In the summer between my sophomore and junior year of college (undergraduate), I participated in a medical volunteering program for 2 weeks in Antigua, Guatemala. As a pre-med student, I knew I wanted to do something during my summer that involved medicine and figured volunteering in a hospital or clinic would be my best bet. Unfortunately because I had a mostly full time job, I was unable to secure any type of volunteering program locally since they all required a certain amount of hours that I would not be able to complete before returning to my university in the fall.
I then decided to look online at volunteering abroad, and found a myriad of programs that fit my time constraints perfectly. I honestly did not do too much research and just clicked on the first organization I found that had a solid amount of positive reviews and wasn’t too expensive. Looking at the cheapest options, I saw that in Latin America they offered an affordable medical program in Guatemala. While scrolling through the program description, the phrases “gain hands on experience” and “provide check-ups and basic medical care” piqued my interest as the idea of actually getting to perform medical procedures sounded incredibly appealing to myself as a student interested in a career in medicine. I imaged working in a hospital with doctors and nurses and getting the opportunity to experience medicine directly. The program description made it seem that these “poor” communities needed any help they could get, so I figured that I could kill two birds with one stone-help this underserved country while also gaining medical experience. Even though there were red flags consistently throughout the program description-the program oozed “voluntourism” and provided very brief and limited information on what actually would take place during participation- I wasn’t suspicious at all because I didn’t expect anything that involved volunteering to be problematic.
After signing up, there was a very brief pre-departure guide I had to complete before embarking on my trip. The guide was just a general guide and mostly focused on the logistics of getting there (ie. visas, packing list, etc.). There was a short list on my responsibilities, but it didn’t really mention anything about ethics. There were also 2 optional pre-departure training modules that were more informative on ethics, but were brief and took less than 30 minutes to complete. I didn’t really feel that prepared for my program, but figured I would get more instruction and guidance once I arrived.
Once I finally made it to Guatemala, I started to see problems and holes within the program. Before starting my rotation, I met with the medical coordinator for the program to have orientation. The orientation was pretty short and consisted of a powerpoint on the kind of care we could provide. After telling him I had had no prior experience in medicine, he told me that I would act somewhat like a nurse, taking weight, height, blood pressure, heart rate and temperature, making beds, cleaning, talking with patients, preparing materials and sterilizing equipment. Even though I told him I didn’t know how to take blood pressure or heart rate, he assured me the other visiting volunteers at the clinic would teach me. This orientation started to leave me a little hesitant about the program since he asked us to provide medical care, but expected other volunteers to teach us instead of himself as a doctor showing us.
After arriving to the clinic where I would be volunteering at, I was sent to work at the nurse’s station. At my rotation, there were 2 other volunteers placed there as well who had been there for about 4 weeks. One was applying to medical schools in the United States and the other was a 3rd year medical student at a university in Ireland. Luckily, one of them spoke spanish fairly well and was able to translate for us when we interacted with both the nurses and patients.
After the other volunteers briefly taught me how to perform the basic nurses duties (blood pressure, height, weight, and temperature), I was mostly on my own. It was definitely very nerve wracking having these duties when I’d never done them before and was even more difficult considering I spoke very little of the language. I was especially confused on taking blood pressure and while I immediately should have said that I wasn’t sure what I was doing, I was embarrassed to tell the other volunteers since they insisted it was an easy task and that I’d get the hang of it eventually. This is definitely something I wish I could’ve gone back to and done differently because there is a large possibility that patients’ information was recorded incorrectly due to my lack of experience. This was when I started to realize that gaining hands on experience wasn’t what I imagined at all. In my head I thought that everything would go smoothly and I would be ready to help the professionals in anyway possible. In reality though, my lack of experience became even more apparent to myself and I started to become suspicious that the “help” I was providing wasn’t all too helpful.
While my lack of training may have led to incorrect patient information being taken down, there were other pre-med volunteers who were given duties that were even further beyond their scope of understanding and led to medical complications for patients. Since there were other volunteers working at my clinic, they cautioned me right away that I shouldn’t help with procedures such as giving stitches or injections since we didn’t have the training for that (I think they figured taking down patient information was harmless enough that my inexperience wouldn’t be an issue). I was very thankful for that advice since I was already feeling uncomfortable with the duties I had, I couldn’t even imagine how stressed I would have been if I had to perform anything more advanced. However, other volunteers weren’t as reserved. I remember this one other volunteer bragging to me about how the doctor had allowed him to give injections to a patient. He said that he didn’t really know what he was doing and he ended up piercing her 5 times because he kept doing it wrong. Another volunteer told me she helped stitch a patient up and said she was concerned that her stitches weren’t done right since she had never done it before. It was at this point that I really started to question the program we were on. Why weren’t there more regulations enforced by the program? Why were the duties of the volunteers so ambiguous? Why was I starting to feel so uncomfortable with what I was doing and why weren’t the other volunteers having the same questions I was?
Besides just the volunteer aspect of the program, there were a lot of problems with the program as a whole, in particular when it came to safety. We were warned to never travel by ourselves at night. In keeping with those rules, two volunteers on my program walked home together one night after hanging out downtown. On their way home, someone pulled a knife on them and took all their belongings. The volunteers were traumatized and felt very unsafe about what had happened and contacted the program to let them know of the situation. The program responded incredibly insensitively and told them it was their fault for walking home late at night and didn’t provide any support for the two. Their response to an emergency situation such as this really made me concerned about the legitimacy of this program. They had told us it was okay to be out at night as long as we weren’t alone, yet blamed the volunteers for what happened instead of offering emotional support and/or more information on how we could stay safer while out at night.
I left my program feeling differently than I had expected. While I loved the country I was staying in, I felt disconnected from what I was actually doing. I felt uneasy about what myself and other volunteers had done without any medical experience and questioned my helpfulness. My experience showcases how easy it is for medical volunteering programs to be problematic and harmful for the communities they’re situated in when there is not an emphasis on global health ethics.
Note from CFHI: Many thanks to Zoe for sharing her story. If you have questions about ethical engagement in global health experiences please visit the publications page on the CFHI website (https://www.cfhi.org/publications) or listen to a recent webinar (https://www.cfhi.org/cfhi-webinars). We are also always available to answer questions about ethical global health engagement- contact us at firstname.lastname@example.org.
One of the best ways to get to know CFHI is through the experiences of the students who attend our programs. Below is a story from Southern California student, Daniel Sarkissian.
I am a third year neuroscience major at UCLA. I currently do clinical research at the Neuromodulation Division of the Semel Institute of Neuroscience and Human Behavior and volunteer at the UCLA hospital as a Care Extender. After graduation, I plan to take a gap year, during which I will apply to medical schools across the United States. Going into medicine has always been my life goal, and when my biology professor told me about this program and how I would gain valuable clinical exposure, I knew this was meant for me.
Why he chose CFHI
I chose the Hospital Medicine program in Córdoba, Argentina because I wanted to gain clinical exposure shadowing surgical procedures and to explore the beautiful sight s in Argentina. My experience of volunteering at the emergency room is what made me strive to attend this CFHI program, as I wanted to expand my knowledge of global health, how hospitals are run in other parts of the world, and to enhance my Spanish skills. Southern California has a large population of Spanish speaking people, which is also why I chose to go to Argentina, as I would be forced to get out of my comfort zone and speak Spanish on a daily basis. When I first began volunteering at the emergency room at the local hospital in Glendale, CA, one of my notable experiences was translating Armenian, as that is my native language. Seeing this language barrier is also why I decided to go to Argentina, as I would improve my Spanish skills and have a larger outreach to people who do not speak English. The Spanish lessons, both the one on one and the group session, greatly improved my Spanish communication skills. My experience with the Hospital Medicine program in Córdoba was at the Hospital Pediatrico del Niño Jesus, where I gained experience in general pediatric care, surgical procedure, and radiology. I observed over 30 surgical procedures which taught me more about different disabilities and conditions while learning about human anatomy underlying each procedure. I departed Argentina with improved Spanish skills, a greater understanding of their healthcare system and a greater drive to pursue my medical career in surgery.
Reflection on what’s next
The four weeks I spent in Córdoba were undoubtedly the most enlightening four weeks of my life. The general pediatrics unit taught me where to check with a stethoscope for various conditions. When I was shadowing surgeries, some doctors responded to questions and explained the procedure. After seeing all these surgeries and how big an impact each surgery has on the patients’ lives, it reinforced my ambition to become a surgeon. This experience also drove my lifelong ambition to work with Doctors Without Borders, to further broaden my understanding of other cultures and deliver healthcare to all of those who need it. CFHI gave me the opportunity to fully immerse myself in the surgical field and this experience of learning medicine in a totally different culture is invaluable to my future.
For our newest Student Spotlight we introduce CFHI Alumni Ariel from California. In June this year Ariel chose our program Healthcare Challenges with focus on Hospital & Inpatient Medicine, HIV/AIDS and Global Health Nursing. She went to Cape Town in South Africa for 5 Weeks. A few months after her return, we asked for a short reflection on her adventure:
CFHI Alumni Ariel in South Africa
A little about Ariel:
I am a third year biological sciences major at UC Davis. After graduating from Davis I want to pursue a career in health by becoming a nurse practitioner or PA. Studying abroad was one of the experiences I was most excited for when I came to college. When I heard about an internship abroad opportunity through CFHI it seemed like the perfect fit.
Why she chose CFHI:
I chose CFHI for a number of important reasons to me. First, I wanted to experience living in a new country to really understand the culture and daily lives of another part of the world. I chose Cape Town because the city seemed like such a lively place with so much to do and so much history to learn about regarding Apartheid. The best way to truly get a feeling for another way of life is to immerse yourself in the country’s culture. I had never been to Africa so I was super excited to learn about a new continent and compare the healthcare challenges with the ones we face in the States. Also, volunteering at Community Day Centers and observing procedures at a pediatric hospital in Cape Town were unlike any other opportunities I had had in the past. Through CFHI, I was able to witness healthcare first hand and be a part of a typical day for physicians right in the middle of the action.
What is next for Ariel:
Taking part in a CFHI program opened my eyes to the different fields of medicine and global healthcare. Before I went to Cape Town, I thought I was set on going into nursing. After going through rounds with med students, watching surgeries, and attending lectures and tutorials, the experience influenced me to consider a PA program. Also, it confirmed my inclination that I want to work in pediatrics. I plan on becoming involved with one of the student run clinics at UC Davis to get more experience with patients. If I was given the opportunity after I become licensed, I would definitely work in a hospital in another country for a longer period of time.
CFHI student spotlight showcases students who have been and are working in one of our many programs . This is a feature where we highlight the students’ experience, if you would like to be featured please contact CFHI’s outreach director Keaton Andreas via email Keaton@cfhi.org.
Ross is involved in Pace University’s Physician Assistant program. He is interested in Women’s Health, Primary care/preventative medicine, and pediatrics. He selected the Reproductive Health rotation in Quito, Ecuador, because he is around spanish speaking patients back at home and wants to be able to speak to his patients in whatever language that makes them most comfortable.
What school did/do you go to? Pace University’s Physician Assistant Program
How did you hear about CFHI? It’s the international rotation provider my school works with.
What areas are you interested in regarding medicine? Women’s Health, primary care/preventative medicine, pediatrics
What program are you in and how did you determine that was the right one for you? Reproductive Health rotation in Quito Ecuador; I selected this program based on my interest in reproductive health and my desire to improve my medical Spanish. I live in NYC, where many patients only speak Spanish, and I want to be able to speak to my patients in whatever language makes them most comfortable.
What were your expectations for the trip and how have those matched up with reality? My expectations were that the rotations would be largely observation with the opportunity to take histories and present patients in order to practice discussing patients in Spanish. My expectations have been surpassed. I have rotated through very different locations in OB/GYN, emergency medicine, and primary care, giving me exposure to a diversity of medical situations.
What has been the best part of your experience so far? The best part is definitely the cultural immersion, which also happens to be the most difficult part. The discomfort of being in a totally new place is what forces you to adapt. It is absolutely the reason my Spanish has improved so much.
Who are you working with?Depending on the location, I have mostly worked with the attendings. At one of the sites, I was matched with a resident, which was a nice opportunity, as they usually do more procedures.
What is the overall goal of your program?My overall goal was to improve my medical Spanish.
What is your overall goal? What do you want to accomplish through your program? Same ^ [Same answer as the previous question]
What are some cultural things you have learned?The primary cultural difference I have noticed, at least medically, is that family is prioritized by patients over everything, including privacy. This is definitely different in the U.S. We learn that in order to get an honest history it is best to talk to the patient alone. That is often not an option here. It is interesting that people have such a level of comfort regarding their personal medical details, definitely surprising at times.