When I found out I would be leading a work team of youth to volunteer in a hospital in Antigua, Guatemala I groaned internally. Hospitals aren’t the only tough assignment: Construction is hard work. You’re out in the sun all day mixing concrete and moving cinder blocks. Picking coffee can lead to a lot of sore muscles too and as a person with arachnophobia I would have to suffer my silent paranoia about encountering a tarantula hidden in the coffee fields. But either one of those work teams seemed preferable to spending a morning hanging out in the hospital.
Still, I did it anyway. I would love to say it was a beautiful experience where I made lifelong connections and really felt of service, but the truth is that my time at Hermano Pedro’s hospital left me feeling sad, angry and depressed.
I was angry because though by Guatemalan standards the facility was state of the art, the equipment was outdated and even the waiting room (a hallway lined with folding chairs) gave this sense of making do with what was affordable. And I was sad because I sat with people with developmental disabilities whose families had abandoned them. They were people who would never have a life outside of the hospital. I painted the fingernails of old ladies knowing that other than the aides that came to help them bathe and change clothes, I was probably their only physical contact for that day. I couldn’t help but wonder what their lives would be like had they been born in countries with more access to higher quality medical care.
It’s that tug on your heart strings, that Sally Struthers “for just five dollars a month, you too can feed an entire 3rd world country” feeling of guilt mixed with superiority and privilege which is both the motivation and the pitfall of cross cultural volunteerism. Can we just throw time and money at a developing nation and hope for the best?
More complicated than the ethics of short term study abroad program participants volunteering in hospitals are the ethics of medical professionals visiting other countries to provide medical care. As medical practitioners in the United States and other industrialized countries have become more interested in global health issues and technology has made connecting to countries around the world much easier, medical service tourism is becoming commonplace.
Here in Seattle it seems that more and more doctors are partnering with hospitals and clinics in developing nations to donate everything from medical supplies to free surgeries, though it is difficult to give concrete numbers because such programs are often piecemeal and based on individual relationships. People want to “help,” but often don’t know how to connect.
There are of course large organizations like Doctors Without Borders or the Red Cross whose focus is more on relief work and triage during large-scale disasters and times of conflict. But there are also individual hospitals and clinics interested in day-to-day operations and cultivating sustainable relationships with U.S.-based medical centers.
“I think ultimately that is the best way to help them, so that they can do it on their own,” says Dr. Rod Oskouian, a neurosurgeon from Seattle who recently returned from his first trip to Kenya. The small team of volunteer medical professionals paid their own way on a ten day trip to Kenyatta National Hospital in Nairobi, Kenya where they performed a series of donated spinal surgeries. “We can’t do it without the local hospitals there and the local surgeons there because when we leave they have to take care of the patient.”
The Kenyatta National Hospital is a teaching hospital whose complex includes the University of Nairobi’s College of Health Science, Kenya Medical Training College, Kenya Medical Research Institute and the National Laboratory Service. For the last four years, Kenyan surgeons Dr. Richarch Ombachi and Dr. Soren Otieno have collaborated with many U.S. surgeons through the Spine Project to help more than 200 patients in critical need of corrective surgery.
“Even when you go over there and you bring all the equipment,” said Oskouian, whose team brought medical supplies donated by Swedish Medical Center and Providence Health Services, “it’s a challenge because they just don’t have the physician and the clinic manpower that we have in the U.S. or the technological things associated with running an emergency room or an ICU.”
During their time in Kenya, they performed corrective surgeries on patients like Nancy Gichngu, a 52 year old woman whose scoliosis was so severe she was no longer able to stand or even lay down straight. She cried after her surgery because she was able to stand up straight for the first time in years.
But for Dr. Oskouian it was the patient he was unable to treat that impacted him the most. “There was nothing I could do for him because he was already paralyzed and couldn’t walk.” He said, showing me a picture of a smiling boy who sat on the ground with his legs permanently tucked beneath him. “He was eight years old and he just said ‘God Bless You.’ It was like there wasn’t anything wrong with him. He didn’t care. It’s like as long as he had his mom there it didn’t matter.”
“I learn a lot when I go on trips like this. You learn how spoiled you are and how easy we have it in the U.S. No more complaining when you come back from a trip like this.” Though physical travel is not the only option.
“Because we’re in Seattle there is a lot of intellectual capital in town and a lot of technology,” said Dr. Oskouian. “Let’s say I’m doing a surgery here, but I want to beam it to Nairobi. They don’t even have to travel. They just have to have a computer. They can downstream or they can get on facetime.”
For Dr. Oskouian and his crew it is all about being able to help as many people as possible. “Whether it’s going to Africa, or you know we have patients that come internationally to the person that is just down the street and has developed a bad infection of whatever it is. That’s the cool thing about what I do. No matter what goes on in healthcare it’s all about taking care of the patient.”
While of course there are always questions about what we are really giving when we offer “help” to other countries, it seems that there are more and more ways for people who wouldn’t ordinarily have access to get the standard of medical care that might truly enrich their lives. “The next ten years will be about infrastructure,” explains Oskouian. “I think with time all that will come and places like Africa will be up to speed.”