The Growth of Global Health Service-Learning Programs: How to Build Responsible Relationships with Host Communities
By Becky Davis, 7/12/07

Health Science Institutions across the United States and Canada have seen a rapid growth in student-led demand for global health electives within the past few years. Global health is a rapidly emerging medical course, with studies showing that the number of medical students who enrolled on overseas rotations increased six fold between 1993 and 2005 (source: American Medical Students Association). As Maria Nardell stated in her recent article “Dr. Paul Farmer and Philanthropy for Global Health”, the popularity of visionaries such as Farmer, and the work of philanthropists such as Bill Gates, have helped raise students’ awareness of global health issues, and inspired a movement within the next generation of doctors, nurses, and allied health professionals to work internationally.

In order to meet the increasing demand for global electives, many universities and colleges across the U.S and Canada have designed service-learning programs which offer students the opportunity to gain clinical and non-clinical healthcare experience in a community setting, often within a country located in the global South. In many cases, students will gain academic credit for completing the program. Accommodation is oftentimes with local host families, adding to the students’ experience, and the overall amount of cultural competency they gain from the program. A growing number of independent (non-academic) organizations also offer global health service-learning programs, frequently in addition to other non-health related international “volunteer” experiences.

Local healthcare professionals who host the students in the clinics and hospitals where they rotate often give up a large chunk of their (already highly demanded) time. By doing so, these local professionals may gain greater career status by linking to foreign academic institutions, as well as personal satisfaction from educating students who are inspired and committed to learning about local healthcare practices.

The growth in demand for global health service-learning programs by students and institutions is overall an extremely positive thing. It is essential that students become global citizens and are aware of and understand the need to think laterally and inclusively. Yet, there is one crucial question that students should ask when choosing which program to participate in:  What benefits are gained by the local community?

Designing a program that has sustainable benefits for a local community may not always be a priority for institutions who must meet scheduling and other requirements.  Students who participate in global health service-learning programs may gain more from the experience than those who host them, or the patients they encounter within the clinics and hospitals they visit during their program. Not only are there strong ethical considerations that underlie any student/patient interaction, but also practical issues to address, such as the heavy time demands placed on the local healthcare professionals who host and teach international students.

Members of the local population who see hundreds of students helicopter in and out of their community, without gaining any tangible benefits for local health care facilities or otherwise, should quite rightly feel that programs created without any consideration towards the local community’s needs—and more as a way for students from wealthier countries in the global North to gain another notch on their resume—talk the talk without walking the walk.

Ensuring that the newly-created programs are implemented in a responsible manner is possible. Transparency and inclusion of local partners in the planning and implementation stages of programs is a priority. Face-to-face meetings with all stakeholders, especially local community members and partners who will be hosting students, are critical.

The importance of giving back to the local communities is something that should be recognized by any institution or independent organization which is implementing service-learning programs. Organizations such as Child Family Health International—which funds community-initiated and locally devised health initiatives, professional development opportunities for its local partners, and regularly sends donated medical supplies to clinics and hospitals in the communities which host their students— have found that valuing and supporting their partners’ work in tangible ways is not only the right thing to do, but is crucial to sustaining long, fruitful relationships.  Adopting these kinds of best practices helps to ensure that an increasing number of health science students can benefit from participating in a global health service-learning program, while minimizing or off-setting the potential burden to the communities that host them.

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