Canadian medical student project in Tanzania (KA)

From straightjacket

Scenario:

• 8 multidisciplinary health professional students travelling for 7 weeks to a site in East Africa, with plans to provide free screening physical exams to both persons living with HIV and related disease, as well as orphans and vulnerable children.

Initial impression:

• An annual project, each year raising money and supplies for travel and local contributions, with continuity between student teams.
• Faculty oversight from an infectious disease specialist.
• A local (in-country) physician involved and paid by the student team to provide care to the same screened individuals between each summer student visit.
• Students spend six months learning the local language before departure.
• The physical exams are conducted in the local language, with referrals for additional care made to the local physician.
• Scholarships provided for screened children to attend primary school.

Further concerns based on information that came to light during the project:

• At the screenings, it becomes clear that the children and PLWHA told (by local physician and nurses) they were being screened by physicians, not students.
• PLWHA receiving screenings found to have multiple care providers and adequate healthcare already; came to screenings mostly to receive travel stipend.
• Students did not adequately prepare for HIV screenings; had never knowingly met an individual living with HIV. Unable to recognize local clinical problems. No supervision.
• No translators available due to confidentiality concerns; nurses end up translating for students and neglecting care for other hospital inpatients, as well as neglecting teaching local nursing students.
• Almost all individuals referred on to local physician, as we were unable to rule in or rule out disease.
• Extreme disagreement on the team regarding the benefits and risks of our involvement; team considers shutting down the project.

18 months later:

• I met the Dean of the local medical school. He describes the ethical and practical problems surrounding too many visiting medical students.
• In 2007, 120 local medical students; 120 visiting medical students.
• Likely due to hospitable culture and sociopolicial/financial agreements with sending institutions, visiting medical students are given absolute learning priority.
• Local healthcare infrastructure failing in part due to inability to teach local medical students.
• Receiving institution feels hard pressed to decline additional visiting medical elective students.

Currently:

• A new team preparing to leave.
• The information package begins: "In our Medical Outreach programs, students go to third world countries to help."

Questions

• What are all my reasons for pursuing this global health elective?
• Am I accepting of my less altruistic motivations?
• Is there a cost to satisfying these motivations and if so, who will pay that price?

• Do I feel a need to intervene in the lives of others to make them "better"?
• If so, where did it come from? What are the assumptions behind it?
• How do I know if this intervention is wanted?
• How would I tolerate being on the receiving end of such intervention, from somebody from a very different culture, with whom I can not communicate adequately?

• Are my gut instincts sufficient in assessing my impact on a community I visit?
• If there is an inherent risk of community harm through my presence, is the proven benefit to my own education worth the risk of that harm? Should this be my decision alone?
• How do power imbalances impede my ability to understand how welcome or useful I am?
• To what extent will I ever know the full impact of my involvement in a vulnerable community?

The more we disregard the context of our work and presence the easier it is to convince ourselves that we are making a difference when we are not. Is this true?