Partners and Hosts: Narratives about Power and Relationships in Short-term Medical Service Trips

Short-term medical service trips (MSTs) performed by volunteers from high-income countries (HICs) represent an effort to address healthcare resource shortages in low- and middle-income countries (LMICs). The development literature asserts "partnerships" as the gold standard for ethical and sustainable service delivery, but the concept is poorly defined. We aim to present the perspectives of MST volunteers to examine their descriptions of relationships they pursue and maintain with healthcare workers (HCWs) in other countries. The MST literature does not previously include examinations of these relationships for their effort to establish reciprocity and local empowerment.

Using a case-study approach, we gathered data from 27 semi-structured in-depth interviews conducted with the key members of a single medical service organization and analyzed the qualitative data using the constant comparative method.

Efforts to establish relationships between medical service teams and local HCWs face challenges of mutuality that mirror those of other development activities. The actual terms the volunteers use for relationships formed with HCWs in LMICs are inconsistent. The descriptions of these relationships also vary illustrating mechanistic elements and signs of partnering. While the organization encourages the development of partnerships with local HCWs, there is no uniform reflection of a balance of power. Those relationships that reflect a balance could serve as the basis for improving others.

Historical and cultural barriers to the development of partnerships may be exaggerated by the short-term nature of MSTs and be difficult to overcome without a constant presence or consistent culturally sensitive communication between the parties involved. Individual team leaders are responsible for the culture on their team. That leadership can either promote interactions that empower or overpower local HCWs. Awareness of the lack of balance in power and the sociocultural impact of that imbalance may help medical service volunteers provide higher quality care in these settings.