“Hey there! I am looking to do a volunteer nursing trip in another country. I have been interested in going to Costa Rica… Does anyone have any experience with medical or health projects that has any recommendations on agencies or countries? Thanks!”
This is just one post to the Facebook group Critical Volunteering Reviews, but it’s echoed constantly as summer begins. Vacation and warm weather mean beaches, hiking, and (for many), packing up bags for a volunteer travel trip. Students, church members, dentists, and retired people stuff their bags with donated medical supplies, check their vaccinations and malaria medications, don their matching T-shirts (often splashed with the word “hope”), and jet off to a poor country to do good and have a meaningful experience.
They work in pop-up clinics in rural communities or in disaster relief areas. They may visit an orphanage or paint a community building. A week or two—maybe a month or two—later, they return with heartwarming stories, sun-splashed photos and souvenirs, and the hope that they have made life better for their hosts.
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Some will wonder, however, whether they did make a difference. Many may be hit with the growing criticism that they are playing “white savior,” serving neocolonial power relations, meeting their own selfish needs. One popular commentary on this is the Instagram account @barbiesavior, which mocks the volunteers as naïve, ignorant, and even racist. Onlookers challenge that emotional and fun day in an orphanage as contributing to the exploitation of children, or that day spent painting as depriving residents of jobs they need. And groups such as Critical Volunteering Reviews report on abuses by profiteering organizations that take advantage of well-meaning volunteers and needy host communities to set up poorly designed programs.
As an academic sociologist at Lehigh University who has worked with students going on such trips, I wanted to know whether there was any evidence that all this money and effort devoted to short-term volunteer trips actually makes host communities’ lives better. Might they actually hurt, as more and more critics are claiming? That question led to several years of research, a book called Hoping to Help: The Promises and Pitfalls of Global Health Volunteering, and my current advocacy for improving volunteer programs.
It’s not that the international community hasn’t tried to figure out exactly how to design short-term programs in ways that maximize their value. Guidelines—developed separately by medical and hospital associations, NGOs, missionary doctors, and academics—agree that effective short-term programs have a number of common characteristics, which include having local partners who define the needs and direct the program, sustainability through local capacity building, respect for local laws and for ethical standards of patient care, recruitment and supervision of appropriate volunteers, and, last but not least, regular evaluation.
As the number of volunteers and the volume of the criticisms both increase, the need to actually figure out impact also grows. It makes sense: There has to be a way to directly measure how much, and at what cost, volunteers help people.
And yet, to my surprise, when I asked trip organizers, volunteers, and host staff in surveys and interviews how they know if their programs are contributing to host communities, most could not answer my question except with anecdotes. They could report the number of patients seen, the number of projects undertaken, or the satisfaction of the volunteers. But many program staff actually seemed surprised by my question about evaluating community impact, as if they had not really thought about it. They just knew somehow that this was a good thing to do.
Sure, a lot of these programs alleviate individual pain and disability. But are one-time visits from church groups or students or NGOs, even if repeated occasionally, the best way to improve the health of vulnerable populations? As one NGO director told me, “The myth is that you can show up in a random, rural community and hand out antibiotics and actually have an impact on patients... the elephant in the room here is that if the best way to provide health care to low-income communities was through short-term trips, then you and me would be going to short-term trips to get our own health care—clearly not the best way to do it.”
My interviews with host country staff who work with volunteers revealed that their ideal program differs quite a lot from the most common practices, practices documented by surveys of program sponsors in the United States. For example, most volunteer trips are two weeks or less, yet most staff consider three weeks a minimum to accomplish anything of value unless one is highly skilled.
Host staff I interviewed want their own communities to do the work of defining the needs rather than going along with whatever outsiders propose to do. They want volunteers to be skilled and prepared for the language and culture and needs of the country they will visit, and for activities to be focused on training to increase capacity. None of these preferences are commonly practiced by volunteer organizations.
Professionals and staff in low income countries are particularly offended by foreign volunteers’ lack of respect for their knowledge and experience. The outsiders’ assumption that people in poor countries have nothing and know nothing is pervasive and often the justification for unethical and ineffective programs. For example: Untrained students pushing aside hospital staff so that they can get experience on patients. A training program for experienced professional midwives that wasted time and insulted hosts by teaching basic introductory materials they had studied years earlier. Visiting doctors reorganizing a hospital pharmacy according to how they think it should be done without even asking the local pharmacist for permission to enter or knowing the rationale for how it is currently organized.
The guidelines mentioned earlier are designed to counter these bad practices. But they are written almost entirely by people in the Global North, based on research conducted by outsiders to the host countries, and they do not propose any means of enforcement.
But there’s hope: Some host countries are taking steps to assert controls over the growing and unregulated industry of “voluntourism” (PDF). Studies of host country preferences and regulatory efforts are now underway, conducted by scholars from those countries.
Additionally, more organizations from across the spectrum of program sponsors—faith-based, academic, and NGO—are re-examining their activities and aspiring to follow these best practices. Dentists, midwives, church leaders, universities, nonprofits large and small, are recognizing that their old ways—sending mostly unskilled people to do things that might be unneeded, perhaps even harmful—must change. A few have suspended overseas trips entirely until they can figure out how to do it better, or whether to do it at all, while others have organized conferences and workshops to focus their planning on improvements.
So can voluntourism help? The numbers aren’t clear, but perhaps we’ll have a better idea soon of how much time and effort actually help locals.
