How to Find an Ethical Medical Mission Trip

Probably once a week, an email appears in my inbox from a nurse asking: Can you recommend an ethical medical mission trip organization for me to volunteer with?

I honestly love getting these messages, because it means these nurses care deeply about the impact they’ll have when they volunteer abroad. They’ve read enough to know that some medical mission trips cause real harm, and they want to make sure they’re working responsibly in developing countries.

Unfortunately, there’s no easy response to this question. There are no black and white answers here – and if you need them, global health is not the field for you.

I wish I could copy and paste a list of organizations that are “good” and “bad” so that medical professionals would know who to volunteer with – but it’s not that simple. Just like everything else in global health, it’s complicated. So I usually end up sending a looong reply to this question, and then never hear anything back from the person who asked (probably because I scared them off!).

But I want to address this question here, in all its complexity – for those of you who truly care about doing this work ethically and want help getting there.

(I’m speaking as a nurse, but this applies to all medical professionals – nurses, doctors, anesthesiologists, midwives, nurse practitioners, physicians assistants, etc.)

So which medical mission trip should you volunteer with?

 IT DEPENDS, mainly on these four factors:

1. Your specialty.

Just because you’re a medical professional doesn’t mean you’ll automatically be useful in every developing country or on every medical mission trip. What exactly do you have to offer? The more specialized knowledge and experience you have, the more useful you’re likely to be.

Some organizations want midwives but don’t need nurses; other places are desperately short on skilled surgical staff but can’t utilize anyone without operating room training; still others are seeking dentists, or pediatric specialists, or oncology experts.

For OB nurses like me, I recommend Midwives for Haiti or PRONTO International (I’m sure there are more but I’m limiting recommendations to organizations that I’ve personally worked with). For other specialties, appropriate options would be completely different (see below under Short Term Missions for examples for OR specialists).

 

2. How Much Time You Have. 

Whether you only have a week of vacation time or you’re planning to take six months off to volunteer, the medical missions you’re looking at will be very different. Being clear about your length of stay will immediately narrow down your options. Check out the section below on Short Term vs Long Term Medical Missions for more details on the difference between the two models.

Volunteering with Midwives for Haiti

3. Where You Want to Go.

Some volunteers have their hearts set on Africa; others speak Spanish and would be more comfortable in Latin America; or maybe you traveled extensively in Asia and you feel comfortable there. The more picky you are about your destination, the narrower your choices will be. Most organizations only run medical mission trips in a few countries – in fact, I’d be vary wary of any group that offers to take you anywhere you want to go (like IVHQ and other big volunteer placement companies). There’s simply no way for one organization to create authentic partnerships with local communities in every country on the globe.

If you have a legitimate reason to limit yourself to a certain location (like language skills, past experience, or cultural background) then this can be a good way to narrow down your choices. If not, be open to volunteering wherever your particular medical specialty can be most useful.

 

4. Your Level of Experience.

I’ll be honest: It’s hard to find an ethical option for your first medical mission trip. The most well-respected organizations get a lot of applicants so they can afford to be picky. And that’s a good thing – you don’t want to be on the ground with a bunch of volunteers who have no idea what they’re doing and just end up making a mess. Any organization that doesn’t thoroughly vet its volunteers is one I would not recommend working with. You’ll need to be honest about your experience in order to find the right option for you.

Medical mission organizations want volunteers who have both professional work experience at home in their own specialty, and experience working/volunteering abroad in limited-resource settings. The more experience you have, the more options will be open to you. This may sound harsh, but don’t bother applying to Doctors Without Borders unless you have at least two years of work experience at home and you’ve spent serious time in developing countries.

But of course, everybody has to start somewhere. If you’re still at the beginning stages, check out the How to Get Experience section below.

 

→ There’s one more less obvious – but equally important – factor here. Ask yourself: What do you really want to get out of this?

Be honest.
If you’re looking to get clinical experience you can’t get at home, an impressive line for your resumé, or cool stories and photos that make you look like a hero – I get it, you’ve seen plenty of people doing medical missions for just those reasons. But it’s probably more beneficial to just plan a regular trip to the country you’re considering volunteering in. Stay in a homestay, spend your money at local businesses, and post positive messages about the place on social media. That still has a positive effect on the local community, without exposing it to the damage of an unethical medical mission.

If you’re committed to doing the work and really making long-term change while volunteering abroad, keep reading.

Let’s delve a little deeper into some of the factors that help you find the right medical mission trip…

 

Short Term vs Long Term Medical Missions

There is an incredible variety of medical missions out there, from one-week surgical trips to 12 months managing a team of local nurses – and everything in between. Let’s break down the options so you can figure out what exactly you’re looking for:

Short-term (One week to six months)

This is what most people mean when they talk about medical missions. Most nurses tell me they only have a week or two of vacation time to spare, to which I answer: Unfortunately, in most cases that isn’t enough time for an effective medical mission.

Most medical missions that last only a week or two are doing “mobile clinics”. This means they bring in a team of foreign volunteers and donated medical supplies, set up a makeshift clinic in an empty building, and offer care to anyone in the community who shows up. On the surface, it sounds great – but is it really making a sustainable difference to these under-served communities?

If no one follows up on these patients or makes a plan to transition responsibilities over to skilled local clinicians, then all you’re really doing is creating a dependence on foreign volunteers. You’re throwing a bandaid over a gaping wound. There is almost always some form of medical care available locally – no matter how basic – and if your work isn’t focused on empowering that healthcare system, then you’re doing them a disservice.

That said, there are some organizations offering opportunities for ethical short-term  medical missions. Their volunteers still see patients, but they also acts as teachers and mentors for local staff. Responsible organizations have built relationships with local healthcare providers, asked them what they feel they need, and are doing their best to provide it.

In this vein, I recommend a few organizations that are open to medical professionals in a variety of specialties: Health Volunteers OverseasMedical Teams International, and MedTreks.

In Uganda with Medical Teams International, my role was training and mentoring local staff.

 » A word on surgical missions:

Surgical missions are another option for short-term medical mission trips. If you are a surgeon, anesthesiologist, or operating room nurse, these are for you.

Because they provide care in highly-needed specialties, surgical staff can often find shorter-term options. But, again, it’s best if their projects include a component of training local surgeons. It’s not sustainable to fly in foreign doctors to repair cleft palates and obstetric fistulas forever, when local surgeons could certainly learn to do it and treat far more patients long-term. Make sure any organization you work with has a plan to work themselves out of a job.

Operation Smile is probably the most well-known surgical medical mission option, though I haven’t worked with them personally and can’t speak to the ethics of their program. ReSurge International is another great choice (check out this excellent article about how ReSurge had an epiphany and changed the way they do missions).

 

Long term (6 months to permanent)

Generally speaking, the longer you can stay, the more likely you are to have a positive impact. You’re also more likely to pay a smaller volunteer fee, or maybe even get paid. Some medical professionals even make global health their permanent jobs – I have friends who just go from one six-month stint with Doctors Without Borders to the next.

There are many more ethical and well-respected medical mission organizations open to long-term volunteers than short-term ones. Doctors Without Borders (known in most of the world as Médecins Sans Frontières, or MSF) is the most well-known, so they can afford to take only the best applicants. Other great options are EmergencyInternational Medical CorpsPartners in Health (who I worked with on Ebola response in Sierra Leone), and Doctors of the World.

Most long-term positions with these organizations will be paid and may even offer benefits, but you’re not going to get rich off this.

Training to treat Ebola patients for a disaster response deployment in Sierra Leone

Disaster Response vs Development Missions

If you have a somewhat flexible schedule, disaster response missions are also an option. I think this is an important distinction to discuss, because these types of missions break some rules but they’re still doing important work!

Here’s the difference between the two: Disaster response missions are meant to respond to an emergency, while development projects are aimed at long-term change.

For example, I worked in Sierra Leone during the Ebola outbreak and my role was to provide hands-on care to patients during the acute phase of the epidemic. Once the virus was under control, disaster response teams slowly phased out and handed over operations to different groups focused on long-term development projects (like follow-up care for survivors, preparing hospitals and clinics for the next outbreak, and improving the country’s broken health systems overall).

The ethical rules in a disaster response are a bit more flexible, since your role is to literally and figuratively stop the bleeding. Volunteers do much more direct care than I would normally recommend because it’s not the time to focus on teaching. They also might stay for shorter stints, just until the emergency is under control.

If you’re interested in getting into disaster response, you’ll need significant experience working or volunteering in limited-resource settings (this is definitely not for beginners). You’ll also need to be able to travel on short notice, because there’s no way to predict when a disaster will occur. International Medical Corps often has openings for disaster response, and Medical Teams International and Heart to Heart International maintain a roster of volunteers to call in case of an emergency deployment.

 

How to Get Experience

This is the hard truth of searching for an ethical medical mission trip: Quality organizations want quality volunteers. Most of the organizations I’ve listed here are unlikely to take you on unless you have some experience in limited-resource settings.

So, what exactly does that mean? And how can you get it?

Limited-resource settings don’t necessarily have to be developing countries. When interviewers say, “Tell us about the experience you have working in limited-resource settings,” this is what they really want to know:

Have you worked alongside people from other backgrounds and cultures? Are you flexible in challenging and constantly changing situations? Are you going to freak out when you arrive in Tanzania and there’s a cockroach in your bedroom or the electricity and running water shuts off?

If those questions don’t immediately bring to mind several personal stories to illustrate that you can hang in a new and challenging environment, then you need to get some more experience. 

I’m going to be completely honest here: If you’re serious about gaining experience to get your foot in the door of a serious global health organization, you are probably going to have to go on a medical mission with a less-than perfect group. It’s a nasty catch-22 of this work: You can’t get in with great organizations without experience, but you can’t get experience without volunteering for less-than-great organizations.

THAT SAID: This does not give you free rein to break your own ethical rules or to volunteer repeatedly with irresponsible organizations. I am not encouraging you to just pick any medical mission, hop on a plane, and start treating patients in developing countries. Do your research and choose the most responsibly-run organization you can sign on with, and then stick to your own ethical boundaries when you’re on the ground (See the “It’s Up to You” section below for more on this).

If that option makes you feel uncomfortable (it sure did for me!), here are some other ideas for gaining experience if you’re having trouble getting accepted by the organization you really want to work with:

I took a tropical nursing course to gain experience for global health work.

• Go on a learning missionYou can get experience in medicine in developing countries without necessarily providing care while you’re there. Go in a learning capacity instead. This is what I encourage medical and nursing students who are interested in global health to do. If your school (like many) runs an optional summer medical mission, go along as a student, not a medical care provider. Don’t provide care outside of what you’re allowed to do at home – this isn’t a chance to gain experience on poor people without informed consent. Just shadow local clinicians, ask lots of questions, and help out in simple ways if they ask you to.

• Volunteer locally. You don’t have to fly halfway around the world or spend a ton of money to get some valuable experience. Chances are there are under-served communities near you. I live in Seattle, where every year volunteers staff the Seattle King County Clinic, which offers free medical care to anyone who needs it for four days. Remote Area Medical runs similar programs in different locations all over the United States.

You can also get in contact with your local public health department and see if they have volunteer opportunities. I’m a member of the King County Public Health Reserve Corps, which provides medical support during public health emergencies – but we also do regular volunteering at women’s shelters and among the homeless population. Do a google search for medical volunteer opportunities in your area and see what’s around!

• Travel. That’s right, just regular travel – no medicine involved. Plan a trip to the area of the world you’re considering volunteering in. Book a homestay instead of a hotel (you can find some here). Get to know your host family, travel with local guides, eat at locally-owned restaurants. The longer you can stay, the better. That way when organizations ask about your experience in limited-resource settings, you can tell them about living with your host family in Kenya or how you learned Spanish in Guatemala.

• Get a job in an under-served community. If you’re serious about doing global health work, make sure your day job at home is preparing you for it. Seek out a job in a hospital that serves immigrant populations or in a remote area where you’ll have a lot of autonomy. (Friends of mine have worked in remote health centers in Northern Canada and the Australian outback, and taken travel nurse positions on Native American Reservations).

• Take classes. Having certain education on your application can make organizations less concerned that you don’t have a ton of experience in limited-resource settings. A tropical medicine course (like this one at the Liverpool School of Tropical Medicine, which I took and LOVED) is a major plus. It’s also helpful to take Hostile Environment Awareness Training (Medical Teams International runs a multi-day HEAT course for volunteers applying to their disaster response roster, and the Humanitarian Response Intensive Course at Harvard is very well-respected).

• Learn a langauge. Certain language skills can also make you a very attractive candidate (Spanish for Latin America obviously, and French will make you an asset for many organizations working in Africa). If Doctors Without Borders is your ultimate goal, you will likely need to be proficient in French.

How to Research Medical Mission Trips

If you’ve made it this far, you know that choosing a medical mission trip is a highly personal endeavor. You’re going to have to devote some serious time to researching what’s right for you.

So now that you know what parameters you’re looking for, where the heck do you even start?

First: Set aside some time, grab your laptop and a snack, and get comfortable.

Next: Start searching! You can just search for “medical mission trips” but you’ll get an absolute flood of options – and the ones that make it to the top of Google are not necessarily the best. Here are a few resources that would be better places to start your search*:

  • ReliefWeb – current job and volunteer postings for humanitarian orgs all over the world. Filter the “theme” of your search into health to see medical openings.

  • One Nurse At A Time – Has a directory of organizations seeking volunteer nurses. Filter your search by specialty, location, and length of service.

  • Idealist – a directory aimed at connecting people who want to do good with organizations to volunteer with.

  • Humanitarian’s Care Network Facebook group – Members often post volunteer openings and share opportunities with each other.

*Not all organizations on these lists have been vetted. You still need to research each one thoroughly!

Use the four factors I outlined at the top of this post to narrow down your search (specialty, time, location, experience). Open up a ridiculous number of tabs and just start digging. Read each organization’s “About Us” page and their mission statement; scroll through their staff to see if they hire locals in leadership positions; look through their volunteer materials for ethical guidelines and application requirements. Learn everything you can to see if they’re a good match for you.

Of course, almost every nonprofit’s website is fully of beautiful photos and inspiring content. All that really means is they have a good web designer – not that they’re doing responsible work on the ground. (Conversely, some fantastic organizations don’t have the time or money to spend on their websites, so don’t rule anyone out just because they don’t look the most polished.) You have to learn to read between the lines.

Here are some good and bad signs that are easy to spot:

🚩🚩 Red Flags:

• No vetting process for volunteers – Proudly stating “Anyone can volunteer with us!” or accepting medical/nursing students in hands-on roles.

• Not specializing in medical missions – Some volunteer placement orgs offer options to volunteer in teaching, wildlife conservation, construction, you name it. You want to work with a group that focuses solely on medical missions so they’re more likely to get it right.

• Orphanages – Any organization that offers volunteers the chance to work in or visit an orphanage is a hard pass. Here’s why.

• No interpreters – How are you planning to provide medical care to your patients without speaking their language? Any organization that would allow volunteers to do so is putting lives at risk.

• Exorbitant cost – It is absolutely appropriate to pay to go on a medical mission (especially a short-term one). But if you’re shelling out more money than you’d spend on a fancy vacation, then someone is making a killing off well-meaning volunteers.

 

++ Good Signs:

• Volunteers’ role is learning and teaching, not just hands-on care – You must do more than see patients and fly home. Yes, it’s exciting to treat patients – but unless volunteers incorporate some aspects of mentoring and working with local caregivers, your impact will not last after you leave.

• A long-term plan to hand over leadership to local caregivers – I love to see wording about program sustainability, empowerment of local care providers, efforts to work in true partnership with the community, locals hired into leadership positions, etc. Every nonprofit should be trying to eventually work themselves out of a job.

• A thorough vetting process – The organization’s website should have information on the type of volunteers they’re seeking, how much experience they require, etc.

• A volunteer code of conduct – Not every organization has one of these, but more and more are starting to pop up. Any nonprofit discussing responsible volunteering on their website gets bonus points from me.

 

A Word on Religion:

While you’re researching medical mission trips, you’re going to find a lot of religious organizations. It’s up to you to decide how much religion you’re comfortable with.

Some nurses are inspired to volunteer by their religion and like to work with faith-based organizations. Others prefer to work with explicitly non-religious groups. Whatever you choose is fine, as long as you do not evangelize to your patients.

You’re reading this because you’re concerned about volunteering ethically, and this is one of the biggest ethical boundaries being crossed by countless organizations (I’ve seen websites that tally “conversions of faith” alongside the number of patients seen and surgeries performed). Using a medical mission as a tool for converting people is deeply unethical.

If you choose to work with a faith-based organization, carefully consider how it affects your patients. Medical Teams International is a faith-based group I felt comfortable working with because they do not evangelize to patients.

You have a responsibility not to exploit the power dynamic that favors you, a medically-trained foreigner. If you offer a child life-saving treatment and then hand their parent your holy book, the pressure they’ll feel to please you is enormous. And medicine is littered with issues that are matters of personal belief (like family planning, abortion, and end of life care, to name a few). Your patients must feel free to make medical choices based on their values, not yours.

It’s also important to be honest and aware of the relationship between your religion and the community in which you’re volunteering. Most developing countries have a long history of colonization and exploitation by white Christians. Or you may be working in a community where the majority religion is different from your own. Remember that your choices affect your whole team and the organization at large. In some cases it may just be unethical to attempt to convert your patients; in others it could be legitimately dangerous.

Does this mean you can’t ethically work with any faith-based organizations? Certainly not. I had a wonderful experience with Medical Teams International in Uganda, even though their website is too explicitly religious for my personal taste. I was assured by friends who had volunteered with them that this wasn’t the case on the ground, and I didn’t find my work to be affected by their religious foundations at all.

The distinction for me is this: I’m happy to work with religious people and organizations who use their beliefs as inspiration to do good; but I will not support those using medical missions as a way to spread their personal beliefs. Want to pray before work to draw strength from your God while you treat people in a challenging environment? Go for it. Want to teach every patient how to pray to your God before they’re discharged? Don’t even think about it.

Finally: As you find organizations on your search that look pretty good, send their volunteer coordinator an email. Let me say again that just because an organization appears on one or all of the lists I linked above, does not mean it has been thoroughly vetted! You are still responsible for doing your research and asking the important questions.

If you’re doing this right, you’ll look at a lot of websites and send a lot of emails. You probably won’t find your dream organization immediately – or maybe ever. Because the truth is: No medical mission organization is perfect.

Even after you’ve done all your research and preparation, here’s the thing:

IT’S UP TO YOU.

Picking the “right” organization DOES NOT MEAN YOUR MEDICAL MISSION IS ETHICAL. In the end, it comes down to how you act once you’re on the ground.

I’ve worked with highly-respected organizations and been shocked by some unethical practices I witnessed among their employees in the field. I’ve also worked with questionable organizations that I wouldn’t recommend to anyone nowadays (hi, IVHQ!) but because I stuck to my own personal ethical boundaries, I was able to maximize the benefits and minimize the harm I caused while I was there.

The vast majority of the time, you’ll be working unsupervised in a hospital or clinic. No volunteer coordinator or hospital manager is going to be watching your every move, and situations will arise where you have the chance to do something you probably shouldn’t.

I made sure to let local midwives take the lead in Haiti.

For example: Every time I attend a birth when I’m volunteering in Africa, the local midwife steps aside and offers to let me deliver the baby. Even if she knows nothing about my credentials or experience, she knows that I’m American, white, and a guest – so she offers to let me do it. It’s my responsibility not to take that opportunity as a learning experience or a cool story to tell later. I provide only the care I’m licensed to provide, unless a medical emergency requires me to do more (just like I would at home in the US).

We’ve all messed up – I once helped stitch a boy’s machete wound in Belize because I wanted to learn how to suture. The local doctor was busy with other patients, and a nurse who had sutured before talked me through it. But nurses aren’t licensed to suture, and I didn’t have that boy’s informed consent to practice on him. That’s not how I would want my family to be treated, and I would never try that in America – which means I shouldn’t have done it at all.

Ethical decisions will be up to you, so make sure you know where your boundaries are and how to stick to them. You’re in charge of how you act and the impact that you have.

 

If you read this entire post, you are amazing and let’s be friends! And if you know of any ethical medical mission organizations from your experience, drop them in the comments, too! I’d love to have more options to suggest to folks.

 
 

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