As American medical students increasingly
want and expect to have international work experience, more and more
short-term programs are being offered to give them that opportunity,
according to Melissa Melby, assistant professor of anthropology at the University of Delaware.
The trouble is, she writes in a new article in Academic Medicine,
that too many of these programs — called STEGH, or short-term
experiences in global health — focus on the needs of the student
trainees and not on what’s best for their patients or for overall health
care in the countries they visit.
“Most students who participate in these programs genuinely want to
help people,” Melby said. “But many of them may not be aware of the
unintended consequences that can occur. In this article, we propose four
core principles that we hope will help guide both the developers and
the participants in STEGH programs.”
Melby, who specializes in the biological and medical aspects of
anthropology, is the lead author of the article, written with colleagues
who are medical doctors involved with global health care issues. She
said her co-authors, who connected with her through the Delaware Health Sciences Alliance,
of which UD is a founding partner, saw problems with many STEGH
programs and sought her out for an anthropological perspective.
“STEGHs are often very short term, perhaps about three weeks or even
less, and many times the participants are dropped into an area with very
little preparation,” Melby said. “They don’t know the language, they
don’t know the culture, and they’re jet-lagged. They’re
well-intentioned, but this is often not the best way to help people.”
The authors of the paper list four principles that they say can be
used to create better STEGH programs and to help students evaluate
existing programs and make good choices about which to join. The
- Cultural humility. “I think there is a tendency to see
these programs as bringing our advanced technology to people in need,
but we need to realize that our approaches are not always the best in
every context,” Melby said. “In fact, in health care, America doesn’t
have the best outcomes in the world.” The authors advocate that STEGHs
provide specialized cross-cultural training to participants before they
travel and ensure that the students be aware of their own limitations
even after such training.
- Bidirectional participatory relationships. Effective STEGHs
will establish true collaborations and partnerships with local health
care providers and communities, Melby said, focusing on what communities
actually need before offering to provide services.
- Local capacity building. The authors note that unintended
consequences often result when STEGHs come to an area, provide direct
health care to some patients, and then leave. Problems might include a
lack of follow-up care and a tendency for patients to delay seeing local
providers while they wait for outside help to return, undermining the
local health care system.
- Long-term sustainability. “We’d like to see these programs
focus less on direct care and more on larger issues of public health,”
Melby said. Those issues include poverty and inequality, public health
infrastructure and human resources in low-income countries.
While STEGHs can provide students with important global and
cross-cultural education, the authors say they believe a paradigm shift
is needed to ensure that the programs benefit both the trainees and the
communities they visit. And, Melby said, the proposed guidelines can
apply beyond medical or pre-med students to include other study-abroad
and global service-learning programs.
“We think these principles are relevant to a lot of student groups
that do global work,” she said. “Most people’s hearts are in the right
place, but there are often aspects to what they’re doing that they just
don’t think about.”
The article, “Beyond Medical ‘Missions’ to Impact-Driven STEGHs:
Ethical Principles to Optimize Community Benefit and Learner
Experience,” is available online. It will be published in an upcoming print edition of Academic Medicine, the journal of the Association of American Medical Colleges.
The co-authors are Drs. Lawrence C. Loh, Jessica Evert, Christopher
Prater, Henry Lin and Omar Khan, who also is an affiliated faculty
member in UD’s College of Health Sciences.