Developing cultural understanding
When traveling abroad for global health placements, interns will often face cultural and societal norms that are sometimes drastically different from their own. This can sometimes pose unexpected challenges and give rise to an array of different emotions. Familiarising yourself with the culture of your host country prior to departure through e.g. online research can help you prepare for some of these challenges and make the most of your placement.
In order to successfully acquire new skills to flexibly navigate challenging situations when norms differ it is useful to first consider and develop an awareness of one’s own culture and norms. Having this awareness can help facilitate a flexible and open dialogue with local placement advisors, colleagues and supervisors. It is not possible to anticipate all differences or difficult situations that may arise, but asking for advice from local colleagues and advisors is one of the most effective and respectful ways of managing potential challenging situations.
Health and safety risks naturally differ around the world due to differences in hygiene and social conditions, resources available and disease prevalence, just to mention a few. This is perhaps even more important to consider in the context of clinical work. Doing a healthcare elective abroad is likely to expose you to a different set of health and safety risks than those you are used to considering at home. Being aware that unexpected incidents may occur is important, although it is difficult to provide a fully encompassing framework to cover all possible risks, as the appropriate actions are likely to depend on circumstances and resources available. Minimising personal safety risks is a joint responsibility of the intern, sending and host institutions. The best way to prepare as much as possible for any potential personal risks is to thoroughly familiarise yourself with the environment and conditions you will be living and working in before departure; make sure that you have the necessary vaccinations and medications (such as e.g. antimalarial medications); and ensure that you have a suitable healthcare insurance in place which covers the specific purpose of your travel and stay.
Level of training
During healthcare electives abroad it is not uncommon that situations arise where interns may be asked (or offer to) execute tasks that are beyond their capacity and level of training. This poses several ethical dilemmas, and most importantly it can put patients, the intern or others at risk. While each situation is unique and should be dealt with accordingly, it is our experience that it is in everyone’s best interest that the following overarching principles are followed:
- Prior preparation and continuous close cooperation between the intern, sending and host institution are essential for ensuring transparency of limitations and expectations from the beginning. Misrepresenting one’s capabilities and level of training should always be avoided. This will help avoid potential misunderstandings and fosters a mutually beneficial cooperation.
- Unexpected or unclear situations may of course arise where interns are in doubt. In such circumstances students should not be shy to ask for advice from supervisors or advisors, both locally as well as from the sending institution if the situation allows.
Sustainable and appropriate benefits
Often students’ motivation to undertake healthcare electives abroad derives from a combination of the wish to gain valuable work experience/training as well as hoping to benefit the local communities through the work that they do. When considering benefits to local communities through short-term work it is useful to think about what these benefits are, who receives them and what makes these benefits appropriate. Some helpful questions to ask yourself are:
- What should be considered as benefits to the local community and why?
- Who concluded that these benefits were needed; are they needed and wanted by the local community?
- Are the benefits adapted to the local community?
- How are the benefits allocated?
- Are the benefits sustainable?
- What could be done to promote sustainability?
Usually sustainability in this context involves supporting the local community to strengthen their ability to independently meet their own needs.
It often happens when students go abroad for their electives, especially if in lower resourced areas, that they observe additional needs in the local community. These needs may sometimes, and often do, fall outside the anticipated purpose of the placement/work.
Such benefits that don’t fit within the intended scope of the elective are often termed “ancillary benefits”. Being asked to, or wishing to, provide ancillary benefits during an elective abroad can raise some ethical issues.
The first step to tackling these ethical issues is to anticipate them – that is, be aware that such situations are likely to occur, often unexpectedly. Additionally, be aware that offering ancillary benefits inappropriately can sometimes do more harm than good. The best approach is to ask local supervisors and colleagues for guidance. Most likely they have observed similar situations in the past and may have ideas for the most appropriate course of action. Importantly, asking for advice from local colleagues is also the most respectful approach.