Hoping to Help

The Promises and Pitfalls of Global Health Volunteering

Judith N. Lasker

• Publisher: ILR Press
• Year: 2016
• Print ISBN: 9781501700095
• eBook ISBN: 9781501703843
• Topic: Social Sciences
• Subtopic: Public Health, Administration & Care
• Index: Social Sciences

Overseas volunteering has exploded in numbers and interest in the last couple of decades. Every year, hundreds of thousands of people travel from wealthier to poorer countries to participate in short-term volunteer programs focused on health services. Churches, universities, nonprofit service organizations, profit-making "voluntourism" companies, hospitals, and large corporations all sponsor brief missions. Hoping to Help is the first book to offer a comprehensive assessment of global health volunteering, based on research into how it currently operates, its benefits and drawbacks, and how it might be organized to contribute most effectively. Given the enormous human and economic investment in these activities, it is essential to know more about them and to understand the advantages and disadvantages for host communities.

Most people assume that poor communities benefit from the goodwill and skills of the volunteers. Volunteer trips are widely advertised as a means to "give back" and "make a difference." In contrast, some claim that health volunteering is a new form of colonialism, designed to benefit the volunteers more than the host communities. Others focus on unethical practices and potential harm to the presumed "beneficiaries." Judith N. Lasker evaluates these opposing positions and relies on extensive research—interviews with host country staff members, sponsor organization leaders, and volunteers, a national survey of sponsors, and participant observation—to identify best and worst practices. She adds to the debate a focus on the benefits to the sponsoring organizations, benefits that can contribute to practices that are inconsistent with what host country staff identify as most likely to be useful for them and even with what may enhance the experience for volunteers. Hoping to Help illuminates the activities and goals of sponsoring organizations and compares dominant practices to the preferences of host country staff and to nine principles for most effective volunteer trips.

Part I

THE SPONSORING ORGANIZATIONS

Each year, thousands of organizations large and small send hundreds of thousands of volunteers to work in health-related projects in other countries. Volunteer programs vary a great deal in their history, the types of activities they engage in, and their models for programming, but certain patterns emerge as they are studied.

In order to understand the impact of international health volunteering, we need to know more about who is sponsoring these activities, what they hope to accomplish, where they go, and what they do. We will see that the volunteering enterprise reflects the goals and history that sponsoring organizations bring to it, as well as the larger social forces that have driven its growth.

1

WHO SPONSORS INTERNATIONAL
MEDICAL MISSIONS?

Most of the volunteer programs I write about began in the last two decades, a time of tremendous growth in NGOs and in university-based international activities. Volunteer organizations, though, have been working in other countries for a long time. For example, Catholic Medical Mission Board dates its origin to 1912 and has worked in 123 countries. Project Hope launched its traveling hospital ship in 1958 and has taken it to 35 countries. Operation Smile was founded in 1982 to provide cleft palate repair and surgical training in poor countries; in recent years, it has expanded to offer dentistry and burn care. These and other organizations operate worldwide and raise millions of dollars each year.

Individual physicians have founded many international volunteer organizations. They are driven by a desire to make a difference and often also by religious faith. Their destination choices are most often a product of personal history or chance encounters rather than an analysis of where needs are greatest. The choice of focus—primary care, surgery, screening, or health education—is also a product of perceived need or of personal capabilities rather than any kind of systematic assessment.

Types of Organizations

The great majority of organizations that send volunteers from wealthy countries to poorer countries to work in health-related projects fall into one of four major types:1

• Faith-based organizations
• Nongovernmental organizations that are not faith based
• Educational organizations
• Corporate groups

Most are nonprofit entities. Some, particularly the NGOs, were created specifically to sponsor volunteer activities. Others have broader goals and activities, of which international volunteering is one part. For example, the volunteers who go on short-term health-related trips for educational institutions and corporations tend to come from the ranks of the students or employees of these organizations, and service trips are only a small part of the overall organizational mission. Since the 1990s, a growing number of for-profit commercial firms offer fee-paying “voluntary work” placements.2 These broker firms may create their own service projects or just connect volunteers to existing projects. They often consult with universities or corporations to help them offer volunteer opportunities to students or employees.3

The responses to my national survey of volunteer organizations encompass three of these groups, with faith-based organizations dominating.4 The small number of corporations that directly sponsor international health volunteering were not included in the survey. They are, however, an important and increasing presence, and I discuss them later.

To get a deeper sense for what these organizations are about and how they became engaged in the world of global health volunteering, we need to look more closely at their origins and growth. Most have stories that reveal how their different goals and personal experiences have helped define their programs and their choices about where to send volunteers.

“Pap Smears for Jesus”? Religious Volunteer Organizations

I am attending a 2013 conference on Christian medical missions with more than five hundred other people. We meet in a large nondenominational church in the Midwest for a weekend of workshops, plenary sessions, and exhibits by many Christian organizations that are there to recruit volunteers or publicize their activities in sending supplies to poor countries. Some sessions are straight medical information—how to deliver emergency care in resource-poor settings, for example. Others focus on how to use medical care to serve an evangelical purpose.

The attendees gather for the opening session in the huge sanctuary. The first speaker is a convert to Christianity who tells us, “God is going to use you to serve someone, and that will raise up attention for a bigger conversation. Meet the need, but something bigger is going on. Meeting people’s needs leads them to ask you why you’re there.”

Another speaker is a physician who asks us not to tell others her name or the place where she has been working, since missionary work is forbidden there. She tells us that God has given her the opportunity to use her gifts of medicine to work with people who have little access to medical care or to the Gospel.

Another medical missionary reports that she prays with 80 percent of patients, and they see that it works. She claims that her prayers healed a schizophrenic. Her advice to the audience: “Take the opportunity to tell people about Christ. Don’t come home bragging about seeing five hundred patients if you didn’t use the opportunity to talk about the Gospel. Be a servant. It’s all about Jesus first, medicine second. Don’t be a jerk. You’re there to serve people. That is what Jesus did.”

I begin with faith-based organizations because the origins of volunteering can be traced primarily to religion and because they comprise by far, the largest component of current short-term volunteering. Just over half of those who responded to my survey identified their organizations as “faith-based.” As Dr. Mark Rosenberg, CEO of the Task Force for Global Health, told me, “The early history of global health was very much dominated by missionaries and mission groups trying to do good.”

To this day, the largest numbers of American volunteers, whether they serve domestically or internationally, are connected to religious organizations.5 The Princeton sociologist Robert Wuthnow estimates that 1.6 million church members travel on short-term international mission trips each year.6 The anthropologists Robert Priest and Brian Howell estimate that “upwards of two million” North Americans per year go on short-term missions. These estimates are not all for health-related mission trips.7

And not all of them adopt the type of evangelism advocated by many speakers at the conference I attended. In fact, many deeply devout volunteers object to including any preaching in the services they provide. For example, one physician who regularly travels with a religious organization expressed strong disapproval of the purveyors of what she calls “Pap smears for Jesus.” As we will see in this chapter, faith-based organizations that sponsor international trips in which volunteers offer health-related services (often referred to as “medical missions”) adopt three quite different approaches to the role of faith in their activities.

The scope of faith-based volunteering is vast; from international missionary branches of major Christian denominations, many founded more than a century ago, to small groups organized by one or two leaders for specific projects, faith-based overseas volunteering groups cover the widest variety of programs.

Just about every major Christian denomination has a missionary branch operating in many parts of the world, with medical care often a central part of the work. The United Methodist Church’s Volunteers in Mission project supports a “global health initiative.” The Catholic Medical Mission Board’s Medical Volunteer Program operates in many countries to provide clinical care and public health interventions. The Presbyterian Church (USA) has a mission branch with a program in International Health and Development. These are but a few examples. The list of churches and church-sponsored hospitals with international medical missions is long and includes Seventh-Day Adventists, Church of the Nazarene, the Episcopal Church, Mormons, and various Catholic orders such as the Salesians and Maryknoll. Hospitals and health systems founded by Catholic and other religious organizations sponsor many short-term medical missions overseas, as do a very large number of independent faith-based NGOs.

Then there are the thousands of volunteers from individual parishes doing work that is not coordinated through any denominational body or larger faith-based volunteering organization. Typically, these trips involve either onetime or occasional missions with local church members and are not usually advertised or affiliated with any national efforts. Most often the trips are carried out in partnership with specific churches in the host country and have a focus on Bible study and assisting the congregation with projects such as construction or repairs on the church building. But some also include bringing medical supplies and setting up onetime health clinics.

Consider just a few recent examples from my own community, the Lehigh Valley metropolitan area in eastern Pennsylvania. One Moravian congregation has made occasional visits to church partners in Tanzania and Nepal; another has sent groups to Haiti. A Methodist church sent a volunteer group to South Africa, while a different Methodist church has sent groups to Jamaica and Kenya. An individual member of a nondenominational Christian church arranged a trip on her own for other church members, working out the details with a Haitian pastor in nearby Philadelphia who has a church in Haiti.

Programs like these, publicized and organized locally, are nearly impossible to study in detail. The numbers are so vast that it is not possible to know their full scope. They have no NGO designation and very little Web presence. The sum total and impact of thousands of such volunteer efforts have yet to be measured, but they are certainly a very important part of the international volunteer phenomenon and deserve attention. They also raise concerns about impact, especially as many of the missions do not return to the same locations and may leave behind medications in communities and never follow up.

Robert Wuthnow writes about the constantly increasing global outreach on the part of American churches. He mentions many of the same factors influencing this growth that are outlined in the introduction for international volunteering activities more generally. Additionally, as congregations become more prosperous, more likely to include immigrants, and more exposed to the global economy and world travel, they increasingly devote resources to international mission activities. This is particularly true of the wealthy “megachurches,” which engage heavily in evangelical activities.8

While almost all faith-based volunteering is located in Christian organizations, there are a few Jewish and Muslim groups. American Jewish World Service (AJWS) places volunteers with NGOs in developing countries on both short- and longer-term projects and provides financial support for many grassroots organizations. In accord with Jewish tradition, its volunteers do not promote their own religious views; their efforts center on the pursuit of global justice, and they integrate volunteer activities with a study of Jewish values to make volunteers more aware of their role as advocates for justice. Hillel: The Foundation for Jewish Campus Life partners with organizations such as the American Jewish Joint Distribution Committee and Repair the World to sponsor short-term trips with similar goals.9 The Islamic Medical Association of North America (IMANA) also sends medical and nonmedical volunteers to a variety of countries to provide medical relief in times of disaster, and it offers training and other forms of development assistance in more than thirty countries worldwide.10

Not all faith-based organizations that sponsor short-term volunteer trips incorporate religious practice in their programs. There is, indeed, considerable variety in how religious faith informs the work of these organizations and of individual volunteers. I encountered three quite different approaches.

One is that religious faith or affiliation with a church community may motivate individuals to create or participate in overseas health programs, but these programs do not include any specific religious activity. Some call this “evangelism through action.”11 For example, Centura Health, a system representing both Catholic and Adventist hospitals, sends medical volunteers to many countries to support religious hospitals. Although this hospital system describes its mission as “extend[ing] the healing ministry of Christ,”12 Greg Hodgson, Centura’s global health director, explains that the organization’s short-term missions are not intended to carry out any religious agenda. “As a faith-based organization here in Colorado,” he says, “often when we have meetings, they’ll start with a reflection. It’s not necessarily worship or something like that, but it’s just some thoughts to hopefully encourage people to think a little bit beyond just the immediate. We do those reflections also when we have these groups out [in other countries], just within our own group, but other than that, we don’t get involved in any type of evangelistic or religious activities outside, so it’s purely health care.”

The second approach has organizations offering religious teaching and prayer when requested by local hosts or after their medical work is completed for the day; they are not purposely or directly integrated into the group’s health-related activities. For example, the founder and codirector of a faith-based organization that sponsors health programs in two Caribbean nations told me, “We see our job as just to fulfill the Great Commission, which is to care for the poor and the lost. In the process of that, people ask about faith or to be prayed for, but we don’t do evangelism. . . . The distinction we made was, if we’re going out to a village to do a mobile clinic, I’m not going to make somebody sit there and listen to a sermon before they get seen.”

She recounted an experience that led to the group’s decision to keep any religious discussion separate from the medical work: “One day after I had been [in Haiti] three years, the Voudou priest came to my clinic. He had never come before. I had a dentist in and the priest had a bad tooth, and I said to him, ‘This is the first time you ever came to the clinic. How come you never came to clinic?’ He said, ‘I came one time and they made me feel so bad out front with the sermon.’ And I stopped it after that. He’s a valuable person, too, right? I don’t want to alienate him. If my job is to show the love of God to someone and I alienate them, how am I going to show them the love of God?”

Evangelical practices and preaching are integral or primary in the third approach. “As a Christian organization,” one responding organization wrote, “sharing our purpose and message of salvation in Jesus is our major goal. However, we do desire to improve the health of the people in any area we serve. This is the right thing to do. We have helped pilot world-class health programs in some areas.”

Even when proselytizing is not directly incorporated into the work, though, the religious basis for that work is often made quite obvious to patients. “None of us would be here without the conviction that Jesus calls us to love our neighbor and that our relationship with Jesus is primary in our life and ministry,” reads an e-mail sent by a physician who served in a mission hospital in Nepal. “The motto of the hospital is ‘We serve, Jesus heals,’ and we have seen wonderful examples of that. There is no proselytizing, but patients are given the opportunity to be prayed for and/or attend chapel services. I believe strongly that a good part of the problems of the ...

Table of contents

• Acknowledgments
• Introduction
• Part I. The Sponsoring Organizations
• Part II. The Volunteers
• Part III. The Host Communities
• Part IV. Principles for Maximizing the Benefits of Volunteer Health Trips
• Conclusion
• Appendix A
• Appendix B
• Notes
• References
• Index