When people ask me to tell them about my study abroad trip to León, Nicaragua, I often blank out – it’s just too much to summarize in a few sentences. The main reason for my study abroad trip was to construct an independent research project.  I chose to interview representatives from non-governmental organizations (NGOs) that work in the health field in Nicaragua, especially concerning the tactics they use to deal with cultural and linguistic differences encountered by volunteers. Each week I had to write a reflection paper about my project.  The following the reflection I wrote during my last week in Nicaragua which sums up a lot of what I learned during my short 6 weeks in León.

When reflecting on these past few weeks, I had a lot of regrets. I wished I had made more contacts, talked to more people, and conducted more interviews. I was focused on the quality of the written component of my experience, and I was afraid my final paper would fall short of the expectations I had initially established for myself.

However, I now see that my thought process was off track. I was focusing on the physical product – the paper – and not paying enough attention to the process that brought me to the writing phase of my research. No, I did not have as many interviews as I set out to have, but the ones I did have were incredibly insightful, and the majority of them turned into deep conversations that lasted well over an hour. Many of my contacts also referred me to other people or resources relating to my topic, and from that I gathered a well-rounded view that I could not have experienced from only poring over journal articles.

The greatest product I took away from this study abroad is a nearly complete change of mentality about NGOs and their work with populations such as those in Nicaragua. Though it may sound corny and cliché, I feel that, as a future health care provider, I have greatly matured. I have begun to see the ‘bigger picture’ and have changed my views concerning work with underserved populations.

I am somewhat ashamed to say that I was one of those people whose intentions were not entirely selfless when I spoke of participating in future health brigades abroad or taking part in short-term service work. I was selfish, and I wanted another space on my résumé to be filled.  I felt this was justified by the fact that I would have a fulfilling experience and would have made some huge difference in someone’s life. However, I found that on a trip so short-lived, the only real change would occur within oneself, unless that person is lucky enough to make an impact on someone else.

I have come to realize the potentially devastating effects such “volunteer tourism” may have on a community. We may think there is nothing wrong with providing free health care or community workshops, as they may be items some populations may never receive – but if done the wrong way, the work of NGOs can lead to dependency and a lack of confidence in a community’s own self-sustainability. A two-week medical brigade from the states is likely to have more high-tech equipment and more access to resources like lab tests or specialty care than the health care providers of the native population. Will this lead the members of the community to believe that the care they are provided year round is inferior, and will they lose faith in their local health care providers’ work because of his or her lack of resources? Oftentimes brigades are short-term, provide inadequate follow-up care, and do not work in conjunction with existing organizations or the government. When this occurs, is it really making a positive impact on the community? If it does, then why are there still so many areas in Nicaragua that struggle with inadequate healthcare even after numerous brigades visit every year? Wouldn’t you think conditions would be much better after all this hard work? Perhaps the correct reasoning is that not all the time and money from NGOs has been used in sustainable practice.

I don’t mean to sound pessimistic – there are many great NGOs that do amazing, well-planned work. However, the “good Samaritan” attitude often overlooks the needs of the populations most at risk.  To prevent such mistake we must educate ourselves on the consequences of our actions.  As future physicians, we have a calling to serve people in need – let’s make sure we do it ethically.