Expectations –When Helping is Complicated

Kim McLennan, an accomplished physical therapist, and long-time CFHI volunteer, is now in Haiti and has been communicating to us some of the complexities of just trying to help.  A veteran of many humanitarian missions, Kim knows that to lend a helping hand is not always as easy as it looks on the surface.  The crisis in Haiti, and the

Some of the many peopel who have volunteered their time going to Haiti in the aftermath of the 7.1 earthquake
This is a U.S. Navy photo of some of the many vounteers who have gone to Haiti to help after the great earthquake

outpouring of volunteers to give assistance has amplified the Grey Areas of coordinating and managing international aid.  The questions of culture,  ethics, passion, compassion, and the realities of unexpected complexities are raised in her moving, first-hand account.  Dr. Evaleen Jones, CFHI’s Founder and President, asked Kim if we could share her writings through this Blog.  Kim gives us her experience alongside her on-the-spot reflections which are informed by her years of cross-cultural work in some very challenging situations.

We are grateful to Kim for her permission to present her observations and thoughts here.  Unfinished and raw, they give us an unvarnished view of reality with no easy answers –much as the real situations in Haiti, and elsewhere in the world.  You are welcome to click on the “Read More” button to leave a comment.


Here in Haiti, 5 months after the devastation of a 7.1 earthquake, volunteers are coming in droves.  I am one of them.  By the end of my stay, I will have been here 7 weeks.  Most of my fellow volunteers come for one week or two if they’re lucky.  Professionally, the greatest number are doctors, nurses, emergency room specialists, pediatric and wound care specialists, prosthetists and physical therapists. The majority have never been to a developing country or to Haiti before they arrive.

They come with the expectation of being welcomed for their concern and service, everyone paying their own expenses and hoping their week of selflessness will do some lasting good.  Most leave, probably feeling that their mission was accomplished, even if in some small isolated way.  This morning, at the hospital I’m working in, there are 20 American doctors, nurses and other hopeful people wanting to do something useful.  They’re surprised when they realize how different the system is here, how charts and notes and procedures that are standard in the US are hardly used here. They are surprised that the Haitian nurses don’t speak English or seem happy to share their small desk or coveted stash of medical supplies.  Many come with their own supplies of state of the art medical technology and toys and blankets and shoes.  Most of it is very useful and appreciated by the patients.  The Haitian staff seems to disappear when the volunteers arrive to see the rare and unusual patient injuries that have occurred here.

There have been many surgeries and interventions that would have never occurred without the volunteers being here.  External fixators and wound vacs are found throughout the hospital, and the meticulous care given to the patient’s wounds is without parallel.  But this is precisely the problem. The nurses here do not have the training to change the dressings or change the wound vacs and no one is training them. There will be no physical therapy or discharge planning when the NGOs pull out for good.  For all their good intentions, the volunteers seem to ‘take over’ when they arrive and then complain that the Haitian staff doesn’t seem interested.  Cultural differences aside, who likes it when someone new arrives on the scene, walks in,  starts to do your job and then leaves, making you feel less than adequate after witnessing such expertise.

As you know, this is a touchy subject.  Everyone who comes here has the best intentions, simply wanting to help.  The problem is when they come, they come in groups with their own comfortable systems in place, just in a new setting.  Most of the Haitian hospitals are not equipped to house or feed these additional visitors and the plumbing in Haiti already is barely serviceable.  They often don’t seem to try to learn a few words of Creole, or go outside the compound to meet the Haitians and share a local meal.  It probably feels like a vacation except that the food is scarce and the air-conditioning doesn’t work.

The first time I went overseas to volunteer 12 years ago in South Africa, I stayed for one month and it took me almost three weeks to feel I was accepted a little by the local staff and they still did not seem keen to have me in their midst.  I have been looking ever since for better ways to interact and contribute to poor people in need of basic healthcare.  I believe the answer is recognizing the potential of the local people….

It truly does no good to ‘do your thing” as a volunteer, no matter how much it is needed if you don’t teach someone else how to do it also.  Volunteering in Haiti can contribute to the Haitian infrastructure only if we volunteers think about the consequences of us being here.  Are we willing to be patient and work alongside someone whose future may improve from our training?  Are we willing to trust that they may know a better way than the way we’ve been taught?   We are influencing an entire system by our presence and we should be including them every step of the way…..”

  • Kim’s sentiments touch on many of the most basic challenges in ‘global health.’ It prompts me to reflect on my response to the Haitian earthquake. As a family doctor, urgent careist and hospitalist, I was invited to go to Haiti to ‘help out.’ I asked myself three questions- Will I be of any help? Am I the right person to help? Would the cost of the trip be proportionate to the impact I would have?

    In response to the first question- “Will I be of any help?” I thought, yes, at least I could be an extra set of hands, if not a skilled provider. Secondly I asked myself “Am I the right person to help?” Reflecting on this brought several deficits to mind- my training in the US (albeit in an “underserved” county hospital) did not prepare me for post-disaster medicine in the Haitian context, my inability to speak Creole limited my ability to interact with Haitian doctors, nurses and patients and may further detract resources as someone would have to use their time interpreting for me. In addition, the schemes under which I could go to Haiti did not prioritize transfer of skills or sustainability of efforts. I calculated that I would need to be in Haiti for many months in order to overcome these limitations and hurdles.
    Finally, I asked myself “Would the cost of the trip be proportionate to the impact I would have?” I calculated the cost- $500 flight to Miami (where a sponsored flight would take me to Porte Au Prince), $400 in extra childcare hours in my absence, and lost wages in the range of several thousand dollars for a 2 week stint. I decided that the amount of money it would cost me, in travel expenses and lost wages, did not equal benefit I would have for Haitians.

    Certainly, if I factored in the personal and professional benefit of the experience, the scale would have tipped in favor of going to Haiti- I would most certainly get more than I was able to give. I would certainly have had the experience of a lifetime. But, I would be going to Haiti under the auspices of helping Haiti, not of helping myself. It seemed unauthentic to do so under such pretenses. In the aftermath of this disaster many local and international doctors who had worked in Haiti for decades required material and monetary support to scale up their efforts (and they continue to require additional investment and will for many years to come). I decided to support locally-relevant, linguistically-sound, and sustainable efforts- I decided to send money rather than myself.

    This was a difficult decision. It’s not quite as exciting to recollect the money you donate rather than the time spent in a low income disaster struck country. But, for me, it was the right thing to do. I donated an amount of money equal to what the cost of a 2 week medical volunteerism trip to 2 organizations- Partners in Health and MEDICC (Medical Education Cooperation with Cuba). Cuba supported 402 Cuban-trained Haitian medical graduates and 736 Cubans who were already in Haiti prior to the disaster and will be there for many years to come. Partners in Health employees many hundreds of Haitians and has had ongoing skills transfer and sustainable health systems development since 1983.

    I’m not suggesting that my approach is right for everyone, but I think its important to realize that short-term medical volunteerism trips are not right for everyone, either. It’s important to recognize our individual limitations- in the realm of skills, language, cultural sensitivity, and time commitment. It’s important to recognize the value of monetary support for people on the ground that are able to speak, relate, and stay in a way that truly serves the local population.

    I think CFHI experiences, as they frame local health care workers as the ‘experts,’ and CFHI participants as the benefactors of this expertise does a great deal to challenge many of the norms of global health work and immersion. Hopefully, when medical students, nurses, and allied health trainees are introduced to global health in such a fashion, they will be more likely to be cognizant of the necessity of placing local personnel in the forefront of any health efforts and avoid some of the missteps witnessed by Kim in places like Haiti. As CFHI says, “Let the World Change You,” but in times when the world really needs a lot of immediate help, sometimes it’s better to support local resources than to circumvent them with the best intensions.

    Kim’s insights are helpful to make us all look at how we do global health work and what we demand of the organizations we do it with. Often short-term volunteers are very necessary, but these activities need to be married to a strategy of knowledge transfer, building the workforce capacity of local people and providers, and prioritizing sustainability. As we look at organizations to do such work with- we need to ask if these important components are integrated into their approach. Thanks to Kim for this candid commentary.

  • Thanks again Kim for allowing us to share in your experience and in your reflection on what you are experiencing. Your words stay with me: “Are we willing to be patient… Are we willing to trust that they may know a better way than the way we have been taught?…” Through my experiences in other cultures, I have come to see that Americans, in particular, often have a reaction of seeing a need and filling it, and often filling it with abundance. There are times when this is a good and necessary response. There are also many situations when a more measured, careful response is called for, one that is informed and shaped by the people we are trying to help. To engage in a respectful manner, doing as much or more listening as anything else, allows us to respond in a manner that may be different than we had initially thought but is often more integrated and sustainable.

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