How do we determine if an intervention abroad is ethical?

Just recently, as I was reflecting on what to write about as a response to our third GHLP session on “Primary Health Care and the Strengthening of Health Systems,” I read something that truly made me step back and think about how we evaluate the credibility and efficacy of health care interventions abroad.

On a recent AMSA discussion board, a medical student within our AMSA region posted an entry about an organization he and fellow medical students started in response to the disaster in Haiti last year (in fact, their organization is affiliated with the same medical school that pioneered AMPATH in Kenya that we focused on in our discussion for this session). The entry seemed benign when I first read it; it explained the program, described what they had done in the past year, and invited any interested medical students to get involved, donate, and spread the word. I was truly impressed- for anyone to initiate and undertake such a large project, let alone a group of medical students pressed, is remarkable. And to make an impact in Haiti so quickly after the disaster hit, mobilizing forces and getting people and resources to the area within a year, on top of that.

Then, another medical student posted a comment that forced me to look back and think a bit more about this program. He expressed concern and disgust at the group’s claim to join them and experience medicine in a setting unlike anything they would find in the United States. This, he claimed, was encouraging people to practice outside of their scope of training and unethical; utilizing a vulnerable population for the sake of bettering the medical students’ skills.

I think this example poses a lot of interesting questions about interventions abroad, many of those that we discussed during our discussion about AMPATH’s inception and the motivation behind its creation. How do we evaluate health care programs initiated in the US that are meant for developing nations abroad? Does the desire for the continued affiliation for medical students with a health experience abroad preclude it from being a moral and ethical program? Or do we need such an impetus to keep a program viable, bringing students and faculty to the site year after year, maintaining a steady flow of oversight and workforce?

These questions, no doubt, can be applied to many programs that have been created abroad, whether they be medical or providing another type of service. Of course, I'm sure many of us would agree that such a program is unethical if it was created for the sole purpose of giving American medical students unique opportunities to put on their resumes and applications and talk about on their interview trails. But I think we need to be careful in dismissing the credibility of a program because of the desire of students and institutions to get involved with experiences such as these. Without a motivation for a long-term partnership between a medical school and areas such as those in Haiti and Kenya, would such a program be sustainable?