In response to the first question- “Will I be of any help?” I thought, yes, at least I could be an extra set of hands, if not a skilled provider. Secondly I asked myself “Am I the right person to help?” Reflecting on this brought several deficits to mind- my training in the US (albeit in an “underserved” county hospital) did not prepare me for post-disaster medicine in the Haitian context, my inability to speak Creole limited my ability to interact with Haitian doctors, nurses and patients and may further detract resources as someone would have to use their time interpreting for me. In addition, the schemes under which I could go to Haiti did not prioritize transfer of skills or sustainability of efforts. I calculated that I would need to be in Haiti for many months in order to overcome these limitations and hurdles.
Finally, I asked myself “Would the cost of the trip be proportionate to the impact I would have?” I calculated the cost- $500 flight to Miami (where a sponsored flight would take me to Porte Au Prince), $400 in extra childcare hours in my absence, and lost wages in the range of several thousand dollars for a 2 week stint. I decided that the amount of money it would cost me, in travel expenses and lost wages, did not equal benefit I would have for Haitians.

Certainly, if I factored in the personal and professional benefit of the experience, the scale would have tipped in favor of going to Haiti- I would most certainly get more than I was able to give. I would certainly have had the experience of a lifetime. But, I would be going to Haiti under the auspices of helping Haiti, not of helping myself. It seemed unauthentic to do so under such pretenses. In the aftermath of this disaster many local and international doctors who had worked in Haiti for decades required material and monetary support to scale up their efforts (and they continue to require additional investment and will for many years to come). I decided to support locally-relevant, linguistically-sound, and sustainable efforts- I decided to send money rather than myself.

This was a difficult decision. It’s not quite as exciting to recollect the money you donate rather than the time spent in a low income disaster struck country. But, for me, it was the right thing to do. I donated an amount of money equal to what the cost of a 2 week medical volunteerism trip to 2 organizations- Partners in Health and MEDICC (Medical Education Cooperation with Cuba). Cuba supported 402 Cuban-trained Haitian medical graduates and 736 Cubans who were already in Haiti prior to the disaster and will be there for many years to come. Partners in Health employees many hundreds of Haitians and has had ongoing skills transfer and sustainable health systems development since 1983.

I’m not suggesting that my approach is right for everyone, but I think its important to realize that short-term medical volunteerism trips are not right for everyone, either. It’s important to recognize our individual limitations- in the realm of skills, language, cultural sensitivity, and time commitment. It’s important to recognize the value of monetary support for people on the ground that are able to speak, relate, and stay in a way that truly serves the local population.

I think CFHI experiences, as they frame local health care workers as the ‘experts,’ and CFHI participants as the benefactors of this expertise does a great deal to challenge many of the norms of global health work and immersion. Hopefully, when medical students, nurses, and allied health trainees are introduced to global health in such a fashion, they will be more likely to be cognizant of the necessity of placing local personnel in the forefront of any health efforts and avoid some of the missteps witnessed by Kim in places like Haiti. As CFHI says, “Let the World Change You,” but in times when the world really needs a lot of immediate help, sometimes it’s better to support local resources than to circumvent them with the best intensions.

Kim’s insights are helpful to make us all look at how we do global health work and what we demand of the organizations we do it with. Often short-term volunteers are very necessary, but these activities need to be married to a strategy of knowledge transfer, building the workforce capacity of local people and providers, and prioritizing sustainability. As we look at organizations to do such work with- we need to ask if these important components are integrated into their approach. Thanks to Kim for this candid commentary.