit that at times my own western values were challenged and I found this difficult, particularly when we were discussing domestic violence and the role of women in the family and the community. However, I had to respect local beliefs and values and we managed to reach some conclusions that we all accepted. Work has to be collaborative for any sustainable solution.

I have learned about other types of medical aid, for example in response to disasters or in humanitarian crises. This is a totally different type of volunteering to my experience. I can see how principles may be altered slightly given that a quick emergency response is needed – this may be done in more of a vertical manner with help simply been given rather being integrated into local services. However the underlying respect for culture and belief still needs to be respected. A good example of this was during the recent Ebola outbreaks – showing an understanding and respect for local burial traditions was key in gaining trust of communities in order to control the disease.

I think there is potential for harm in medical volunteering but on reflection I feel that if you have the right placement, you are adequately prepared and trained then this is a great opportunity to learn and help in the development of a less resourced health system. I absolutely loved being in Ghana and if you are thinking about a similar placement then I would be happy to be contacted.

l.shiner@doctors.org.uk

http://f-h-n.org

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