This past class Dr. James Saunders attended our class and gave a presentation on healthcare. He is  an otolaryngologist, specializing in ear, nose and throat disorders. He has a lot of experience in healthcare specifically in Nicaragua due to his work there with an organization he helped to co-found: Mayflower Medical Outreach

I  really enjoyed his entire presentation but I was most interested by his explanation of the seven sins of humanitarian medicine. This is something that we had learned about a while back in our class, but it was nice to hear it from someone who has actually been part of many humanitarian health brigades to Nicaragua. He began by talking about #1: leaving a mess behind. He gave an anecdote about arriving in Nicaragua ready to do ear surgery  with his team after being there 6 months prior. Him and his team were received very coldly due to the fact that a different health team had just been in the area fixing cleft lips and right after they had departed the wounds began to open. The children were then left much worse off than before. Dr. Saunders emphasized the importance of having a plan in case things do go wrong and not taking on more than you can handle.

Next he talked about sin #2: failure to match technology with local needs and abilities. He discussed the use of cochlear implants with people with very bad hearing loss or deafness. These cochlear implants are not only very expensive but they require a lot of upkeep which is certainly not feasible in Nicaragua. Dr. Saunders then compared the situations of 2 girls in Nicaragua with profound hearing loss. One girl lives in Managua and comes from a middle class family and the other lives in a very rural part of Nicaragua. The one in Managua was able to get a cochlear implant because the technology was available to do so, but the other didn’t have the same resources so a low-tech solution was more realistic for her situation. This made me reflect on how sometimes as Americans we believe that our technology and our ways of doing things are universal, but we have to take into account the locations in which we are helping because high-tech solutions in some cases can prove disastrous.

Sin #3 is the failing of NGOs to cooperate and help each other. There are many charitable organizations out there that do wonderful work in countries like Nicaragua. However, when they don’t cooperate, they don’t make the biggest impact that they could make. Dr.Saunders discussed how in places like Nicaragua communities will never reject service because they are grateful. Nonetheless, there are time when they get the same services over and over which is not really beneficial to them. An organization that provided an already provided service could have allocated those funds for an other purpose that the community could have benefited from.

Sin #4 is failing to have a follow up plan. This sin corresponds with leaving a mess behind. When a medical service is provided there is no guarantee that there will be no complications. Thus, Dr. Saunders stressed training people in the communities to address those complications because realistically there won’t always be an American health professional available. He made the wonderful analogy of not only teaching a man to fish but also giving him a fishing pole. So, Dr.Saunders’ organization is not only training people to handle these complications and to do other general medical work, but it’s also providing the proper equipment to facilitate god medical care.

Sin #5 is allowing politics, training, or other distracting goals to trump service, while representing the mission as service. In certain occasions, political parties within some countries want to use these service missions to their benefit in order to make themselves look better. Dr. Saunders emphasized that you can’t always ignore the politics going on around you, but you just have to along with it and not get sucked into it. In my opinion, I think its very easy to get sucked into politics and very controversial issue when doing service work. I think the best plan is to do work that benefits the masses and that doesn’t take a stance on an issue. For example, one wouldn’t  go into a developing country and start facilitating abortions.

Sin#6 is going where you are not wanted and being poor guests.

Coming from the first world, we tend to think that we are the saviors of the third world and we know what’s right for them. Hence, we impose our will and feel entitled because we are providing “service.” Sometimes our help is not wanted or needed and just being poor guests. Dr. Saunders said that in countries like Nicaragua the people are very polite and won’t refuse your help. However, I think it’s essential to really reflect and ask ourselves if we are helping and making the situation better rather than worse. The medical student that spoke at the end of the presentation spoke about needing to test babies’ hearing for her research. She didn’t simply go into hospitals with the expectation to be able to test these babes because she was from America and providing service. On the contrary, she established relationships and didn’t see herself as above the Nicaraguans. So I think part of being poor guest is having a feeling of entitlement and looking down upon those that we are trying to “help” when in reality we might not even be helping.

Lastly sin #7 is doing the right thing for the wrong reason.

This sin is essential especially in my case because  I have frequently questioned myself as to why I’m going to Nicaragua. The worst thing would be going to pad my resume or to have a travel experience. After a lot of pondering, I realized that I’m doing it out of a love for fellow mankind. When I go to Nicaragua I’ll do my best to serve whole heatedly and taking into account that just because I’m there to serve doesn’t mean I can’t cause damage.

Dr.Saunders was great and provided a lot of insight into not only medical service, but service in general. I know that I used to think that simply because I’m volunteering means that I’m doing a good deed but Dr. Saunders has shown that damage can be caused and we always have to  take into account the seven sins of humanitarian medicine. I want to take it further and say that these sins are applicable to all humanitarian service.