First, Do No Harm: ‘Voluntourism’ And The Harm Of Medical Electives


It’s one thing to volunteer overseas to help the sick and poor. It’s another thing altogether to do it for the tourism and adventure. Sarah Forsyth explains.

Helping the local sick and injured by day, relaxing in a tropical villa by night – an idealistic image of what an international medical elective might look like for some. Unbeknown to many of the bright eyed, eager medical students, wanting to help those in need while building their clinical skills, lies the potential for overwhelming harm associated with these short-term placements.

Non-maleficence (do no harm), one of the four pillars of medical ethics from the Geneva Declaration (a revision of the Hippocratic Oath) is key to medical practise to ensure patients are not harmed when seeking medical treatment. However, in the unfamiliar environment of an international medical elective, where confidence is placed in a foreign medical student, this value can sometimes be unintentionally lost.

It is because of this, a discussion among medical students regarding the distinction between volunteering and voluntourism must be had.



Voluntourism focuses on the experience of the visitor (the voluntourist), giving individuals an experience of a holiday while helping a community in need. Projects Abroad, one of the largest volunteer organisations who assist people to find volunteer placements around the world, describes voluntourism as “doing meaningful volunteer work while also participating in tourism”. This has ultimately become the commercialisation of volunteering in the developing world.

However, often there is no requirement for an individual to have any specific training, if at all, and participants can elect to do a medical placement with little or no medical knowledge or experience.

In the case of medical students, trust can be placed upon them to perform procedures they have little to no knowledge about. The concept of ‘see one, do one, teach one’ when it comes to medical procedures can be an effective way to master things such as taking blood, but in an under-resourced, under-staffed setting with improper supervision for more complicated procedures, there is potential for putting both the ‘voluntourist’ and the locals at risk of negative long term health outcomes. The short time frames in many of these placements disallows for continuity of care, and often mistakes and complications are left in the hands of local health practitioners whose workload is already stretched.

There appears to be a misconception that any care in these developing countries is better than no care, which may contribute to the acceptance of lower standards in underprivileged settings. For-profit organisations, such as Projects Abroad, have an economic driven agenda, forcing the idea that these developing countries need constant help from western volunteers. Attitudes such as this are not conducive for assisting these countries to create their own sustainable health care systems, thereby removing the need for foreign aid.



In contrast, volunteering focuses on the community to create sustainable and improved long-term health care, with longer placements, often for months at a time. This may include training local doctors and health professionals, therefore is best suited to those with experience and qualifications.

An example of good volunteering can be seen through Sight For All, a not-for-profit organisation that aims to provide medical care to the blind in Indigenous Australian communities and the developing world. This organisation works with the local people and local health professionals to provide training, resources, infrastructure and eye health awareness to create a “sustainable sight-saving model”. This kind of model is paramount for improving Indigenous community health; working with communities to develop sustainable improvements in health, as opposed to thrusting medications and treatment upon Indigenous populations.

Specialists Without Borders (SWB) is another example of effective volunteering, a not-for-profit organisation that contributes towards building a sustainable health system in disadvantaged countries such as Malawi and Zimbabwe primarily through education and training of local medical students, nurses, interns and registrars.

Dr Peter Tamblyn, a retired orthopaedic surgeon who has volunteered on several expeditions with SWB, says volunteers should take time to understand the needs of the local health practitioners in order to tailor training to what is likely to be encountered in these countries, instead of focusing on the needs of the volunteer.

Dr Tamblyn noticed a flow on effect of education with medical students passing on knowledge learnt from previous volunteer visits, creating a sustainable medical education model that can then be reflected in the health care system.

However, volunteering may not be as appropriate for medical students, due to limited medical experience and time constraints associated with a medical elective. In an ideal situation, a balance between volunteering and voluntourism would have best outcomes for both local communities and medical students.


Other ways to help

There are other, seemingly more mundane but arguably more useful ways to volunteer your time. An example of this is becoming an editor for a Wikipedia page in which you have a particular interest in or knowledge of. Wikipedia is one of the most used and readily available medical resources in developing countries with limited internet access, but relies on accurate and up to date information. Spending 10 minutes editing can be far more useful than donating $10.


Finally, do no harm

Medial electives can offer a smorgasbord of experiences, from working in challenging foreign settings, to travelling and enjoying the local culture. However, a level of awareness is required to ensure the focus is on the health of the local community and to avoid leaving a place with more harm than when you arrived.

Sarah is a third year medical student at the Australian National University and has a Bachelor of Medical Science from the University of South Australia. Sarah has a keen interest in global health and the health of Indigenous Australians. She is also passionate about rural health in Australia and is currently undertaking a medical placement in rural NSW.