Respecting local communities and healthcare workers

I devoted nearly 30 years to the humanitarian-development field throughout Central America. In this time, I have worked with international organizations such as KEPA Finland, SNV from the Netherlands, Center for Economic Justice, Global Insight, International Partners in Mission, Medwish International, and more recently with the Ken and Oli Johnstone Foundation. I have acted as a field researcher, communication officer, regional representative, and region program manager. I have developed experience in gender programs, evaluation and monitoring, logistical organization for short-term humanitarian trips, health projects, economic initiatives, and community development. My exposure to families most in need of assistance has widened my eyes to the human dimensions of sustainable development. Health is a top priority, and I have offered my knowledge, skills, and professionalism to help those who struggle to find better solutions to long-term problems. 

My journey is multinational. I grew up and went to college in Nicaragua. Then, I finished my studies on Conflict Resolution in Birmingham, United Kingdom. Later, I earned a master’s degree in Sustainable International Development from Brandeis University in the United States. Today, I live in El Salvador, supporting a variety of aid projects in Latin American. Besides that, I biked across the United States in 1996 as part of Bike Aid, a student organization from the University of San Francisco.

Magda Lanuza, post author 

School children welcome a medical team in Southern Honduras as families wait for doctor’s visits.

There is a frequent misconception that low-income countries need any medical volunteer with any medical background. Beyond that, some medical aid teams tend to only pay attention to a country in the aftermath of a natural disaster or a post-conflict situation. For example, I saw a surge of short-term medical aid teams and humanitarian aid teams travel to Central America immediately after Hurricane Mitch in 1998. In light of these experiences, several lessons have come to mind that are of paramount importance. When considering a medical aid trip, the first question to ask oneself is this: What is the ongoing reality in the country or community before you arrive there? Subsequently, what will it be after you leave? In my experience, local professionals almost always cover immediate lifesaving needs. However, there might be a constant need for specialized medical personnel with skills that are not readily available in the country, as well as certain medical products. Implementing medical aid projects guided by data and situational awareness have the most significant impact. My hope is this post helps prompt a series of questions to ask and offers a sharper perspective on preparedness before your next project.

Mini Case Study: Central American Health System Challenges

Many Pan American Health Organization (PAHO) member countries strive to offer services through public and private practices, yet health care access remains a challenge. Most public health systems run under the state’s responsibility to benefit the greatest possible majority of the population, including the most financially impoverished individuals and families. The primary constraint of public health that I have seen is the limited investment made since the 1990s. In my interaction with public health officials, it is clear that many countries have followed international financial institutions’ advice to cut public spending, pursue privatization and implement highly targeted health system strengthening programs as opposed to a systemic approach, which has resulted in continued healthcare access problems for low-income communities. In this context, external aid in the form of skilled medical volunteers and medical product donations will find targeted niches.

Outside help is needed, but foreign medical teams must also be familiar with the context and conditions so that their efforts are targeted to the places of need.

In Central America, I’ve seen public healthcare facilities under strain. The budget cuts are an important factor leading to the overwhelmed systems, with large percentages of the population requiring public assistance. This dynamic sets these countries up as prime recipients of medical aid. Skilled and knowledgeable professionals handling day-to-day medical care can often be found throughout public healthcare facilities, even if they are frequently understaffed. Some of the greatest needs are usually from a lack of equipment, furniture, and supplies available to meet the demand. Outside help is needed, but foreign medical teams must also be familiar with the context and conditions so that their efforts are targeted to the places of need. Considering a thorough pre-coordination effort and making direct contact with officials and others on the ground before your visit is the first step in ensuring a successful short-term medical aid trip.

Suggestions & Advice for Medical Aid Teams                     

In the last five years, the effort to achieve the Sustainable Development Goals are moving some nations to invest more in improving access to quality healthcare. Part of those efforts is infrastructure improvements and extension of the services to reach larger portions of the population. One incredibly effective way I see for achieving greater reach is the practice of engaging local health volunteers trained to offer basic advice, conduct patient intake interviews and gather data for professionals at healthcare facilities. These volunteers are involved in outreach to patients at the community level – particularly in rural villages where health facilities are not universally found. These volunteers often know the community’s health issues well and educate families on managing their health situations with a preventative approach, thus significantly reducing the long-term dependence on outside care.

In addition to knowing how a country’s health system is set up and where its gaps exist, medical teams should prepare for a tremendous lack of resources in some countries. It can be extremely challenging for volunteers when faced with environments drastically different from what they have known. Medical supplies are often scarce and their use is adjusted in light of this scarcity. For example, in some places throughout Central America, I’ve seen that gloves are primarily for doctors’ use during check-ins and surgical procedures. I once was told of a nurse practitioner from the United States who came to Nicaragua as a public hospital volunteer. She could not believe that nurses were not using gloves and was appalled. She was so upset that she offered them her own gloves. The nurses rejected her offer and said they would not wear them because it was too hot. This incident became a huge source of controversy for the volunteer and the experience was frustrating on both sides. Mutual learning may have occurred if the volunteer built a greater relationship, understood she received a polite excuse and she sought to understand. The medical team leader should prepare their team members for these experiences.

Health care workers on the ground have tremendous experience and knowledge of the local health challenges.

Health care workers on the ground have tremendous experience and knowledge of the local health challenges. Even more importantly, local people can often trust their own healthcare workers the most. When a short-term medical aid team comes in, advanced information and context should come from those local experts; going without this knowledge can be like entering a dark, unknown forest. For instance, I once visited a remote El Salvadorian village with a medical aid team. Suddenly a local community health volunteer said upon hearing of our next stop, “You cannot go to that place for obvious security reasons.” How could we have known this was a gang-controlled area without the help of this local health worker? Local input not only increases medical knowledge, it undoubtedly saved us from putting our volunteers’ lives in harm’s way during this particular trip.

Magda Lanuza (far right) Meeting with Salvadorian Doctors in 2013

The experiences of medical aid teams are life-building. A significant value of the visit in the end often is not the help offered, but the beautiful possibility of learning from others. When the trips are designed carefully, they can provide critical support for local health systems. Ministries of Health often have protocols to follow for effective service. By considering these protocols and working with local medical staff, teams are set up for success. Local contacts or pre-established relationships with a medical clinic, public hospital, or a local health organization, will make a difference. Medical aid trips offer an opportunity for a positive experience of volunteer and host community. Sometimes, a lack of resources can be shocking. However, a willingness to learn about the specific local needs makes an essential difference in the lives of those who seek support and hope.

Questions to consider when planning a Medical Aid Trip:

  • What is the ongoing reality in the country or community before you arrive there? What will it be after you leave?
  • How will your team learn about the country you will serve? How has its medical system evolved? What is the current setup?
  • What health system gaps can your team fill that make a meaningful long-term impact?
  • What efforts are your team making to build a relationship with a locally run organization, health facility, or local government agency that could invite your team to support that locally run effort?
  • How will your project reduce dependency on outside help?
  • What can your group learn from local medical providers?
  • What local government protocols, regulations, and licensure requirements does your team need to understand before embarking?


This post is part of our resource toolkit on community input and leadership for program success.

Comments (1)

Arnold Matlin, M.D.

This is a very important article. We can all learn from it.

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