A harm in 'medical tourism'

Anyone living in or around a city has likely encountered someone asking for spare change. A reasonable person knows such help is temporary and insubstantial, yet some of us hand it over regardless. It assuages some guilt, makes us feel better about ourselves, and is, after all, better than nothing. Or is it?

This is a good analogy for the state of medical volunteering by American citizens overseas. The ultimate goal of global health workers should be to establish permanent, local systems to deliver care in poorer countries - not to import care providers and resources sporadically and temporarily.

Global health experts refer pejoratively to the latter as "medical tourism," which implies that the care provider benefits from the experience more than the recipients of the care. The medical tourist may improve his surgical technique with practice on foreign patients. He may feel good about participating in a "mission trip" - a one-off deal with no follow-up. But the patient may end up worse off than before, without the knowledge or encouragement needed to stay healthy.

In January, I was fortunate enough to participate in Unite For Sight, a global health organization at the vanguard of the field. Three fellow students from other universities joined me in and around the capital of Honduras, in the southern, poorer part of the politically and economically embattled Central American nation. We worked with the staff of an eye clinic, the Centro Oftalmológico Vida Abundante, which is based in Tegucigalpa but sends workers to remote areas several hours from the capital.

Over the course of four days in these areas, we helped perform vision screenings, distribute eyeglasses, and explain the use of eye drops. Our skills and qualifications were limited; we underwent comprehensive training for the program, but none of us was a health-care professional.

This may not sound like a lot of work, or the kind that's likely to make a difference. But besides the hands-on work, our purpose was to inaugurate a Unite For Sight program in Honduras. The organization has operated similar programs for years in India and Ghana. There, the organization provides continuous support, but the program is run by local personnel. Now there are prospects for a similarly permanent program in Honduras.

During our trip, we encountered a group of what might be called medical tourists on a mission trip. Their stay overlapped with ours, and we worked together for two days.

The collaboration was mutually beneficial for several reasons. The mission group had a variety of materials and several warm, friendly, enthusiastic volunteers at its disposal. We would not have been able to deal with nearly 400 patients as effectively without their assistance.

Of the other group's dozen or so members, only one was fluent in Spanish; the rest just spoke English more loudly and slowly to their Spanish-speaking patients. The Spanish speakers in our group helped to alleviate some of the resulting frustration. And, serendipitously, these medical tourists supported the fledgling infrastructure we were helping to create.

A key difference between their group and ours was that they were on their own, representing nearly the full membership of their organization, which sporadically sends resources to areas in dire and perennial need. But we represented just a small part of what is now a continuous flow of personnel, monetary donations, and materials.

Since both groups were doing nothing more invasive than recommending eye drops, no terrible consequences would arise from this difference. But in other kinds of care, the lack of a follow-up plan, educational program, and established relationship with local personnel could have drastic results, such as medication abuse or improper self-care following surgery.

It takes just one bad experience with medical care by foreign volunteers to eclipse many instances of good care and results. Trust in an outsider is easier to erode than to build. This underlines the need for local authority.

Like urban poverty, complicated, long-term health-care needs will not be met by the equivalent of handing out change - that is, providing care removed from the context of the life of the person receiving it. Many of us have good intentions that may be undone by lack of direction. So next time you think about handing out change, think of how much more you can do, and how much more it will matter, if you are part of something bigger than yourself and your immediate experiences.