The law cares about actions and outcomes, not intentions. When it comes to volunteering, so should we.
Sidney Peters. She’s the whole package: an incredibly talented athlete, an emergency medical technician (EMT), and an aspiring Coast Guard physician. She combines excellence, perseverance, and a sincere desire to do good under adverse circumstances.
Peters is the starting goalie of the University of Minnesota Women’s Hockey Team. The Minnesota Gophers hoped to become the second women’s hockey team in NCAA history to win three straight national championships. Clarkson ultimately won. But a main reason the Gophers got to the semi-finals was because Peters’ talents were able to pull the team out of a serious slump. No one expected Peters to turn things around for her team. She became a major story.
Asked how she kept her cool on the ice, Peters cited perspective she gained during a brief trip to Haiti last summer, where she volunteered as an EMT in a hospital. She treated patients with AIDS, tuberculosis, gun shot and stab wounds. She even learned to suture. She called it a “hands-on medical experience” that might help her get into medical school, but more importantly, allowed her to help others. By comparison, stress on the ice was relative.
As faculty in Global Health Studies at Northwestern University, I’ve researched trips like Peters did—often called “international medical volunteering”—for six years. The vast majority of people undertaking these trips are young women with remarkable aspirations who want to have a positive impact on the world. They’re very much like Peters, and like my own students, many of whom engage in this form of volunteering.
Yet, the results of my research demonstrate that regardless of best intentions, medical volunteering does more harm than good, in part because volunteers often lack the expertise necessary to truly be helpful.
When contemplating volunteering abroad, we have to ask ourselves: Would I be allowed to do what I’m going to do abroad here at home? If the answer is “no,” there are important reasons why, and these should also inform our efforts to help abroad. Regulation may seem boring, until you appreciate its critical role in protecting patients.
Peters is a licensed EMT. The U.S. National Guidelines outline what EMTs should be entrusted to do. While variable by state, generally an EMT’s role is to stabilize patients for transit to a hospital: protect airways, administer over-the-counter medications, and stabilize fractures or wounds in preparation for transit to a health facility, where qualified professionals take over. That is, EMT’s stabilize patients in an emergency; they don’t treat them, because they lack the skills necessary to do so.
In the U.S., generally, four requirements must be met for a practitioner to be permitted to treat patients: education, certification, licensure, and credentialing. As an aspiring physician, here’s what Peters would undergo in order to legally treat hospital patients in the U.S.
Initially, she’d spend four years attaining an MD or DO degree. Once completed, Peters wouldn’t be allowed to practice until certified. For certification, she’d need a residency placement—a type of “internship” specializing in one aspect of medicine, under close supervision of a seasoned physician for several years. Then, a national board evaluates her, and after she passes an exam, she’s “certified” into a specific field of medicine.
Even with education and certification, Peters would need state licensure before she could treat patients. States have different licensing procedures. This requires another set of procedures, as well as a state-defined minimum amount of training in a certified program. Further, state licensure doesn’t cross state lines. A physician licensed in Minnesota can’t even work in neighboring Wisconsin.
With a state license, Peters still wouldn’t be able to treat hospital patients without being credentialed by the hospital employing her. This generally entails a committee reviewing Peters’ qualifications, then outlining which specific medical procedures she can be trusted to perform.
Thus, two doctors could share the same specialty, licensure, and certifications, and both be credentialed to work in the same hospital; yet one will be entrusted to deliver babies, whereas the other won’t because they’re deemed insufficiently skilled in that procedure. Credentialing defines the scope of practice locally, so that a dermatologist can’t perform caesarian sections, a neurologist can’t perform appendectomies, and an EMT can’t suture your wound.
As commendable and impressive as Peters is as a goalie and an EMT, what she did in Haiti violated an EMT’s scope of practice. Suturing may seem minor, but she might have inadvertently caused infections, sepsis, or even death. She left Haiti before she could know her patients’ outcomes.
Like the U.S., other countries regulate healthcare professionals. Countries like Haiti are not equipped to sufficiently enforce regulations, but the regulations are there.
Certainly, Peters isn’t the first well-intentioned star college athlete to have treated patients abroad without a license. Former University of Florida star quarterback Tim Tebow circumcised boys in the Philippines while on a medical mission.
Would you allow Peters to suture your wound? Tebow to circumcise your little brother? When we flip it around, the idea seems preposterous. Applied to the poor abroad, somehow it seems reasonable. But it’s not.
To be sure, Peters had good intentions. But this justification disintegrates when we substitute Haitian patients for Americans. An 18 year old Floridian man arrested for practicing medicine without a license purportedly “just wanted to help people”—the very same justification that we often make about volunteering. Regulatory laws prevent not only criminals, but also the well-intentioned but insufficiently experienced, from practicing medicine on patients. The law cares about actions and outcomes, not intentions. When it comes to volunteering, so should we.
What I’ve seen in Tanzania is why I continue to advocate against this form of volunteering, even when inspirational people like Peters do it. There, volunteers—mostly overwhelmingly nice and well-meaning students—regularly deliver babies, participate in surgeries, dress wounds, and supervise one another rather than work with local professionals. In 2013, I observed a high school graduate amputate a man’s limb—something he would never dream of doing in Britain, but felt would be appropriate in Tanzania because he aspired to be an orthopedic surgeon. I know of another case wherein a volunteer inadvertently killed a patient.
I often get asked: What can volunteers do in health facilities? Why can’t they take blood pressures or vital signs? But volunteers can cause inadvertent harm even with simple procedures. In one memorable case, a volunteer accidentally used an uncalibrated blood pressure cuff on a newly-admitted pregnant woman in labor. The volunteer missed the woman’s extremely high blood pressure; that patient nearly died because her eclampsia was not identified upon arrival. In another case, a volunteer took an inaccurate blood pressure reading on a woman in labor, who was then rushed to the surgical theater for a c-section. Local professionals took her pressure again during surgical preparations, only to find it was within normal range. That woman almost received an unnecessary surgery, which increased risk to both her and her baby. The mistake also tied up existing Tanzanian professionals, who could have attended to other patients.
“Do no harm” is the oath every doctor makes. When unqualified volunteers go abroad to assist in health care, they can inadvertently harm, precisely because they don’t know what they don’t know in terms of how to practice medicine, not matter how laudable their intentions.
Peters is a remarkable athlete, and a true inspiration. Her impressive accomplishments on and off the ice demonstrate that skill emerges from combined passion, commitment, perseverance, practice, and mentoring. These same qualities are necessary in the realm of medicine, at home and abroad. Good intentions are important, but they’re just a start.
Here’s what else I’ve learned: If you want to travel and make a difference at the same time, go to see and learn about a new place, and support locally-owned businesses instead of high-end (and often foreign-owned) touristy establishments. The boost to the local economy supports countless people. If you want to help with health care abroad, find organizations already doing great work, and fundraise from home to support their efforts.
Noelle Sullivan is an Assistant Professor of Instruction in Global Health Studies and Anthropology at Northwestern University, a Board Member of the 501(c)(3) charity Worldview Education and Care, and a Public Voices Fellow with The Op-Ed Project. Twitter: @ncsullivan