From short-term engagements to meaningful and equitable global health partnerships

Abstract

he struggle for global health equity is complex, often fueled by a desire for quick solutions. Though global health should be a broad, ‘big-tent’ endeavor, quite often it gets simplified to the immediacy of clinical medicine. Short-term global engagements in global health (STEGH), like medical missions and student trips, embody this impulse. These, like many other aspects of global health, have roots in the late 19 th century as a largely neocolonial pursuit of “interna- tional medicine” [1]. These may also be driven by availability of opportunities and push towards broader marketization of global experiences—not just by the need of the respondents, but also by the supply of these opportunities [2]. While these activities may come from altruis- tic intentions, that of ‘hoping to help’, they often create more problems than they solve [3]. STEGHs may inherently be hampered by lack of context, thereby neglecting the unique needs and cultural nuances of communities, leading to interventions that are irrelevant, dis- ruptive, or even harmful [4]. Despite overwhelming evidence that clinical care contributes to ~10% of the health of a community, emphasis on a predominantly biomedical model of health and healing ignores socio-cultural and sprititual perspectives that can predispose a rejection of health services by communities [5]. Imagine delivering a week-long diabetes management workshop in a community struggling with malaria—the mismatch is clear. This mismatch in disease-based approaches, or when the socio-cultural factors are not considered, can lead to lasting mistrust of health care systems, as has been seen in the rejection of vaccination or emer- gent Ebola care