Perceptions of Orthopaedic Volunteers and Their Local Hosts in Low- and Middle-Income Countries: Are We on the Same Page?

Abstract

Objective: Our goal was to compare the perceptions of overseas orthopaedic volunteers and their hosts in low-and middle-income countries (LMICs) regarding the role of international volunteerism. We also sought to determine if differences in perception exist between trainee and fully trained orthoapedic surgeon volunteers. Methods: Surveys with similar multiple-choice and open-ended questions were administered to 163 Health Volunteers Overseas orthopaedic volunteers (response rate 45%) and 53 members of the host orthopaedic staff (response rate 40%). Fifty-four volunteers and 20 hosts also contributed open-ended responses. Quantitative responses were analyzed for significance using Mantel-Haenzel x 2 tests. Open-ended responses were coded using thematic analysis.Results: Both the international volunteers and their LMIC hosts agreed that volunteers learned new skills while volunteering. Both groups believed that international volunteerism had a positive overall impact on the local practice, but hosts viewed these benefits more favorably than volunteers did. LMIC staff believed that, besides altruistic reasons, volunteers were also motivated by professional gains, diverging from volunteer responses. In open-ended responses, hosts desired longer term commitments from volunteers and had some concerns regarding volunteers' qualifications. Between volunteer trainees and fully trained surgeons, trainees were more likely to be motivated by personal benefits. Conclusion:Efforts must be made to further align the expectations and goals of volunteers and their hosts in LMICs. Certain measures such as predeparture orientations for volunteers and developing a more longitudinal and bidirectional experience may enhance the impact of orthopaedic volunteerism in LMICs. Further studies are needed to explore the impact of international orthopaedic volunteerism on the host population.

Clinical Observership Opportunities in North America for International Orthopaedic Surgeons

“…Despite strong interest in these rotations from orthopaedic programs 2,3,8 , literature reporting their motivations and impact is sparse. Thus, for this analysis, we included surgical resident rotations beyond orthopaedics to identify practices that minimize harm and share benefits with LMIC partners 43,44 . The available data from the LMIC perspective shows that the most important component of HIC collaboration is sustained investment.…”

Resident Rotations in Low- and Middle-Income Countries

“…Despite strong interest in these rotations from orthopaedic programs 2 , 3 , 8 , literature reporting their motivations and impact is sparse. Thus, for this analysis, we included surgical resident rotations beyond orthopaedics to identify practices that minimize harm and share benefits with LMIC partners 43 , 44 .…”

Global Surgery Pro–Con Debate: A Pathway to Bilateral Academic Success or the Bold New Face of Colonialism?

“…For example, a survey of orthopedic volunteers and host country staff indicated "Although volunteers and hosts typically believed that the volunteers were strongly motivated by the altruistic aspects of volunteering, host responses suggested that they perceived that volunteers were also motivated by their desire to practice and learn new techniques and enhance their professional careers." 30 The authors postulated that "Discrepancies in perceptions of volunteer motivations could be due to a paternalistic attitude of the volunteers, who may have preconceived notions that they come from a superior medical system and that their primary role was to teach rather than participate in a bidirectional relationship". 30 In an accompanying editorial to the previously mentioned general surgery survey, it was stated that "there must be competent supervision provided for all trainees so that unsuspecting and uninformed patients are not harmed by inadequately trained residents.…”

“…30 The authors postulated that "Discrepancies in perceptions of volunteer motivations could be due to a paternalistic attitude of the volunteers, who may have preconceived notions that they come from a superior medical system and that their primary role was to teach rather than participate in a bidirectional relationship". 30 In an accompanying editorial to the previously mentioned general surgery survey, it was stated that "there must be competent supervision provided for all trainees so that unsuspecting and uninformed patients are not harmed by inadequately trained residents. 31 Meanwhile, how many hospitals in the United States do we see LMIC medical students, residents, and fellows walking around going to operating rooms and trying to operate?…”