Chapter 20 of Global Health 101, Fourth Edition, addresses the types of players in global health employment and the kinds of knowledge, skills, and experience that one needs to work in the global health field. This post highlights some of the ethical issues that arise in experiential learning in global health and how such experiences might best be structured.
One of the pre-requisites for effective work in global health is an understanding of:
- The health conditions people face in different settings globally
- A range of cultures
- The social, religious, political, and economic settings in a variety of countries
- How different health systems are organized, managed, and operate to address local health conditions
As Global Health 101 makes clear, it is essential if one is to gain such understandings that learners engage in field experiences in global health. Ideally, those interested in pursuing work in global health will have a number of opportunities during their training to undertake such experiences.
Yet, experiential learning in global health, at every level, raises a host of ethical issues. Some of the most fundamental such issues include:
- The relationship between the sending and receiving institutions
- The clarity of goals of the experience to be undertaken
- The extent of the participants’ preparation for the experience and the attitudes and behaviors of proposed participants
- The possibility that participants will engage in actions that exceed their competence and can cause harm to the local community
- The relative costs and benefits of the experience to all involved parties and the clarity and transparency with which they are understood, acknowledged, and paid for
The manner in which institutions, faculty, and participants should approach experiential learning in global health and the ethical issues that relate to it has been the subject of considerable discussion and literature. Faculty and students who are involved in experiential learning in global health are encouraged to scan this literature.
In addition, given the growth of global health courses, the expansion of experiential learning in global health, and the ethical issues involved in such learning, it is essential that those involved in such experiences take a principled approach to them.
The most widely accepted “guidelines” for experiential learning in global health are those published in 2010 by an international “Working Group on Ethics Guidelines for Global Health Training (WEIGHT).”
The WEIGHT guidelines focus on:
- the need for well-structured programs between partners
- the importance of accounting for all program costs
- the goal of mutual and reciprocal benefit
- the value of embedding short-term experiences in long-term partnerships
- the centrality of preparation of trainees, their attitudes and behavior, and the characteristics they need to succeed in their training
- trainee safety and the characteristics of programs that merit support by sponsors
- the importance of adequate mentorship and supervision for trainees
Those organizing, managing, and participating in experiential learning in global health will want to carefully consider the WEIGHT guidelines.
In addition, they will want to pay special attention to the pre-departure training of all participants. There is a range of approaches to and offerings of such training. These come up immediately when one searches for such information. Unfortunately, however, there has been very little evidence-based research about either specific programs or about the relative costs and benefits of alternative approaches to pre-departure training.
Thus, faculty involved in developing or managing such programs may wish to examine a recent review of the literature on such programs:
They may also wish to explore, among other things, the case-based training that Johns Hopkins and Stanford Universities developed for global health field experiences: