Orthopaedic surgeons are increasingly interested and engaged in short-term volunteer experiences in low-resource settings. Such experiences may focus on direct service delivery, teaching and training, humanitarian relief work, or global health electives for medical students and residents. The growing interest has sparked a conversation regarding practical and conceptual considerations of overseas volunteer work.

During the AAOS 2019 Annual Meeting, the Global Volunteerism Instructional Course Lecture (ICL) provided an important venue for this conversation. The ICL featured the expertise of learned international volunteers who have extensive experience with global volunteerism: Todd Kim, MD; Divya Singh, MD; Peter G. Trafton, MD; and Coleen S. Sabatini, MD, MPH.

The panelists shared their own experiences and walked the audience through the practical challenges of finding the right organization and working overseas. They also noted the ethical considerations of overseas volunteerism.

The conversation then moved beyond the nuts and bolts of volunteering to explore not only how to participate but also how to do so in a way that ensures a sustained, long-term impact. This article continues the conversation sparked by the panelists’ observations and also offers recommendations from the perspective of Health Volunteers Overseas’ (HVO) education-focused global volunteerism model.

Options and ethics

Choosing the right organization is the first consideration when volunteering overseas. During her presentation, Dr. Singh highlighted broad categories of organizations for orthopaedists to consider, including disaster relief, surgical services–oriented work, and education-based initiatives.

Disaster relief and surgical service organizations focus on direct delivery of care, whereas education-based organizations focus on building the capacity of local providers to deliver high-quality care. The categories help define the environment, goals, and scope of work that a potential volunteer can expect to encounter.

In addition to outlining the different categories of international volunteer organizations, Dr. Singh noted the benefits of working with an established organization that can match volunteers to projects based on their particular skills.

For example, HVO, a nonprofit organization dedicated to improving global health by bringing education, training, and professional development opportunities to health workers in resource-scarce countries, tailors every project to the training and educational needs of local health institutions. HVO specifies the skills and information volunteers must have in order to make the most impact. By working with multiple institutions with varying internal capacities, HVO also creates opportunities for volunteers with diverse expertise, including those with no trauma background.

Another benefit of volunteering with established organizations is the support they provide to volunteers preparing for overseas experiences. Beyond offering travel information and advice, visa and licensing support, and logistical coordination, many established organizations offer guidance on how to navigate cross-cultural challenges and ethical issues.

Dr. Trafton highlighted some of those challenges, noting that volunteers may encounter beliefs, values, customs, and behaviors that differ from their own but are deeply rooted in the culture of the host country. Dr. Trafton reflected that volunteers can best prepare for and overcome cross-cultural challenges by exhibiting cultural sensitivity, flexibility, and respect. Esteemed organizations should offer support to volunteers as they navigate those differences. HVO, for instance, connects prospective volunteers to seasoned veterans, so they can benefit from the experiences of individuals who are familiar with the culture and customs of both the host country and local health institutions.

Dr. Kim provided information on the ethical challenges of global volunteerism, which can include a high burden on host institution staff; power imbalances; a lack of collaborative planning, mutual goal-setting, and sustainability; and concerns about patient safety. Working with organizations that have well-designed global health partnerships and effective volunteer-management systems can help volunteers avoid or overcome such challenges, maximizing the positive effects of volunteers and minimizing the risk of harm.

The HVO model relies on international partnerships and education to improve global health. HVO has found that the most successful model of partnership relies on collaborative relationships between two or more parties based on trust, equality, and mutual understanding for the achievement of a specific goal.

“It is important to understand the potential pitfalls of short-term global health engagement so that we don’t fall in,” noted HVO Executive Director Nancy Kelly, MHS. “At HVO, we develop and maintain long-term and mutually beneficial partnerships with local institutions, ensuring that volunteer efforts benefit local health providers and communities, are sustained, and evolve as the needs of local health systems change over time.”

Building capacity beyond surgery and the role of education

As interest in global volunteerism grows, so too does the call to ensure the long-term sustainability of volunteer efforts. NPR global health and development blog Goats and Soda recently highlighted expanded efforts to incorporate education in short-term global volunteer work, particularly in surgical missions like those hosted by the nonprofit service organization ReSurge.

That mirrors discussions among the ICL panelists, who highlighted the role of education in making long-term, sustainable impact. Dr. Trafton noted that partnerships and collaborations with local surgeons are important components for successful, sustainable impact. He highlighted his experience and its focus on education and training, and he emphasized that education supports the capacity of local health systems, providing service beyond surgery. In addition to education, he also identified interprofessional collaboration as an essential ingredient of a successful international volunteer experience.

By exploring not only how to participate in global volunteerism but also how to do so in a positive, impactful way, participants at the AAOS 2019 Annual Meeting Global Volunteerism ICL moved the conversation beyond the basics of volunteering overseas to the long-term sustainability of the efforts. That conversation continues as organizations like HVO pursue quality health for all through global volunteerism.

Katie McMullen is communications manager at HVO.

References:

1. Pinner A, Kelly NA: Health Volunteers Overseas: 30 Years of Leveraging International Partnerships to Strengthen Health Worker Capacity. Available at: https://www.frontiersin.org/articles/10.3389/feduc.2017.00030/full. Accessed May 3, 2019.
2. Silberner J: Why Surgeons Are Rethinking the Fly-In Medical Mission. Available at: https://www.npr.org/sections/goatsandsoda/2019/03/27/656172038/is-it-time-to-rethink-the-fly-in-medical-mission. Accessed May 3, 2019.