When numbers eclipse narratives: a cultural-political critique of the ‘ethical’ impacts of short-term experiences in global health in Dominican Republic bateyes

• Published in: Medical humanities Vol. 48; no. 2; pp. 190 - 199
• Main Author: Wilson, Brenda K
• Format: Journal Article
• Language: English
• Published: United States BMJ Publishing Group Ltd and Institute of Medical Ethics 01.06.2022; BMJ Publishing Group LTD
• Subjects: Attention; Blocking; Counting; Critical theory; Ethics; Ethnography; health care education; Health disparities; Humanities; Learning activities; medical anthropology; Medical ethics; medical humanities; Migrants; Original research; politics; Power; Preoccupation; rhetoric of bioethics; Service learning; Short term; Stakeholders; Volunteers; Dominican Republic; politics; health care education; medical anthropology; medical humanities; rhetoric of bioethics
• ISSN: 1468-215X; 1473-4265
• DOI: 10.1136/medhum-2021-012252

With the rising demand for short-term experiences in global health (STEGH) is an ever-increasing volume of literature that focuses attention on ethics and ethical concerns, such as the effects of STEGH on host populations. Such concerns have driven the development of ethical principles and guidelines, with discussions and debates largely centred around normative questions of positive/negative and benefit/harm for us/them. Using a critical medical humanities lens, this paper blurs these dichotomous framings and offers a more complex understanding of the effects and effectiveness of STEGH on hosts. I explore STEGH that send volunteers from North American universities to the Dominican Republic to participate in service-learning activities aimed at improving the lives of impoverished Haitian migrants living in bateyes. I address the following questions: What perspectives about the impacts of interventions on host communities manifest through STEGH? What tensions emerge through interactions among diverse stakeholders related to those perspectives, and with what effects? Drawing together critical theory and ethnography, I examined the perspectives of three stakeholder groups: student and faculty volunteers, host organisation staff, and hosts in batey communities. Data collected from observations and interviews were counterposed; I analysed interactions and interplay between stakeholders. My findings revealed conflicts around an emergent theme: counting efforts, or volunteers’ proclivity for numerical evidence of impactful STEGH for hosts. With attention on power relations, I argue that a preoccupation with quantifiable evidence eclipsed and erased the lived realities of hosts, thereby blocking a fully ethical engagement. These sociopolitical effects, often overlooked in conventional ethics assessments, are no less harmful and may reinforce rather than reduce inequalities that the global health movement seeks to eliminate. My study offers a compelling case for how the critical medical humanities lend critical insights in the name of improving global health.