Ethical Considerations of Global Health Volunteering

by Kayla Peters and Jenna Scott

How the Naturopathic medical principals can help the efficacy and sustainability of Global Health Volunteering.

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Global health volunteering has great potential to be a comprehensively beneficial situation. A community receives health services which they often desperately need, while in return the volunteers receive an opportunity for professional development and education.

It is easy to assume of that intrinsically noble and altruistic actions do not need to be analyzed ethically. However, even the most well intended action can have a negative impact. Some of the risks that global volunteering presents include:

  • creating a dependency on foreign volunteers
  • creating a negative impact on the local economies and their stability
  • retracting work from locally trained health care providers
  • lack of continuous care for patients

While there is a body of research outlining the ethical implications of global health volunteering, it is beneficial for Naturopathic doctors to consider them through the perspective of the principles. The principles of Naturopathic medicine is what differentiates Naturopathic physicians in the medical realm, and should be considered in all aspects of practice, at home and globally.

First, Do No Harm (Primum non nocere)

Above all else, the job of a Naturopathic doctor is to do no harm. Harm refers to physical harm, as well as mental or socio-economical.

In general, the volunteers aim to help in these ways. Issues arise when volunteers take jobs from local residents and as a consequence create a dependency on foreign volunteers. The local economy could shift to attracting volunteers and making their stay enjoyable instead of directing those resources towards sustainable development of the community.

Some volunteer organizations invest heavily into creating a pleasurable stay for volunteers such as through expensive residences for volunteers which may reduce the benefit to the patients and create a disillusioned experience for the volunteer. In resource scarce areas, volunteers could also place an additional strain on the community’s economy.

Furthermore, students and doctors may be presented with opportunities to perform medical procedures which may be not be within their scope in their home country. This increases risk of physical harm to the patients. We recommend that Naturopathic doctors and students anticipate this as a possibility and be aware of their professional capabilities and limits.

Identify and Treat the Causes (Tolle causam)

Uncovering the root cause of disease could potentially be a challenge due to a language and cultural barrier, leading to a decreased ability of the Naturopathic doctor to communicate, empathize and diagnose.

Identifying the cause often takes several visits and implementing more than one treatment strategy; this may not be possible if the Naturopathic doctor is only on a short term placement. This could be further complicated due to a likely lack of access to patient files and potentially no follow-up with the patient.

If sanitation, nutrition or clean water is identified to be the root cause, the Naturopathic doctor is unlikely to be able to correct this issue particularly if their placement is short.

Logistical obstacles, such as availability of medical supplies, limits treatment options and increase difficulty in treating the cause of disease. Many of these obstacles may be overcome by having a consistent presence of Naturopathic care in the area, even if the physicians themselves vary.

The Healing Power of Nature (Vis medicatrix naturae)

Naturopathic medicine believes that every individual possess a vital force, the ‘vis’, that has a natural capacity to heal the body. It is the role of a Naturopathic doctor to remove barriers to healing and help stimulate the body’s natural ability to heal.

This belief that healing is more than physical may allow Naturopathic doctors to better relate to cultural and religious views. A second part to this principle is that nature provides what an individual needs to heal.

Naturopathic doctors could recommend such simple treatments as hydrotherapy, light exercise, sunbathing or fresh air which are inexpensive and often easy to perform when resources are scarce. Another example of this is the use of botanical remedies. Many cultures have diverse traditional medicinal practices for many health issues. Furthermore, the patients may even prefer to use their traditional remedies over the allopathic alternatives.

As naturopathic doctors are trained to prescribe botanical remedies they see the intrinsic value of natural remedies which may allow for improved cooperation with local traditional medical practitioners as well as an appreciation and respect for cultural practices. This can contribute to patient empowerment, which can work to stimulate the vis to further promote healing. However, when the barriers to health are socioeconomic or environmental in nature, it may be difficult for the doctor to remove.

Doctor as Teacher (Docere)

Providing education benefits the patient after the Naturopathic doctor has left, creating the potential for a lasting and sustainable difference in the individual’s life. Teaching someone something as simple as to boil water before consuming it could save a life.

The World Health Organization states that key preventive services to provide in developing countries are prenatal care and family planning, which Naturopathic doctors are well equipped to do. Another great option is to train locals so that they may provide care to others in their community.

However, providing education is met with challenges. Language differences is a significant barrier as accurate translation of medical information is critical. A sensitivity to cultural differences is key, as this could come into conflict.

Treat the Whole Person (Tolle Totum)

The principle of ‘treat the whole person’ demonstrates the value Naturopathic medicine puts on encompassing physical, mental, emotional and spiritual health in the treatment of an individual. Because this is so integral to the understanding of health, Naturopathic doctors are well-suited to treat with respect to cultural and family healing practices.

Furthermore, Naturopathic doctors are often trained in counseling, so they may be better at identifying and cultivating the emotional, mental and spiritual health of patients to help them achieve optimal health. This is as important in developing countries as it is in North America.

However, the cultural and language barriers previously discussed may prove difficult to achieve this principle optimally. Furthermore, this principle is best achieved over time and with the development of a relationship with a patient, which is prevented by the short work term.

Prevention (Praevenire)

An important aspect of prevention is educating the patient on sanitation practices and nutritional guidance. Any such information given to the patients must be possible when taking into account their current resources. Prenatal care is another area preventative care of utmost importance.

Improved prenatal care and nutrition decrease congenital abnormalities, leading to improved community health over time. Generally, vaccines are considered an essential part of preventative health care in developing countries. Vaccine administration is only included in the Naturopathic medical scope in select regions in North America, so it is unclear if these could be legally administered by a Naturopathic doctor in foreign countries.

Summary:

It is evident that medical volunteering has the potential to improve the quality of life of many populations; nevertheless good intentions can produce harmful results if the autonomy and sustainability of the local populations are not respected. The principles of the Naturopathic oath guide the practice of Naturopathic doctors in the Western world, and should be further applied to practice in global health.

Considerations:

  • Ethical, cultural and language training gives the volunteers a better ability to adapt to situations on the ground and to better serve the local communities through improved communication. Having an understanding of cultural practices can show respect and allow for better communication. This training may also help volunteers to not see themselves as ‘saviours,’ but as equals.
  • Naturopathic doctors may benefit from knowledge of the local usage of medicinal plants.
  • Health care providers should be aware of their legal limits of practice.
  • Community sustainability is vital. Organizations should venture to work with and support local health care providers where possible.
  • Training locals to provide health care such as aiding with childbirth or providing them with information can make a lasting difference in these communities.
  • Look for sustainable projects that provide a continuum of care for patients.
  • Resource allocation should primarily support the local community; not to volunteer recruitment and support.

 

References:

  1. Decamp, M. (2011). Ethical Review of Global Short-Term Medical Volunteerism. HEC Forum, 23, 91-103.
  2. De Wet, H. & Ngubane, S.C. (2014). Traditional herbal remedies used by women in a rural community in northern Maputaland (South Africa) for the treatment of gynaecology and obstetric complaints. South African Journal of Botany, 94, 129-139.
  3. Loiseau, B., Sibbald, R., Raman, S.A., Benedict, D., Dimaras, H., & Loh, L. C. (2015). ‘Don’t make my people beggars’: a developing world house of cards. Community Development Journal, doi: 10.1093/cdj/bsv047
  4. McCall, D., & Iltis, A. (2014). Health Care Voluntourism: Addressing Ethical Concerns of Undergraduate Student Participation in Global Health Volunteer Work. HEC Forum, 26(4), 285-297.
  5. McLennan, S. (2014). Medical voluntourism in Honduas: ‘Helping’ the poor? Progress in Development Studies, 14(2), 163-179.
  6. World Health Organization. (2002). Emergency Medical care in developing countries: it it worthwhile? (Policy and Practice). Bulletin of the World Health Organization, 80(11), 900.
About the Author
Kayla Peters and Jenna Scott

Kayla and Jenna are just beginning their journey into naturopathic medicine as first year students at Boucher Institute of Naturopathic Medicine. Kayla completed her Bachelor of Science in Human Kinetics at the University of Guelph, and Jenna completed her Bachelor of Health Sciences in Biomedical Studies at the University of Northern British Columbia. When not tackling class, Kayla is an avid hiker and tea connoisseur, while Jenna enjoys playing soccer and creating a mess in the kitchen.