HOPING TO HELP
The Promises and Pitfalls of Global Health Volunteering
Judith N. Lasker
ILR Press
272 pages; Rs 1,625
Some do it to get into heaven, and some do it to get into medical school. Some do it because everyone else is doing it. Whatever the motivation, the number of health care volunteers heading from developed to developing countries has soared in recent years, with commentators straggling behind debating the merits of the stampede.
The reasons to applaud are self-evident: All the old epidemics are compounded by all the new ones, and the health-related fallout of wars and natural disasters never ends. If both skilled and unskilled labour can help, then surely those who provide such labour should do good, feel good and learn much.
Not necessarily, critics say. Some would concur instead with an opinion published by a Somali blogger in The Guardian in 2013 and quoted by the sociologist Judith Lasker in Hoping to Help: The Promises and Pitfalls of Global Health Volunteering - "The developing world has become a playground for the redemption of privileged souls looking to atone for global injustices by escaping the vacuity of modernity and globalization."
And indeed, as Ms Lasker watched groups of American and Canadian volunteers in matching T-shirts surging through the Port-au-Prince airport two years after Haiti's disastrous 2010 earthquake, she was reminded of nothing so much as "the weekly Saturday turnover at American time-share vacation resorts."
Many scholars have discussed the theory behind global aid and the various perils in its execution. Ms Lasker, a professor at Lehigh University, delivers instead a straightforward, data-driven review of a small health-related fraction of the enterprise, aiming to answer a few basic questions: "Do volunteers help or hurt?" she asks. "In what ways?"
It turns out these questions cannot be answered, at least not very precisely. Still, anyone contemplating a volunteer stint is likely to be interested in Ms Lasker's results, which amount to a sort of de facto best-practices manual.
Tens of thousands of religious and secular institutions now send hundreds of thousands of health volunteers from the United States out into the world, generating close to an estimated $1 billion worth of unpaid labour. Volunteers include experienced medical professionals and individuals who can provide only elbow grease; between these extremes of competence are the hordes of students in the health professions, among whom global volunteering has become immensely popular.
Ms Lasker presents data from a few hundred programmes. Most of the programmes she considers sponsor volunteer assignments that are quite short, lasting weeks rather than months, despite almost universal agreement among hosting communities that longer stays are much more helpful.
The hosts generally have expectations that are simple enough: Volunteers should do as they are asked, know enough about their destination not to violate local norms, and understand that dirt, dust and discomfort are part of the experience.
But even well-behaved and unremarkably clad volunteers may cause eddies of unintended disturbance.
Even well-organised programmes may undermine hosting communities in unanticipated ways: For instance, a good volunteer-based clinic may sap confidence in local medical care and, providing free services, threaten to put local physicians out of business.
With all this, do objective evaluations find that volunteer activities actually help? "I did not expect how often the evaluation question seems to take people by surprise," Ms Lasker writes.
While the impact of surgical programmes can be obvious and dramatic, efforts at screening for disease and prevention are often far less so. A representative of one programme told Ms Lasker that they "just know" their work makes a difference, while a sizable minority of programmes attempt no formal analysis of their achievements.
But informal evaluations are inevitably suspect. Host communities may feel it is only polite to laud the results of such well-meaning labour, Ms Lasker writes, and sometimes the cited benefits are quite ephemeral: less suspicion of doctors in a community, for instance.
The benefits to volunteers themselves are equally difficult to pin down. Do they really learn the true meaning of charity? Are they really transformed into more educated global citizens? A few studies on the long-term effects of short-term good works are ongoing. In the meantime, "there is little evidence that short-term volunteer trips produce the kinds of transformational changes that are often promised," Ms Lasker finds.
She winds up cautiously endorsing short-term volunteer work, provided the volunteer chooses carefully among programmes and behaves responsibly while at work. Still, she suggests that returning volunteers be "humble" when it comes to claiming they have made a difference, either for others or for themselves.
© 2016 The New York Times News Service
