A Call to Medical School Admissions Committees to Address the Ethical Implications of Voluntourism
Both authors contributed equally to this article and are listed as first authors.
The years of 2020 and 2021 were marked by closed borders and cancelled summer travel. Amongst the many trips that were cancelled were volunteer holidays, a common activity for eager post-secondary students applying to competitive graduate programs, especially pre-medical students. Voluntourism, the act of volunteering abroad whilst on vacation, had a growing market before the pandemic at an estimated global value of CAD $2.6 billion a year [1]. In this article, we provide a concise critique of the practice of voluntourism and its ethical implications, and call on Canadian medical schools to take a stance on unethical international volunteering to prevent and reduce harm to receiving communities. These past two summers free of voluntourism trips offer an opportunity for Canadian universities to explicitly address the role of voluntourism in their admissions processes.
Original illustration by Cassandra Seal.
Almost every large university in Canada has an undergraduate chapter of a voluntourism-oriented group run by students majoring in the sciences. While voluntourism trips are often marketed to pre-medical students, they also target nursing, dentistry, and even high school students [2,3]. Given that a significant number of voluntourism trips are taken by students aiming to gain admission to medical schools, and as Canadian medical students ourselves, we focus this article on voluntourism in that context.
Low acceptance rates augment the anxieties of pre-medical students and in an effort to appear well-rounded, charitable, and altruistic, an increasing number of pre-medical students engage in volunteer work in low-income countries [2,3]. Many companies exploit pre-medical students’ admissions anxieties, marketing such trips as a way to make their applications to medical school appear more competitive [3]. Companies like Projects Abroad, Go Volunteering by Holidays for Humanity, and Go Abroad encourage voluntourism trips as worthwhile additions to résumés [4, 5]. The Princeton Review, one of the largest Medical College Admission Test (MCAT) prep and admissions consulting companies, states on its website that volunteer spring break experiences can be one of many elements helping applicants “craft a stand-out medical school application” [6].
These marketing tactics are an outright contradiction to many medical schools’ admission processes. For example, recruitment materials for McGill University’s Medical School state that voluntourism does not provide a competitive advantage [7]. The University of Toronto’s admissions committee explicitly trains file reviewers to not add value to volunteer experiences abroad relative to those done locally, and instead focus on the nature and outcome of the activity [8]. However, pre-medical students are likely not aware of these guidelines and continue to engage in expensive voluntourism trips, which can inadvertently harm receiving communities.
Ethical Considerations of Voluntourism
Medical schools have an ethical obligation to address issues surrounding international volunteer trips as medical school admission is often a driver of them, thus perpetuating and sustaining this global industry. Indeed, many of these short-term volunteer abroad experiences are known to be of little or no benefit to communities in which they take place. In reality, they are often deeply harmful and exploitative of marginalized groups, including children and impoverished people [2, 3, 9, 10]. In addition, pressures to participate in international volunteering exacerbate socioeconomic inequities amongst applicants in the medical school admissions process. In the following paragraphs, we elaborate on these ethical considerations.
Voluntourism: Saving Children or Profitable Business?
There are many well-documented examples of unethical voluntourism involving volunteering with children in low-income countries [2, 10, 11]. In Haiti, Nepal, and Uganda, to name a few examples, orphanages have been artificially populated through what is best described as child trafficking. Impoverished families are deceived into giving up their children through assurances of good education, healthcare, and a promising future for their children, as well as financial compensation [12-14]. Images of children in these orphanages are then circulated in high-income countries to raise funds and recruit volunteers, who pay large sums of money to participate in short volunteer stints of two or three weeks. Their advertised roles can include teaching English, helping run the orphanage, or short construction projects.
It is doubtful that any meaningful impact or long-lasting change can be achieved in such a short time. Even more troubling is that in many cases, these children have reported beatings, hunger, neglect, abuse, and forced labour by orphanage owners and operators [12]. While such organizations receive massive funding, orphanages are deliberately kept in poor conditions, enabling continued attraction of more funds and paying voluntourists [9, 13]. Voluntourism has turned the institutionalization of vulnerable children, many of whom in fact have families, into a highly profitable business, furthering neocolonial acts of family separation and exploitation of poverty [10]. In addition to these egregious children’s rights violations, research has shown that intermittent, constantly changing, short-term connections with volunteers cruelly disrupt children’s emotional development and well-being because they are deprived of secure bonds [2, 9, 10].
Volunteers: Overconfident and Underqualified
Another serious problem is that many voluntourism trips encourage volunteers to carry out tasks for which they are neither trained nor qualified [2, 3, 11]. One example includes construction work, such as building houses or digging drainage canals. Investigative journalists have documented how Western volunteers with no construction skills were building structures in impoverished communities, only to have them taken apart and rebuilt by local workers during the night because they were structurally flawed [15].
Another example is medical voluntourism trips, in which volunteers perform work far outside their skillset and practice medical procedures on vulnerable groups [2]. Often, interventions can involve temporary fixes such as dispensing medications with no follow-up or understanding of local context and living conditions [3, 16]. In addition to burdening already overstrained local health workers who must supervise them, volunteers often display superiority and misplaced confidence over the impoverished and racialized “other” even as their presence drains resources from and undermines local healthcare systems [2, 3, 16]. McCall and Iltis (2014) have described undergraduate pre-healthcare students as especially eager to participate in healthcare delivery they wouldn’t be allowed to perform at home, leading to several serious ethical violations [3].
Moreover, some estimates have shown that the amount of money volunteers spend on participating in these trips, or organizations spend on hosting volunteers in comfortable facilities, could provide enough funds for a new hospital wing, local healthcare worker salaries, or other sustainable initiatives to meet needs [2, 9, 11]. With NGOs, charities, and private companies seemingly addressing issues of poverty (often through temporary, superficial fixes), the attention and pressure shifts away from governments and public institutions to effect upstream systemic change [2]. With virtually no accountability, medical voluntourism has been shown to harm patients medically and psychologically through intermittent sub-par care [11, 16]. It detracts from long-term healthcare investment and local initiatives and ensures “that locals remain firmly at an assumed level of helplessness to secure more volunteer placements” [3].
Voluntourism: An Act of Neocolonialism
With these examples in mind, it is not hard to understand how voluntourism has been likened to a form of neocolonialism by critical global health scholars [2, 9, 16, 17]. Voluntourism carries paternalistic attitudes of Western superiority, reinforcement of asymmetrical power dynamics between Western volunteers and receiving communities, direct harmful effects to receiving communities, and often self-serving motives for volunteers and volunteering companies [2, 9, 16, 17]. Voluntourism entrenches stereotypes through trivial and problematic analyses of poverty and culture, and perpetuates inequities by distracting from the structural, political, and economic issues that marginalize in the first place [2, 9, 16].
Inaccurate Marketing
Volunteers drawn to trips promising meaningful and life-changing experiences can become disillusioned upon critical reflection [18]. Some have learned that the orphanages in which they volunteered were not real. Others were disappointed by the unsuitable accommodations they received despite paying thousands of dollars [18]. Furthermore, there are also legitimate safety concerns when travelling abroad or engaging in medical and construction work without the appropriate training to prevent injuries to self and others.
Socioeconomic Inequities in the Medical School Admissions Process
Engaging in voluntourism can not only harm the host community, but also poses a burden on the student engaging in it. Not only does voluntourism carry with it enormous costs, it also requires students to forgo paid work. Students from higher income backgrounds are able to engage in such experiences with limited financial repercussions while students with less financial resources are burdened by their prohibitive cost. This demonstrates how voluntourism exacerbates the well-documented ways in which the medical school admission process confers both implicit and explicit advantages to wealthier applicants, such as greater access to opportunities that build competitive applications [19]. Addressing voluntourism also serves to work towards greater equity in the medical school admissions process.
Calls to Action
Given the serious ethical concerns and harms associated with voluntourism, we urge Canadian universities, and in particular medical schools, to clearly dispel any misconceptions that such overseas voluntourism trips are advantageous to gaining entry into programs, as well as take a stance against unethical international volunteering. This should be unequivocally stated on admissions and recruitment materials. Furthermore, healthcare professional training programs should commit to ensuring that students receive adequate training on the importance of ethical global health engagement based on principles of solidarity and social justice [20].
Zainab Doleeb, BA, is a medical student who is deeply passionate about health equity and global health. Born in Sudan and raised in Winnipeg, she now proudly calls Toronto home. Prior to entering medical school, Zainab earned an Honours in International Development Studies at McGill University. During that time, she concurrently completed two internships and was an active student organizer earning the Community Engagement Award for her work addressing health inequity and refugee health. Before entering medical school, Zainab spent a year doing health policy research in India, studying Spanish and travelling. In medical school, she was a researcher at the Reach Program, a coordinator for the UofT International Health Program and a student leader helping design a global health certificate program for the MD Program.
Nikisha Khare, MPH, has significant global health experience, with a focus on migrant, gender, and environmental justice and their intersections with health. She holds a research-based Master of Public Health and is currently a fourth-year medical student at the University of Toronto. She has previously worked at the First Nations Health Authority and has been an active member with various community and advocacy organizations as well as transnational solidarity efforts. Nikisha has taught medical student and undergraduate-level courses and seminars on various topics in global health and has also presented at numerous conferences. In addition, she has been working towards integrating anti-oppressive approaches in the medical school curriculum and in the establishment of a global health certificate program at U of T.
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