Socially responsible approaches to international electives and global health outreach

Context and setting Participation in global health outreach projects and international health electives (IHEs) has significant potential to offer future health professionals the opportunity to learn about and address the health advocate role, foster global citizenship, and develop a sense of social responsibility to tackle worldwide disparities and inequities in health and social development. Why the idea was necessary Opportunities are often set in vulnerable communities in resource-poor settings where there are pronounced disparities in health and health care. There is growing concern that IHEs are frequently perceived by students as opportunities to practise clinical skills, enhance their résumés and travel to ‘far-away and exotic’ places. Sometimes referred to pejoratively as medical voluntourism, such initiatives can result in vulnerable communities serving as a means to fulfil the students’ own ends rather than first serving the community’s identified needs and facilitating the empowerment of its members. Rigorous and thoughtful pre-departure preparation can help students avoid making any undesirable impact (thus limiting the potential for harm and exploitation) as a result of their participation in global health outreach programmes and IHEs. What was done A series of interactive workshops entitled ‘First, Do No Harm: Global Health Initiatives, Ethics and Social Responsibility’ were developed and piloted for teams of students and medical residents preparing to initiate global health projects in resource-poor settings. Learners analysed several case studies constructed from themes derived from a university-wide study on the ethics of international engagement and service learning.1 The case studies included poetry (The Development Set by Ross Coggins), video clips (They Come in the Name of Helping by Peter Brock) and several articles dealing with ethical issues pertaining to international service-learning, medical voluntourism and social development (cf. http://ethicsofisl.ubc.ca/). In small groups, learners considered a number of critical questions dealing with issues of sustainability, cultural competency, human dignity, power and privilege, colonialism and imperialism, among others. Case studies were constructed in such a way as to increase the complexity of the ethical dilemma with each layer. Evaluation of results and impact Participant evaluations revealed a strong desire for concentrated learning around ethical and sustainable approaches to global health initiatives. Participants recognised that, to ensure ethical conduct, adequate preparation and reflection were necessary prior to participation in global health initiatives. All of the participants indicated that ethics in global health and health advocacy must be taught in medical education. Participants found the problem-based learning approach for this topic to be an effective method for learning about ethical issues and how to address them.