Responding to critiques: dependence - but how and why?

By Lawrence Loh, MD MPH-

‚ÄčOne of the most traditional concerns described about short-term medical experiences is that providing such aid / charity amounts to a hand-out, and if done constantly, will result in breeding dependence the argument is that over time, if constant short-term experiences visit a community and provide downstream aid there is little incentive for local groups and leadership to actually rectify the underlying issues and root causes and easier for them to just wait for the sporadic aid, even adjusting their local institutions and structures to cater to such aid coming into the community. As a result, short-term experiences are not often seen as a viable option by many members of the global health community. At the least its accorded the label of a stop-gap but as a meaningful contributor, sentiments are more mixed.

As you can imagine, our group completely agrees with the notion of avoiding dependence. This is very much, though, the outcome of the imbalanced power dynamic and the status-quo. If a short-term team decides to go in with a superiority complex, as in were here to help you and youll just take what weve got given while cutting the local leadership and people out of the planning and implementation part of it, it doesnt surprise anyone that what may superficially seem like gratitude and deference ultimately leads to expectation and want. But complaining and identifying this phenomenon only goes so far to fixing it. 

Can short-term experiences actually help and make meaningful contributions? The nuance that our organization identifies is this: in their current form, going in with an us-vs-them mentality, handing out on the volunteers schedule (we have an ear surgeon who happens to be available for 2 weeks so yall get cerumen flushes (wax flushes) this week and cataract surgery in a months time) - this is what breeds dependence and makes short-term trips less than desirable.

But thats about the *form* of the short-term trip, not the *existence* of a short-term trip.

The other half of the nuance that we identify is: if done RIGHT, short-term could be part of a wider, multi-strategy solution to address global health issues. Youll always need the people who are working with the national governments and lobbying to get policy changed. Youll always need keen individuals who can move to places for long-term to keep pieces in place. But the need is real and the local leadership knows better than all of us do about what their immediate and long-term needs and goals are. Short-term trips should not be about What can I do with what I have but What can we do collectively, with the local leadership, to address meaningful impacts in their community.  The issue with dependence only arises *IF* short-term trips continue to be ad-hoc, stand-alone activities not part of a wider global health strategy. It is the form that is the problem, not their existence. Their existence, instead, represents an opportunity, an investment, a certain number of volunteer hours, a certain amount of finances, that are being pumped into efforts. If we can figure out how to use that very investment as part of a coordinated model that knows its limits and pursues alternative work in concert with local leadership, then at the very least, qualitatively, we can see that the issue of dependence on handouts will slowly start to disappear. 

No one is saying short-term is going to save the world on its own. But were saying that short-term doesnt need to be completely useless and a hand-out either. If people are going to go, at least provide them a meaningful way to do so; or alternatives if that meaningful alternative is not what the community is looking for right now. Ignoring the issue because its current form breeds dependence ignores the potential benefit these trips could have if a future form got out of the us-vs-them, welp were here to help you so take it or leave it paradigm that underlies many current efforts today.

In short: we believe we can do better than hand-outs but we can also do better than saying dont go and walking away entirely. And as weve described throughout, saying dont go hasnt worked; people still go, and these investments need to be improved. Awareness, research, and innovation can improve the form of short-term work and maximize these valuable investments, and this will shift the balance of the benefits: retain those benefits gained by volunteers and the institutions (nothing is ever real unless its experienced - Keats) while allowing local communities to derive meaningful benefit from short-term experiences as one piece of the multifaceted global health intervention puzzle.


Lawrence Loh, MD MPH is Director of Operations at The 53rd Week.

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