Choosing a career in healthcare is committing to a life of serving others. Many students want to serve in other countries before you begin a health professional program in the US. It is important to understand concerns that revolve around serving abroad. Providing care or services in other countries that you are not trained and/or licensed to provide in the United States causes concern because it is deeply unethical. In addition, serving in cultures with which you are not familiar requires cultural learning, humility, and sensitivity. If you choose to serve abroad, you have the responsibility to ensure that any service you provide in another country is ethical, responsible, culturally informed, humble, and sensitive.
A group of UW-Madison undergraduate students developed a set of Ethical Considerations for health-related service abroad in collaboration with the UW-Madison Global Health Institute, Center for Pre-Health Advising, and School of Medicine and Public Health. Please find these considerations below. In addition, the student leaders of this group wrote an article about their efforts and reasons for them which has been published in Harvard University’s Health and Human Rights Journal. Have a look at the article.
Please also know that many service trips abroad — including trips planned by Registered Student Organizations — are not sponsored or controlled by the University of Wisconsin, Madison. The University of Wisconsin expressly disclaims any responsibility or liability for service trips that are not controlled by the University of Wisconsin.
Ethical Considerations for Service Abroad
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The students of the University of Wisconsin-Madison are committed to the ethical and intellectual exercise of the Wisconsin Idea—the project of making the benefits of the university available to all members of the state of Wisconsin.
The Wisconsin Idea shapes how we as students engage in global health activities. Global Health is the realization that all humans have a fundamental right to health and that global forces affect individual and community health. Striving toward global health equity requires us to understand that the causes and consequences of poor health in individuals and communities transcend national, socioeconomic, and political boundaries.
When we work with organizations that provide healthcare to communities in the United States or abroad, the primary role of students is to observe, listen, and learn so that they may better understand the nature of global health inequalities, the barriers to access that marginalized communities face, and the systemic problems that perpetuate these disparities.
The creation of these ethical considerations can help students to plan and participate ethically in service trips abroad while building relationships to strengthen local capacity, minimize risk, and maximize short- and long-term benefits to the local and global communities with whom they serve.
Before You Go
Student Organizations can plan for a successful trip by:
- Developing a process for students to apply and be screened for participation in the trip.
- Identifying the relevant stakeholders in the student organization, the external organizations, and local communities.
- Volunteering with well-established programs with strong local ties. Programs should have worked with undergraduate students in the past and be engaged in the sustained support of a community.
- Disclosing to the program and any other participating organizations that the trip is not sponsored by, controlled by, or otherwise affiliated with the University of Wisconsin.
- Drafting and signing a Planning Document between the student organization and the external organization.
- Understanding the costs associated with trips, planning a budget for the trip and associated projects, and knowing how student funds are used by the external organization.
- Limiting the choice of trips to areas where students have the ability to communicate with clinicians and patients in that community. This will entail developing a plan for communication prior to leaving that includes identifying students with language fluency and ensuring that translators who are not medical staff are available. This may include hiring translators if necessary.
- Ensuring that every participant is able to communicate the following statements in the local language or languages (recognizing that the language may need to be tweaked to address local cultural norms):
- “I am an American student and not a health care provider. I am here to learn about healthcare. Do I have your permission to be present at this time?”
- “Thank you for offering me the opportunity to do X. I do not feel qualified and I do not have the required training to do this.”
Learn About the Community
Students can develop cultural knowledge of the site by:
- Learning about local cultural norms and practices around clinical practice, including the role that clinicians play in that culture and views on sexual health. Students should also understand norms around privacy and confidentiality in clinical settings.
- Learning about local cultural norms and practices beyond health care, including but not limited to: law enforcement, language, and gender norms.
- Reaching out to UW-Madison faculty and staff who are knowledgeable about the cultures and histories of the country where the trip will take place.
- Developing a training plan and materials to use with trip participants prior to leaving.
- Recognizing that students are going to learn, not to transform another community based on their own cultural norms or expectations.
- Remaining committed to learning even when confusing, awkward, or uncomfortable situations arise.
Prepare to Travel
Students can prepare for the trip by:
- Knowing their responsibilities, role in the group, and what they are allowed to do and not do.
- Understanding how their health might be affected by travel, thinking about how to maintain their health, including a pre-travel visit to a travel clinic, and knowing what to do if they get sick. See the GHI Travel Resources for more information.
- Packing the proper clothing and gear.
- Thinking carefully about the types of donations students bring to communities. It is reasonable to help obtain items requested and considered essential by local hosts. However, students should be aware of the potential ramifications and expectations related to donations. Students can learn more about donations here.
During the Trip
While on the trip, students can plan for a successful trip by:
- Having a detailed plan for activities, including time to debrief at the end of each day.
- Not providing any clinical care to patients and not assuming responsibilities that are inappropriate for their level of training. This includes the distribution of medication because of the potential for harm and lack of adequate follow-up care.
- Not lowering their standards of care because they are in a resource poor region; recognizing that something is not necessarily better than nothing.
- The following are some positive ways that you can participate and make an important impact: observing, listening to local professionals, students, and community members, walking around in approved areas, taking in local cultural and historical sites, shopping locally, and eating local foods.
- Being prepared to politely but firmly say “no” when asked to do something an undergraduate student would not be permitted to do in a hospital or clinic setting in the US.
- Contacting someone in a supervisory role (faculty, organization leader, clinic director, etc.) if they see another volunteer doing something inappropriate or dangerous.
- Being sensitive to local norms around gender, sexuality, and gender identity.
- Identifying and utilizing a translator as a cultural broker to help navigate tricky situations.
- Recognizing that instances of cultural misunderstanding or miscommunication do occur and constitute opportunities to learn and grow.
Consent and Privacy
When in a clinical setting, students should respect privacy and solicit consent by:
- Making sure patients and their families know that they are students from the US, and are not professional students. Students should talk with program staff about the difference between clinical training and education in the US and abroad (i.e., that undergraduate students are not medical students or health care professionals).
- Always asking patients for consent or permission, letting them know they are there to observe and will not be providing health care.
- Working with the translator to secure consent or permission when needed, attending to the cultural norms in the provider-patient relationship. These norms may differ from what students have experienced in the U.S. and may complicate interactions or situations.
- Explicitly requesting permission before obtaining any photographs or recordings, and being prepared to state the purpose for photographs or recordings when asked. Unite for Sight has published important information about the ethics of photography.
After the Trip
After returning to the US, student organizations can evaluate the success of the trip by:
- Organizing a formal debriefing session where students can be honest and upfront about their experiences. This could include a process for students to provide feedback on what did and did not go well.
- Following up with their external organization(s) and when possible the local community.
- Regularly checking to make sure that they are living up to their ongoing responsibilities and relationship to the site as outlined in the Planning Document.
The following UW-Madison Student Organizations co-authored these guidelines with the Center for Pre-Health Advising:
- American Medical Student Association (AMSA)
- Aspiring Physician Assistant Association (APAA)
- CALS Health and Research Society (CHARS)
- Global Public Health Club
- Global Public Health Brigades
- Partners in Health Engage
- Pre-Occupational Therapy Student Organization (POTSO)
- Pre-Optometry Club
- Pre-Physical Therapy Club
- PRIDE in Healthcare
- Professional Association of Latinos for Medical School Access (PALMA)
- Project 1808
- Public and Global Health Interest Group @ School of Veterinary Medicine
- Support, Advocacy, and Awareness of Neurodegenerative Disease (SAAND)
- Student Emergency Medical Services (SEMS)
Sports Medicine Club
Village Health Project
To learn more about challenges associated with short-term clinical service trips, explore this free course offered by Stanford University’s Center for Innovation in Global Health.
QUESTIONS TO CONSIDER
If you do decide to pursue a clinical service trip abroad, here are some questions to guide your research and evaluation of programs:
- What are your reasons for wanting to go on a health-related service trip?
- What are you hoping to learn from this experience?
- What do you know about the program you want through which you want to go abroad? Is it for-profit or non-profit?
- What are you paying for when you go on your trip?
- Does the program have a presence in or near the community on a sustained basis, or is it a mobile clinic?
- Does the program partner with local clinicians and community leaders?
- How much do you know about the community you will be serving? Will there be language or cultural barriers? How does the program address these barriers in providing care to patients?
- Will you be caring for patients independently? Do you have certification or qualifications that allow you to perform the same patient care duties in the United States?
- Duffle Bag Medicine (article)
- Some Health Programs Overseas Let Students Do Too Much, Too Soon (article)
- Guidelines for Premedical Students Providing Care Abroad (AAMC)
- Guidelines for Shadowing Health Professionals (AAMC)
- Foundation for Advancement of International Medical Education and Research
You might also consider learning more about the Global Health Institute on our campus and the Undergraduate Certificate in Global Health. Students pursuing this certificate choose from field experiences led by UW-Madison faculty in many different countries. These field experiences are a great opportunity to learn about healthcare delivery in an international context and the broader social, cultural, and environmental factors that impact human health.