Beyond Voluntourism: A Sustainable Approach to Global Medical Missions

As the field of dermatology becomes increasingly global, medical volunteerism continues to attract physicians eager to make a difference in underserved communities. The visual language of dermatology allows dermatologists to contribute greatly to cross-cultural education and teaching despite language barriers. Successful volunteer programs must provide a safe and comfortable environment for volunteers, who take time out of their busy clinic schedule and responsibilities to volunteer in foreign countries whose medical institutions, practices, and culture are often unfamiliar territory.

Similarly, volunteers should be culture-aware for successful missions, thus allowing pleasant volunteer experiences and sustainable future medical missions. Many international mission trips—despite good intentions—fall into the trap of “voluntourism:” offering transient aid without meaningful, long-term impact on local health systems.^1-4 While these experiences can be incredible opportunities for medical volunteers, they often fail to provide a lasting impact for the host country and host medical community despite exposing volunteers to valuable insights into unique cultures and global health disparities.^3,4

Our recent dermatology-focused multispecialty mission to Agadir, Morocco and region, sought to break this cycle and establish a sustainable relationship with the local health care partners. Organized with medical volunteers from Peer2Partner.org and in partnership with the American Moroccan Competencies Network (AMCN), we leveraged the established collaboration between AMCN with the Moroccan government, specifically the Ministry of Foreign Affairs and Ministry of Health, as well as the local authorities, including university hospitals and medical schools. Our mission embraced a sustainable volunteerism model focused on long-lasting education, collaboration, and responsiveness to community needs. We made sure to not only provide a unique cultural and enjoyable experience for our medical volunteers, but also to contribute in a sustainable knowledge transfer to the host medical community.

Aligning With Host Country Needs

The most common reasons volunteer efforts fail and/or fall short of achieving sustainable outcomes are a misalignment with the host country’s medical infrastructure, resources, and priorities. We began by identifying key areas of improvement in dermatologic care and education in southern Morocco–particularly the shortage of dermatology teaching faculty and limited access to equipment for skin cancer screening and excisions.

Rather than bringing a large team of US-trained generalists or trainees, we assembled a focused group of board-certified specialists with teaching experience. Volunteers were chosen based on local host community needs, ensuring that their expertise would not only supplement clinical care, but also empower local providers through training and mentorship. Our physician team consisted of 6 dermatologists accompanied by physicians from other specialties, including ophthalmology/oculoplastic surgery, radiology, and obstetrics and gynecology.

Collaboration as a Cornerstone

True impact requires effective collaboration with existing host medical partners and institutions. Our medical volunteers with Peer2Partner.org worked directly with the leadership of AMCN, to plan in advance the details and collaborations of our mission along with our colleagues in Morocco, a key metric of successful mission. In Agadir, we worked closely with academic dermatologists, teaching faculty, hospital leadership, local nonprofits, and government officials. This groundwork allowed us to co-develop our schedule and align our goals with the local needs, creating a framework for trust and continuity.

We found that shared ownership of the mission objectives significantly increased local engagement and opened doors for future partnership. Our team didn’t “drop in” for care. Rather, we partnered to plan, teach, and learn side-by-side. We coordinated our efforts based on the specific community needs by offering a medical symposium along with direct teaching in larger cities with an existing academic community (Agadir), while providing more 1:1 teaching to generalists in more remote and rural communities (Tafraoute) with limited medical professionals.

Teaching Over Triage

While it is tempting to focus on high patient volumes during short-term missions, our team prioritized knowledge transfer through teaching over direct, unsupervised care provided by our volunteers without imparting knowledge to the local existing medical professionals who would be present and would continue to implement strategies gained. Working in tandem with Moroccan dermatologists and surgical specialists, we delivered hands-on clinical education through teaching rounds, bedside instruction, and joint surgical procedures.

A highlight of our mission was the Innovations in Medicine: Agadir Symposium, a one-day academic event hosted in collaboration with Université Ibn Zohr’s Faculty of Medicine. With attendance from local medical students, residents, fellows, and faculty, the symposium featured high-yield lectures in dermatology, Mohs surgery, hair transplant, oculoplastics, and radiology from our US-based team. Interactive Q&A sessions sparked discussion and relationship-building that extended well beyond the day.

Responsive Planning and Needs Assessment

Impactful missions require a thorough initial needs assessment of the local health community, including their resources and challenges. The goal should be to collaborate and provide education in a manner that is sustainable, reproducible, and to the benefit of the local community within their existing infrastructure. While our team visit was only for 1 day at the hospital, we observed specific challenges that may not be systemic, which include:

• Low faculty-to-resident ratios, which limit hands-on dermatology training. Opportunities exist for improving the medical resident training opportunities by taping local physicians as well as overseas collaborations through direct and virtual mechanisms.
• Limited availability of standard medical tools, such as #15 blades for skin excisions (only #11 blades were widely available). Performing excisional surgeries with an 11-blade when similarly priced alternatives such as #15 blades could be utilized.
• Limited availability of instrument maintenance equipment, due to a lack of instrument sharpening equipment many procedures were difficult and led to poor quality specimens for histological evaluation. Instrument sharpeners are affordable and can easily be integrated into equipment maintenance protocols.
• Underutilization of population-based cancer screening, particularly for skin, breast, prostate, and colon cancer screenings. Providing education regarding the importance of readily available population-based screening examinations and tests can provide significant health benefits for the local population.
• Limited access to advanced therapeutics. Despite the lack of some of the latest therapeutic options, such as biological medications commonly used in the US for common immunological conditions, it is still important to educate local medical providers about potential treatments that exist. Local medical community members should be educated regarding standard therapies and disease state guidelines in order to move towards best practices for the local population.
• Need for community engagement. We met with and developed partnerships with not only local physicians and physician leaders, but with local philanthropists and the local rotary club, who are all vested in improving the medical knowledge and care of the local community. Developing partnerships with community members beyond the medical community is critical in establishing long-term improvements that will benefit the community.

These insights are now informing our future mission planning and collaborations, including potential collaborations with the local Health Ministry and hospital leaders, focused on equipment transfers, enhanced medical sub-specialty education, and faculty exchange programs. In collaboration with AMCN and the local authorities, we are actively establishing a partnership to allow for bidirectional faculty and trainee exchange to allow opportunities for Moroccan residents and faculty the opportunity for exposure to training in the US through the medical education non-profit Peer2Partner.org as while continuing our medical missions to Morocco.

A Model for Impactful Dermatology Missions

Our experience in Morocco underscores that impactful medical missions must move beyond short-term, feel-good experiences and toward strategic, collaborative knowledge transfer-based education-focused models that support the host community. While it is important to provide an excellent mission experience for medical volunteers visiting a different country and culture, the need for a lasting impact on the local medical community is essential for maximum community impact. Dermatology, with its visual diagnostics and procedural skill set, is uniquely positioned to make a lasting impact when volunteerism is paired with local partnership and system-specific goals. Due to limited trained board-certified or equivalent dermatologists and sub-specialists in Africa and developing countries, we can play a significant role in teaching while working within a multidisciplinary medical volunteer mission that creates a lasting impact for volunteers and the host community. By resisting the allure of “voluntourism” and instead investing in capacity building, dermatologists can become powerful agents of global health equity and medical education.

Dr. Arash Izadpanah is a board-certified dermatologist, division head of dermatology, and professor of medicine at Scripps Clinic Medical Group based in San Diego, California. He serves as the current President of Peer2Partner.org, an entirely volunteer-run nonprofit 501(c)(3) dedicated to medical education and community outreach in San Diego and beyond.

Dr. Mohamed Boutjdir is a professor of medicine in the cardiovascular division at NYU Grossman School of Medicine and the Director of the Cardiovascular Research Program at VA New York Harbor Healthcare System in New York, New York. He is also President of the American Moroccan Competencies Network (AMCN), a 501(c)(3) organization (https://www.amcnusa.org).

Dr. Mohamed Akhiyat is a board-certified OB-GYN practicing in Florida with a long history of medical education and volunteer work in Morocco and abroad.

For any author questions, Arash Izadpanah, MD, can be reached at info@peer2partner.org.

Acknowledgment

We are grateful to Dr. Mohamed Boutjdir, President of AMCN, and Dr. Mohamed Akhiyat for their help in organizing our mission with the Moroccan health ministry and local partners. We are grateful to Dr. Boutjdir and our medical volunteers: Drs. Maryam Afshar, Mohamed Akhiyat, Sophia Akhiyat, Natasha Carter, Erik Gilbertson, Yehia ElGuindy, Arash Izadpanah, Omar Ozgur, Nelly Salem, and Daniel Zelac

References

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