Mobile professional voluntarism and international development : killing me softly?

This book explores the impact that professional volunteers have on the low resource countries they choose to spend time in. Whilst individual volunteering may be of immediate benefit to individual patients, this intervention may have detrimental effects on local health systems; distorting labour markets, accentuating dependencies and creating opportunities for corruption. Improved volunteer deployment may avoid these risks and present opportunities for sustainable systems change. The empirical research presented in this book stems from a specific volunteering intervention funded by the Tropical Health Education Trust and focused on improving maternal and newborn health in Uganda. However, important opportunities exist for policy transfer to other contexts

The ethics of educational healthcare placements in low and middle income countries : first do no harm?

This book examines the current state of elective placements of medical undergraduate students in developing countries and their impact on health care education at home. Drawing from a recent case study of volunteer deployment in Uganda, the authors provide an in-depth evaluation of the impacts on the students themselves and the learning outcomes associated with placements in low resource settings, as well as the impacts that these forms of student mobility have on the host settings. In addition to reviewing the existing literature on elective placements, the authors outline a potential model for the future development of ethical elective placements. As the book concurs with an increasing international demand for elective placements, it will be of immediate interest to universities, intermediary organizations, students as consumers, and hosting organisations in low-resource settings

Volunteering and overseas placements in the NHS : a survey of current activity

Objective The study aimed to establish current levels of overseas volunteering and placement activity across all staff grades within the NHS in the North West of England. Design Cross-sectional survey. Instrument Descriptive statistics. Setting Four main regional hospitals in the North West of England, and additional NHS staff training events. Participants Convenience sample of NHS staff (n=911) Results 911 NHS staff took part in the survey. The medical and dental staff group returned the highest number of responses (32.1%). 42% of staff reported some form of overseas volunteering or placement experience. Most staff took an international placement as students (33.6% males; 40.6% females). Medium term placements were undertaken by 46.7% of males, and 52.5% of females. Settlement stays (i.e. over 1 year) were reported by 7.6% males, and 8.3% females). The majority of respondents engaged in international placement were from the age groups incorporating ‘below 25’ to ‘41-50’ (74%). Multiple placement experiences were uncommon: 2.5% of respondents reported three periods of overseas activity, and 1.5% reported four. All those with multiple placement experience came from the staff groups incorporating midwife / nurse / health visitor, and medical and dental. Conclusions This survey captured a snapshot of current levels of volunteering and overseas placement activity across NHS staff grades in the North West. Due to relatively homogenous organisational structures, findings are likely to broadly represent the position across the organisation as a whole. Although some degree of overseas placement activity is undertaken by a relatively high proportion of NHS staff, such activity is currently heavily skewed towards higher clinical staff grades. Significant numbers of allied health professionals and equivalent non-clinical cadres also report overseas experience, and we anticipate that numbers will continue to rise if current policy initiatives gain momentum

Optimising student learning on international placements in low income settings

This paper challenges the assumption that student visits to low resource settings inevitably promote the acquisition of cultural competence. Much of the literature and marketing rhetoric advocating the expansion of such ‘exposures’ lists numerous positive outcomes with an emphasis on ‘cultural learning’. With important exceptions, the concept of cultural learning remains uncontested, nestling in the fluffy haze of an inherently benevolent multi-culturalism. The emphasis in current research is on ‘learning’ or ‘competency’ at the expense of definitional clarity around the concept of culture itself. This results in a tendency to overemphasise (and essentialise) difference rather than commonality and conflates cultural learning with narrow (stereotypical) concepts of race, ethnicity and religion. The paper discusses the experiences of students undertaking placements in Uganda through Knowledge For Change, a UK charity hosting the Ethical Educational Placements project, to identify and critique this dimension of ‘learning’. Using an action-research approach combining observational research with qualitative interviews and surveys the paper uncovers the nuance of cultural learning. In important respects the behaviour that students are witnessing and attributing to culture is connected more to the specific organisational contexts that they are placed in and the patient groups they ‘serve’ than any connection to an homogenous ‘national’ culture. Poverty and gender inequality, amongst many other forms of structural inequality, result in ‘othering’ behaviour on the part of health workers towards patients that is a fundamental characteristic of public health organisations in residualised welfare systems. In this complex environment, cultural learning is not so much about celebrating difference. It is more about understanding social context and accepting that you don’t and can’t possibly know a person’s situation; and with that in mind you should treat everyone with the same degree of humility and respect. Adopting and practising ‘epistemic humility’ (Hanson et al 2011; Ahmed, Ackers-Johnson & Ackers 2017) is crucial to meaningful learning in any context. Further, a lack of understanding of the broader structural processes perpetuates inequalities between the Global North and South (Husih, 2012; Ahmed, Ackers-Johnson & Ackers, 2017) and impedes knowledge acquisition, particularly cultural learning. Moreover, hubris – or Western students’ assumptions of superiority over host health care workers (Bauer, 2017; Elit et al, 2011, Ahmed, Ackers-Johnson & Ackers, 2017) – may act as a further obstacle to cultural learning. Cultural learning is as much about learning about ourselves and what it feels like to be ‘othered’ as it is learning about others. International placements in LMICs create critical opportunities for relevant student learning. But achieving this and guarding against the risks of ‘mis-learning’ requires the level of cultural brokerage provided by ‘More Knowledgeable Others’ that we take for granted with clinical learning

Healthcare, frugal innovation, and professional voluntarism : a cost-benefit analysis

This book investigates what international placements of healthcare employees in low resource settings add to the UK workforce and the efficacy of its national health system. The authors present empirical data collected from a volunteer deployment project in Uganda focused on reducing maternal and new-born mortality and discuss the learning and experiential outcomes for UK health care professionals acting as long term volunteers in low resource settings. They also develop a model for structured placement that offers optimal learning and experiential outcomes and minimizes risk, while shedding new light on the role that international placements play as part of continuing professional development both in the UK and in other sending countries

Opportunities and challenges for improving antimicrobial stewardship in low and middle income countries ; lessons learnt from the maternal sepsis intervention in Western Uganda

This paper presents findings from an action-research intervention designed to identify ways of improving antimicrobial stewardship in a Ugandan Regional Referral Hospital. Building on an existing health partnership and extensive action-research on maternal health, it focused on maternal sepsis. Sepsis is one of the main causes of maternal mortality in Uganda and Surgical Site Infection, a major contributing factor. Post-natal wards also consume the largest volume of antibiotics. The findings from the Maternal Sepsis Intervention demonstrate the potential for remarkable changes in health worker behaviour through multi-disciplinary engagement. Nurses and midwives create the connective tissue linking pharmacy, laboratory scientists and junior doctors to support an evidence-based response to prescribing. These multi-disciplinary ‘huddles’ form a necessary, but insufficient, grounding for active clinical pharmacy. The impact on antimicrobial stewardship and maternal mortality and morbidity is ultimately limited by very poor and inconsistent access to antibiotics and supplies. Insufficient and predictable stock-outs undermine behaviour change frustrating health workers’ ability to exercise their knowledge and skill for the benefit of their patients. This escalates healthcare costs and contributes to Anti-Microbial Resistance

POCARIM policy report 7 : The importance of networking to the careers, mobilities and impacts of POCARIM respondents

Between 2011 and 2014 a multinational team of academics and researchers collaborated on a research project funded by the European Commission under the Framework 7 Programme: Mapping the Population, Careers, Mobilities and Impacts of Advanced Research Degree Graduates in the Social Sciences and Humanities (POCARIM).One aim of the project was to further our understanding of the role of networks in the careers of social science and humanities (SSH) researchers: how they are formed, how they are sustained or fall out of use, how they link researchers across disciplinary, sectoral and national boundaries, and what impacts they have on careers.In this policy report we present the project’s key findings on the nature of networking in the careers of SSH researchers. Our findings are based on original work carried out in each of the POCARIM countries and which includes: a review of the literature, policy and existing data, as well as original empirical survey and interview research. In the conclusion we draw out the implications of our findings for policymakers