BACKGROUND
An estimated 40% of medical students seek out experiences working in resource-poor settings during their training and significant numbers also contribute after graduation.1 It is argued that this benefits their hosts and, some believe, the UK too.2,3 In this issue Elnawawy et al report on the complex issues identified through qualitative study of one such voluntary primary care scheme in Nepal.4 Despite a small number of respondents from a single non-governmental organisation in one country, these interviews highlight a number of important issues that chime strongly with our experiences, including the risk of significant unanticipated negative impacts. We argue that elective students, doctors seeking out-of-programme experiences, and experienced GPs should be encouraged to deeply consider what they are hoping to achieve, and how they can ensure their contributions are positive, both for themselves and their hosts. ‘Donor’ organisations facilitating placements (including medical schools and deaneries) should also plan, prepare volunteers, and carefully consider contextual issues as part of their responsibility.
Elnawawy et al offer few specific solutions, so in this editorial we seek to increase awareness among medics wanting to work in resource-poor settings and argue for more considered models. Collectively we have witnessed highly-effective, positive outcomes as well as poorly conceived and misguided visits. We discuss some of these and conclude that there should be more organised ‘fair trade’ type opportunities, perhaps including a ‘kite-mark’ system to improve standards or to be in line with the …