Ethical considerations for health-related service-learning programs.

To the Editor:

I read with interest Saffran’s[1] commentary “Dancing Through Cape Coast: Ethical and Practical Considerations for Health-Related Service-Learning Programs.” This and several other recent articles give U.S. medical students, clinicians, and educators plenty to digest regarding the ethics of temporary international learning experiences.[2-4]

From where I live and work in El Salvador, having advised several visitors on medically related work here, I have developed views less nuanced than those presented in these articles. Recognizing primary intent as the critical object of concern, here I present reasons for individuals not to participate in short-term medical programs.

If you are going to be close to a beach, a mountain, or other tourist destination, do not go.

If you are going to learn a clinical skill or research methodology in which you have not previously developed some level of proficiency, do not go.

If you are going to use your medical skills to convert others to your religious, political, or economic ideology, do not go.

If you are in training, and going (as one student commented off-handedly) to “do whatever you can get away with clinically,” do not go.

If you are a specialist, and are going to practice outside of your specialty, do not go.

If you are a generalist, and are going to practice beyond your regular capabilities, do not go.

If you are a medical educator, and are going to be the authority without considering the social context of your area of expertise, do not go.

However, if you are going to learn, to grow, and to open yourself to potentially life-changing experiences—if your interest is in developing new understandings of illness and disease from multiple biological, psychological, and social perspectives—then by all means, go.

Go in humility, go in reflection, and go in solidarity. And return a better physician for having gone.