This week, I’m thinking about our Nicaraguan collaborators, Bridges to Community, as well as other service-learning organizations that we’ve heard from like Compas de Nicaragua and the Fabretto Foundation. Bridges to Community is actually one of the main reasons that I decided to apply to go on the CCESP trip this year. I’ve always wanted to experience a medical service trip. I’m a pre-health student who is always seeking more clinical exposure, and I’m interested in public health, so to see how a community health initiative works from a position on the inside is something that could really help me determine my career path. I’m also an avid traveler and a firm believer that you can’t learn about the world around you unless you get up and explore it, and I think that service abroad is a valuable way to give back to a community as you learn from it. The idea of going somewhere new and being able to experience and learn from the people and culture there while simultaneously gaining more medical and public health knowledge is something that has drawn me into research about a variety of medically-focused service trips. However, I’ve always been a bit hesitant to actually commit to a group.

My issue with a lot of medical mission groups is something that we’ve explored in LACS 20 at length – the need for responsibility and cultural respect when doing international service and development. In providing medical care as a form of service, there are many serious concerns about whether a group from another country and culture can possibly do less harm than good in the developing world. To paraphrase Suchdev et al., whose Model for Sustainable Short-Term International Medical Trips we read in LACS 20 this week, the dangers of short-term medical service include:

• Providing value for the visitors, including an opportunity to be a tourist but feel like a volunteer, without actually helping the community
• Sending in volunteers without proper medical training and providing sub-par care
• Sending in volunteers without proper language training and creating a barrier to communication and integration with the community
• Imposing burdens on the local hospitals or clinics by using their resources or leaving behind waste
• Failing to provide continuity of care
• Failing to provide equity of care or access to care
• Failure to provide sustainable care
• Providing care or being a presence that is culturally inappropriate

Initially, it can be hard to imagine how a medical service trip could be harmful. After all, there are people in these under-resourced communities who need medical attention and who would not have received care if not for the medical volunteers. However, this scenario can still be more harmful than good. Consider an individual with diabetes – short-term volunteers might be able to treat some of the complications, provide insulin for a time, and give advice about diet, but they can’t provide long-term blood glucose monitoring, lifelong insulin treatments, or access to healthy but expensive foods that compose a better diet. Or consider a case where doctors are treating a number of GI disorders due to unclean water – they can clear up the immediate illnesses in the patients they see, but without access to clean water, the problem will inevitably return. Then, at the community level, there is a whole host of other potential problems – the burden of using clinic resources, the potential for creating dependence on foreign medical professionals by reducing government funding to areas that are known to be hosts to foreign medical brigades, and the larger problems associated with paternalistic attitudes and lack of cultural awareness in service. Essentially, providing foreign aid is a hugely tricky process and there are a ton of pitfalls to avoid. The extent of the problem is so huge that some people have suggested we should just do away with service trips as a whole, especially for people who are not highly qualified professionals like doctors or engineers.

So that was my dilemma for a long time – medical service trips sounded like an amazing opportunity, but I couldn’t get over the sense of concern that going on one would be irresponsible. Enter Bridges to Community – an organization based in Nicaragua, staffed by Nicaraguans, and dedicated to sustainable development in individual communities. Their Nicaraguan clinic provided an opportunity to be part of a long-term project as a short-term volunteer. I liked the idea of continuity, of Nicaraguans being in charge of the implementation of the project in their community, and of a focus on creating a system that will work without the presence of foreign aid in the future.

Another group similar to Bridges that we heard from this week is Compas de Nicaragua. Michael Boudreau, the director, came in to class to talk about his work with Compas and his thoughts on providing foreign aid. Compas is involved in service learning trips and the support of Women in Action in Managua, a group of Nicaraguan women who organize education and health projects in their area. He had a lot to say about what service means to him – his thought was that the group consistently learned more from the communities they visited than the people there learned from him, but that the value of their presence came from their willingness to integrate into the community and share friendship with the people there. In his words, the Nicaraguans that his group visits get to share their stories, meet men and women from other places, and break up the monotony of life at or below the poverty line, which brings hope and happiness into the communities. The volunteers aren’t always the most efficient workers for the job, but he believes that there is an inherent value to the cultural mixing that occurs. Additionally, of course, is the value of the funding provided to Women in Action and other local groups, who know how best to use the money and resources to address community needs. By putting the decision-making into the hands of locals, Compas does a good job of ensuring that it meets the true needs of the community.

A third group that I’d like to touch on before signing off is the Fabretto Foundation. While Bridges works in both health and community development, while Compas is involved in health, development, education, and women’s empowerment, Fabretto is a group that focuses mainly on education. Specifically, they work in education centers and public schools to provide a holistic education that gives children the skills they need to leave poverty behind. To do this, they engage parents and teachers, work on food security, provide vocational training, and fortify primary and secondary education programs. The point of this approach is to improve quality of education from many different angles – level of parent involvement in their children’s education, extent to which children are well fed and able to focus on their studies, and job opportunities lined up for after they finish school.

There are a ton of different facets to international service and development, and health, education, and community development are just some of the ways in which organizations can seek to improve the function of communities. Still, no matter the goal of the group, the most important thing is to focus on serving the community in a way that emphasizes sustainability and cultural appropriateness and prioritizes their needs over the desires of the volunteers.