Cover image courtesy of Global Brigades.
Written by Saumya Kagal, The University of Oklahoma
An in-depth investigation of the intentions and impact of the non-profit health and sustainable development organization, Global Brigades and its Ghana program.
Abstract
As one of many international humanitarian NGO’s, Global Brigades is a group that aims to provide holistic care to various communities spreading from countries in Central America to Ghana. From one perspective, Global Brigades seems to be feeding into the culture of voluntourism by promoting short-term travel of students to Ghana but from another, Global Brigades focuses on a Holistic Model to address determinants of health other than just access to healthcare. This Holistic Model encourages community members to work with Global Brigades members to improve upon their community without erosion of their culture. In addition to provision of healthcare and public health education, the Global Brigades Ghana program addresses economic inequalities, directing attention to social and economic determinants of health. Currently Global Brigades has active business, medical, water, and public health programs in Ghana that work with volunteers, staff, and locals. A large critique of voluntourism organizations is that they reinforce existing inequalities within a community but from the literature, it seems that Global Brigades actively works to close these gaps and give community members the resources that they need to become autonomous.
Introduction
Africa’s resources and people have historically been exploited and mistreated and certain aid organizations continue to participate in indirectly exploitative practices. The history of international humanitarian aid has historically had issues regarding white saviorism and the rising voluntourism industry. However, some contemporary aid groups are working to provide more holistic support for the communities that need it. Global Brigades is one of those more holistic aid groups whose intentions and impact are often up for debate. After extensive research, Global Brigades appears to do more good for communities than harm by empowering community members and volunteers alike.
Voluntourism And Its Critics
International aid organizations have had a long and complicated history in Africa. On one hand, these NGOs have outwardly positive intentions as they recruit volunteers and workers under the guise of gaining worldly experiences and helping underprivileged communities. Many of them utilize “voluntourism” which is marketed as a “seamless blend between volunteering and tourism”, creating about $173 billion annual revenue as an industry [1]. The draw of participating for students includes gaining valuable life and professional experiences while making a difference for those in need. Beyond the “good Samaritan mentality”, the main attraction of participating in these trips lies in the potential learning opportunities that differ from the volunteers’ home countries [2]. The concept of voluntourism is utilized different types of humanitarian aid including the medical humanitarianism industry that this post will focus on.
Voluntourism can have many consequences within the communities that aid programs claim to help. First, “volunteers are normally sent to foreign countries with little to no training” leaving them to play catch up with local customs and culture [1]. This ignorance creates a rift between locals and volunteers and can have harmful repercussions that arise when volunteers and NGOs do not take local culture into consideration. Another argument against voluntourism is that it takes steady employment from locals and gives them to the voluntourists who are only in the community for short-term periods [1]. This is a widely shared sentiment among critics of voluntourism who believe that these NGOs prioritize volunteers over local community members and their interests [3]. By giving easily learned jobs to international volunteers, NGOs are withholding these positions and incomes from locals for the benefit of volunteers.
Critics also believe that sometimes more effort goes into creating an “authentic” experience for volunteers rather than on providing the promised aid to locals [1]. This type of humanitarianism is largely performative by being more volunteer-centered and overall “actively harms the community under the guise of helping”. Examples of this include spending money to ensure that volunteers are comfortable and having rare experiences rather than funneling these funds directly into the community. Some voluntourism organizations focus more on the sightseeing aspect than the actual volunteering which also contributes to this valid critique. This type of spending becomes harmful and exclusionary when benefits are going to international volunteers that are being withheld from locals who need the same goods or services. Voluntourism also perpetuates the harmful and paternalistic idea of the “White Savior” and of Western superiority. In voluntourism, these ideas are implicitly impressed on volunteers through promotion that depicts third world countries as “desperately waiting for the charity of the West” [1]. This imparts a sense of superiority in volunteers that makes them feel like they are fixing problems by participating in these trips when in reality, their short-term help does not do much to address the complicated manner of the systematic issues within these countries. Voluntourism is advertised as a worldly experience for participants that affirms the volunteer-centered nature of such trips that advertise helping others. In some ways, these trips further exploit communities that have already suffered long histories of exploitation by treating them as a learning experience for attendees rather than people in need. However, Global Brigades is a medical humanitarian group that works to address and combat these issues.
Global Brigades
Global Brigades is a national nonprofit organization that recruits volunteers from various Western universities to visit communities in need in Ghana, Greece, Guatemala, Honduras, Nicaragua, and Panama. In the summer of 2019, I was able to participate in a medical brigade through Global Brigades to Panama. From my experience, the organization really cares about both locals and volunteers and encourages volunteers to see themselves as Global Citizens. Their programs differ between countries so this post will later focus on the details and impact of the Ghana program specifically. The video “Global Brigades Sustainable Transition Fund” on Global Brigades’ Vision and Mission page, describes the physical 7-10-day brigades as just the beginning of the work done. The purpose of volunteers is to “build the community’s infrastructure and capacity for development” and the overall goal is to resolve healthcare, health education, and economic disparities [4]. The video also highlights the ultimate goal of Global Brigades which is to “empower [communities] to lead their own development” and their role is to help create support within the community.
The organization prides itself on its use of a holistic view which influences Global Brigades to look at health and community support from a broader perspective than other organizations. Specifically, their holistic model has three main components including “Water & Sanitation Infrastructure, Sustainable Health Systems, and Economic Development” [5]. This alone sets Global Brigades apart from other medical aid organizations which mainly focus on the medical aspect of care rather than seeing healthcare as a holistic concept. As a part of their Water & Sanitation program, Global Brigades aims to create new infrastructure within communities and to support specific community members with assistance when it comes to maintaining a healthy household [5]. Included in their Sustainable Health Systems program is the maintenance of local mobile clinics, provision of medical and dental care, and the recruitment of community health workers. The community health worker (CHW) program is notable because they recruit CHWs directly from the community and train then to “provide basic medical care, monitor chronic conditions, and serve as point persons for urgent care cases year-round” [5]. By including locals in the program, Global Brigades is empowering them to take control of their own community’s health. This program also gives community members a space to voice their concerns and to become advocates for their community. Lastly, their Economic Development program overall supports locals and local businesses. The program invests in local businesses, establishes and trains community banks, and provides loans to locals. All of these programs were created with the intention of sustainability within these communities with the hope that one day they can become completely self-reliant and not need Global Brigades volunteers.
The Ghana program was initiated in 2011 and specifically, $71,061 has been invested in local businesses and banks, 13,754 people have been given access to clean water, and 175 families have benefited directly from public health projects [6]. The Ghana program provides medical care as well as public educations to locals free of cost. By providing public health education, Global Brigades is targeting social determinants of health rather than only focusing on providing direct medical care. Social determinants are environmental factors that impact one’s health beyond direct access and quality of medical care and health education can have a major impact. According to the Ghana Global Brigades website, 39.99% of the rural Ghana population does not have “access to basic or safety managed drinking water” and 91% does not have access to safe and hygienic sanitation facilities. Global Brigades addresses these issues directly by implementing their Clean Water and public health projects. A notable part of Global Brigades’ projects is that the programs vary between each country. To some extent, this can depend on available resources and funding but beyond that, Global Brigades works with community members and does holistic research on the community to determine what they need.
Global Brigades and Medical Humanitarianism
International medical humanitarianism is the specific subset of aid humanitarian work that Global Brigades uses that sends volunteers (made up of students and some staff) to a foreign country in need in order to provide medical supportive services. Medical missions and aid work can be traced back to the 1800s in certain African countries and continues today as a rising industry. One of the first medical humanitarianism “NGOs was Africare…founded in 1970 by 17 U.S. volunteers” which was followed by Doctors Without Borders and UNAIDS in response to the HIV/AIDS outbreak in Africa [7]. It is clear that certain African communities need outside help but the debate is surrounding how this aid should be structured and delivered. Using a voluntourism format in medical humanitarianism can be dangerous for volunteers and patients when volunteers are not carefully regulated and educated. Medical voluntourism has all of the same negative implications that comes with voluntourism alone in addition to the added danger of medical care. Locals go to aid clinics at their most vulnerable time in order to receive proper medical care and volunteers with superiority complexes can put these patients at serious risk.
In a case study of a Tanzanian international clinic volunteer program, it became clear that many of the volunteers carried the mentality that “sub-standard medicine [was] ‘good enough for the poor’” [8]. Because these volunteers had a superiority complex over locals, they justified “practicing [medical care] beyond their training” [8]. On this trip, many of the student volunteers did not respect the authority of local physicians and “saw themselves as entitled to particular experiences by virtue of their self-perception” [8]. This sentiment is a direct reflection of the superiority and entitlement that volunteers felt in Tanzania. Simply because they were from predominantly white countries, they discounted any education and experience that local doctors had and abused their trust. Global Brigades addresses this issue with their comprehensive education programs that take place before volunteers’ brigades. Global Brigades strives to teach students that their goal is to “work collaboratively” with communities to learn and grow together as well as about the disrespectful nature of a savior complex [9].
An extension of this superiority was their “self-perceptions as representatives of ‘modern’ medicine” which reflects a complete lack of respect for local medicine. There are many accounts of these pre-health undergraduate students completing dangerous procedures that they had no training or qualification to do. Students also found ways to enhance their personal experiences by working around local rules and taking advantage of insecurities of the country’s infrastructure. For example, volunteers discovered that weekend shifts were minimally staffed so therefore, they could get away with more hands-on procedures such as delivering babies [8]. In this case, using voluntourism in a medical humanitarianism context only served to belittle local healthcare professionals and to endanger local patients. A major problem with this specific program was the racist “post-colonial tropes” on which the project was based. While this ‘do better’ mentality may have initially been based in morality, reinforcing this idea to volunteers ultimately only made them feel justified in their unqualified provision of medical care to Tanzanian patients. To address this issue with medical voluntourism, Global Brigades has strict regulations about what students are allowed and not permitted to do. Student responsibilities medically are limited to “shadow[ing] and help[ing] with all the clinic stations” rather than providing any medical care [9]. The medical nature of these roles only includes triage (taking blood pressure, heart rate, temperature, etc.), intake, and the public health education station. From my personal experiences, the organization took great care to protect patients by ensuring that students know and respect local physicians and community health workers.
Global Brigades is aware of the valid criticism surrounding voluntourism and international humanitarian aid programs. Their programs are structured with the mindset of helping communities become autonomous and self-reliant. Global Brigades is more sustainable than other comparable programs because their involvement goes beyond sending volunteers for a week and then leaving the community. Global Brigades has a local staff that works with community leaders and member to ensure that their voices are heard and taken into consideration [9]. They also emphasize the “learning exchange” between students and community members and the sustainable nature of the projects. When confronting accusations of participating in a new form of colonialism, Global Brigades clarifies that their goal is to “empower communities and eventually transition out” of them rather than staying indefinitely [9]. Global Brigades also only works with communities that reach out to them to further ensure that they are not imposing themselves on a community that does not want or need external support. They seem to be aware of the implications of the white savior complex and to work against it by educating students pre-brigade. The core way that Global Brigades works against the white savior complex is by their holistic model and by working directly with community members to “determine their own health and economic goals” [10]. While this may seem small, the act of active listening is major when it comes to providing community-centered aid. Many existing programs and aid organizations assume that they know what a community needs without actually making the effort to involve locals in determining goals and making decisions.
How can Help Outweigh the Harm?
In order to be a helpful and fully supportive humanitarian NGO, it is important for the organization to focus on sustainability within the community. A big part of this is addressing the implications that come with international aid and voluntourism. Often despite good intentions, voluntourism can “reinforce stereotypes and actively promote a…’us and them’ mindset” [11]. Aid organizations, especially those that use voluntourism, tend to reinforce paternalistic ideals that imply western and white superiority. At the same time, many of these communities need external help and do not have the resources to help themselves or to be self-advocates. This raises the question of how to determine if these NGOs are doing more good than harm. According to one description of harmful voluntourism, it occurs when solutions proposed are “simplistic, inappropriate or damaging” [11]. A hypothetical example of this type of solution would be a brigade or mission trip that visits a community for only a week to provide medical care and then leaves immediately after without leaving behind any resources or lasting change. These programs are not community-centered and do little to help fix the long-term, systematic issues that many of these communities face. They do not address disparities that exist in communities and only serve to provide a temporary relieve. Additionally, brigades can be disorganized which can give rise to issues with volunteers providing unqualified care. “Lack of coordination between the volunteer brigade and local health care providers” can create tension within the community and can arise from a deficit in proper communication [12]. This circles back to the importance of having strong supportive infrastructure and ensuring that volunteers understand their role on the brigade. They are there to support the professionals rather than to act as professionals themselves.
On the contrary, medical humanitarian groups can be helpful in the correct context and preparation. Helpful voluntourism occurs when “constructive assistance [is offered] …through transference of skills and resources” [11]. This type of voluntourism is more long-term and provides deeper support to community members than the transient nature of the support described previously. In order to make a net positive influence, it is important for volunteers to be “increasingly aware of the impacts of diverse issues” to understand the implications of their involvement. Global Brigades does a good job of accomplishing this through their emphasis on a learning exchange between volunteers and locals. This program structure prioritizes the experiences of both volunteers and community members involved in the program. Overall, while the voluntourism industry has many flaws, there is a way to participate that benefits all parties involved. By listening to community members, self-educating, and prioritizing a bigger impact (addressing structural issues; infrastructure, systematic issues, etc.), organizations can work towards a mutually beneficial goal of helping communities and volunteers to learn together.
The article “Recurrent failings of medical humanitarianism: intractable, ignored, or just exaggerated?” reiterates these points by making several suggestions to improve medical humanitarianism [13]. The recommendations include setting feasible goals rather than desirable by taking inventory of available resources and the overall capacity of the community. This is accomplished by working closely with community members rather than assuming to know better despite being an outsider, a policy which Global Brigades emphasizes across their website [4]. The organization appears to be dedicated to working closely with community members to ensure that they have a voice.
Moving Forward
Despite the many merits of Global Brigades, there is always room for growth. The preparation of students for brigades is fairly minimal and is more limited to a basic medical support education. While the website describes cultural competency education, from my personal experience, our preparation for our brigade pertained more to the medical side of the brigade rather than the cultural side. Our trainings went over how to participate in triage, general day-to-day schedules, and other logistical details. We spent a significant amount of time learning about what Global Brigades does to empower community members which I appreciated. However, I think that the group as a whole would have benefited from a broader cultural and historical curriculum. Volunteers should have a general understanding of the history of the country that they are visiting especially if they will be working closely with people affected negatively by health and economic disparities. Through an understanding of the historical context of the country’s disparities, volunteers can better empathize with patients and therefore provide them with more compassionate, thoughtful care and support.
It is important for volunteers to understand the implications of entering these communities and the role that they are playing in improving the community. Deficits in education prior to the brigades leaves room for mentalities similar to what occurred in Tanzanian volunteers. Volunteers need to understand that they are not the authority on these brigades and that community leaders and Global Brigades leaders are the ones in charge. Beyond this understanding, Global Brigades could provide more educational resources to volunteers about the culture, language, and customs of the country and community that they will be traveling to. Having cultural competency is important in ensuring that the brigade remains focused on locals rather than becoming volunteer-centered to help them overcome culture shock or dissonance. In addition to a cultural curriculum for volunteers, I think that it would be crucial for the organization to provide a thorough education on the history behind the white savior complex as well as western superiority. The best way to ensure that volunteers do not carry these prejudices with them into a foreign country is to directly address this mindset and the reasons and history behind it.
Conclusions
Overall, Global Brigades’ program structure seems to prioritize the local community as much as possible while providing a safe, educational environment for volunteers. I can also reinforce this assertion from my personal experiences because on my medical brigade to Panama, it was clear that Global Brigades cares about both volunteers and community enhancement. Their programs are designed with local insight and consent and were created with the intention of leaving communities with resources to sustain themselves. While there are still cultural impacts to consider, to some extent organizations like Global Brigades require volunteer involvement to continue running. Unfortunately, most people would not donate large sums to the organization without an experience or benefit for them attached and these donations are what sustain Global Brigades and similar programs. Looking forward, it would do no harm for Global Brigades to incorporate more cultural competency education into their pre-brigade curriculum for volunteers. By addressing the cultural differences as well as the history of white colonialism in Africa, the organization would be doing everything possible to ensure that volunteers begin the brigade without any explicit or implicit racial biases towards locals. Obviously, it would not be possible to completely negate the issue of western superiority and white saviorism through one curriculum but it is a start and could potentially make students aware of biases that they were not aware they carried. There are many issues with voluntourism but when structured properly, it serves as a tool to create permanent growth within communities and to promote learning in locals and volunteers.
This post may have been edited by admin for clarity and length.
Bibliography
Primary Sources
“Answering the Tough Questions” Global Brigades, https://fundraise.globalbrigades.org/media/AnsweringtheToughQuestions.pdf.
Colbert S., Kawas R., “We Are Not The Saviors of This Story: Addressing White Saviorism Together” Global Brigades, 6 July 2020, https://blog.globalbrigades.org/addressing-white-saviorism/.
“Global Brigades: Ghana.” Global Brigades, www.globalbrigades.org/countries/ghana/.
“Our Holistic Model” Global Brigades, https://www.globalbrigades.org/impact/holisticmodel/.
“Our Values” Global Brigades, https://www.globalbrigades.org/about-us/vision-mission/.
Secondary Sources
Colombo, Sandro, and Enrico Pavignani. “Recurrent Failings of Medical Humanitarianism: Intractable, Ignored, or Just Exaggerated?” The Lancet, vol. 390, no. 10109, 2017, pp. 2314–2324., doi: 10.1016/s0140-6736(17)31277-1.
Gillett G., “The ethics of voluntourism”, BMJ: British Medical Journal, Jan. 2016, Vol. 352, https://doi.org/10.1136/sbmj.h6135.
McLennan, Sharon. “Medical Voluntourism in Honduras: ‘Helping’ the Poor?” Progress in Development Studies, vol. 14, no. 2, 2014, pp. 163–179., doi: 10.1177/1464993413517789.
Olakanmi O., Perry A. P., “Medical Volunteerism in Africa: A Historical Sketch”, AMA Journal of Ethics, Dec. 2006, Virtual Mentor. 2006;8(12):863-870. doi: 10.1001/virtualmentor.2006.8.12.mhst1-0612.
Palacios C. M., “Volunteer tourism, development and education in a postcolonial world: conceiving global connections beyond aid” Journal of Sustainable Tourism. 18:7, 861-878, doi: 10.1080/09669581003782739.
Sullivan, Noelle. “International Clinical Volunteering in Tanzania: A Postcolonial Analysis of a Global Health Business.” Global Public Health, vol. 13, no. 3, 2017, pp. 310–324., doi: 10.1080/17441692.2017.1346695.
Other
Kakkar R., “International Volunteering and the ‘White Saviour Industrial Complex’”, Affinity, 27 March 2019,http://affinitymagazine.us/2019/03/27/international-volunteering-and-the-white-saviour-industrial-complex/.
Ocampo C., “Worlds Apart: The Divide Between International Medical Brigades & the Communities They Service”, The Pitt Pulse, http://www.thepittpulse.org/worlds-apart.
[1] Kakkar R., “International Volunteering and the ‘White Saviour Industrial Complex’”, Affinity, 27 March 2019, http://affinitymagazine.us/2019/03/27/international-volunteering-and-the-white-saviour-industrial-complex/.
[2] Gillett G., “The ethics of voluntourism”, BMJ: British Medical Journal, Jan. 2016, Vol. 352, https://doi.org/10.1136/sbmj.h6135.
[3] Palacios C. M., “Volunteer tourism, development and education in a postcolonial world: conceiving global connections beyond aid” Journal of Sustainable Tourism. 18:7, 861-878, doi: 10.1080/09669581003782739.
[4] “Our Values” Global Brigades, https://www.globalbrigades.org/about-us/vision-mission/.
[5] “Our Holistic Model” Global Brigades, https://www.globalbrigades.org/impact/holisticmodel/.
[6] “Global Brigades: Ghana.” Global Brigades, www.globalbrigades.org/countries/ghana/.
[7] Olakanmi O., Perry A. P., “Medical Volunteerism in Africa: A Historical Sketch”, AMA Journal of Ethics, Dec. 2006, Virtual Mentor. 2006;8(12):863-870. doi: 10.1001/virtualmentor.2006.8.12.mhst1-0612.
[8] Sullivan, Noelle. “International Clinical Volunteering in Tanzania: A Postcolonial Analysis of a Global Health Business.” Global Public Health, vol. 13, no. 3, 2017, pp. 310–324., doi: 10.1080/17441692.2017.1346695.
[9] “Answering the Tough Questions” Global Brigades, https://fundraise.globalbrigades.org/media/AnsweringtheToughQuestions.pdf.
[10] Colbert S., Kawas R., “We Are Not The Saviors of This Story: Addressing White Saviorism Together” Global Brigades, 6 July 2020, https://blog.globalbrigades.org/addressing-white-saviorism/.
[11] McLennan, Sharon. “Medical Voluntourism in Honduras: ‘Helping’ the Poor?” Progress in Development Studies, vol. 14, no. 2, 2014, pp. 163–179., doi: 10.1177/1464993413517789.
[12] Ocampo C., “Worlds Apart: The Divide Between International Medical Brigades & the Communities They Service”, The Pitt Pulse, http://www.thepittpulse.org/worlds-apart.
[13] Colombo, Sandro, and Enrico Pavignani. “Recurrent Failings of Medical Humanitarianism: Intractable, Ignored, or Just Exaggerated?” The Lancet, vol. 390, no. 10109, 2017, pp. 2314–2324., doi: 10.1016/s0140-6736(17)31277-1.
