Yesterday some visiting doctors came to the hospital as part of a wilderness medicine tour of uganda. I had the pleasure of hosting a couple of cardiologists on our ward and answering their questions about life as a doctor here. Later that evening they invited me up to their lodge to meet the rest of the group and asked me to give a brief impromptu talk about my thoughts on medical volunteering. I was a bit unprepared to say the least, but as usual pressure has distilled my thoughts and I thought I would share them with you here.

1) Enough is never enough Say it. Hold it. Accept it. Own it. You cannot save everyone and you will not succeed in changing everything that frustrates and concerns you. Coming to terms with this early on will save you a world of pain and potential insanity.

2) Sustaining compassion for others requires self compassion When you don’t succeed don’t beat yourself up. People die, projects fail, bad things WILL happen and you cannot be responsible for preventing all of them. Being kind to yourself is a vital component in maintaining your mental and physical health, without which you will not have the energy to continue maintaining the mental and physical health of others. That doesn’t mean you ignore mistakes and mishaps, of course you should examine them and seek learning and growth opportunities. However, don’t waste your energy flagellating yourself, focus on moving forward and learning how these bad situations might be better avoided in the future.

3) Fuel your fire When something terrible happens or you witness something unjust and frustrating… Don’t give up! Don’t roll over and play dead! Don’t turn away because it is all to overwhelming! Take it all in and use it as a force for good, to ignite your passion…as fuel for the fire! Turn it into energy that drives you forward! Remember it not as a tragedy, but as a call to action! Many movements for positive social change in the world are triggered by a moment of realisation, often born out of tragedy, that inspires passion and drive for a better future. Don’t let tragedies be wasted, respect them, honour them and allow them to spark your motivation to prevent further tragedies from occurring.

4) The west most certainly does NOT know best Volunteering in resource poor complex social environments is a humbling experience. It can also be very frustrating. You may often throw your hands up in despair at perceived inefficiencies and seemingly illogical behaviours that, when compared to your own culture, make no sense to you. But understand that every culture and society is different, built on a complex web of historical events, politics, conflict, man made and natural disasters, domineering personalities, religious influences, geographical and environmental effects… The list is endless! You cannot possibly expect to instantly understand all of this intimately and instantly. You cannot possibly expect the cultural and social norms that apply form your own complex cultural background to be perfectly translated to the new world in which you find yourself. Take the time to listen deeply and observe astutely. Be patient and humble… You will likely learn more than you could ever teach and you will likely be personally transformed to a greater degree than any change you might seek to effect.

5) Communication is key Make it your mission in life to learn as much of the local language as you can.  Get lessons form a local and practice at every opportunity even though most of the time you will get it wrong and people will laugh at you or give you strange looks.  Learn colloquialisms and local stock phrases and parables to get insight into the local culture and how people express themselves. this will help you not just in speaking but also in listening and understanding what has been interpreted for you.  However, never underestimate the power of non-verbal communication.  Get on your knees and make eye contact, place a hand appropriately and sensitively on a shoulder or hand, look for the subtle changes in the facial wrinkles and eyes that tell you more than words ever will. Some things are simply universal.  

6) First do no harm Providing clinical care alone may cause more harm than good. It might be jolly interesting for you, but it may not actually best serve the people you are trying to help. This is the real core issue in medical volunteering as I see it. Taking on posts where the main focus is to provide clinical cover in place of locally available health workers is a risky business. It may seem that you are doing good when you are treating the patient in front of you, but consider, if you will, the long term implications… Your presence may remove any impetus for further development of local staff, creating a dependency on volunteers. Those volunteers may not always be there, leaving behind gaping holes that can destabilise already fragile systems. Or let’s say there is a sustainable stream of volunteers, well how will the local system ever strive to develop itself and its own people when it can be so easily propped by volunteers? What if there are perfectly decent local health workers who are not getting employment because all their potential jobs are all filled by well meaning volunteers? It may not only hinder progress, in some situations it can actually lead to regression! This leads me to my final thought…

7) The goal must always be to no longer be needed Any medical volunteering role, perhaps with the exception of acute humanitarian emergencies (although I think ultimately it still applies), should be focused on capacity building local staff and systems… Teaching, training, mentoring, quality improvement, research and development. Working side by side with locals to increase the sustainable capacity of local health workers and systems. That is what it is all about… We should not need to be there at all. We should all be seeking to create a world in which each country can sustain its own health system without depending on the charity of others.