Dr. Shafik Dharamsi, PhD Dr. Shafik Dharamsi, PhD

Assistant Professor, Faculty of MedicineAssistant Professor, Faculty of Medicine&&Associate Director, Centre for International HealthAssociate Director, Centre for International HealthCollege of Health DisciplinesCollege of Health Disciplines

Ethics, Service-Learning, & Ethics, Service-Learning, & Social ResponsibilitySocial Responsibility

Transformative LearningTransformative Learning

Can’t go back to seeing the world in the same way…Can’t go back to seeing the world in the same way…

Never being able to be in the world in the same Never being able to be in the world in the same way…way…

Association of American Colleges and Association of American Colleges and Universities (AAC&U)Universities (AAC&U)

What kind of learning do students need to meet emerging What kind of learning do students need to meet emerging challenges in the workplace, in a diverse democracy, and in challenges in the workplace, in a diverse democracy, and in an interconnected world?an interconnected world?

““Higher education needs to engage in developing Higher education needs to engage in developing responsible learners whose sense of social responsible learners whose sense of social responsibility and ethical judgment is marked by responsibility and ethical judgment is marked by intellectual honesty, social justice, and a discernment intellectual honesty, social justice, and a discernment of ethical consequences of various decisions and of ethical consequences of various decisions and actions “actions “

Can social Can social responsibility be responsibility be taught / learned?taught / learned?

What about honesty What about honesty and ethics?and ethics?

Is it too late to learn Is it too late to learn this by the time this by the time you get to you get to university?university?

If this can be taught If this can be taught and learned, then and learned, then how?how?

UBC's Vision for the 21st CenturyUBC's Vision for the 21st Century

““The University of British Columbia will prepare students The University of British Columbia will prepare students toto

become become exceptional global citizensexceptional global citizens

promote the promote the values of a civil and sustainable values of a civil and sustainable societysociety

serve the peopleserve the people of British Columbia, Canada, and the of British Columbia, Canada, and the world.world.

Our Mission…Our Mission…

As responsible members of society, the graduates of As responsible members of society, the graduates of UBC will: UBC will:

value diversity, value diversity, work with and for their communities, and work with and for their communities, and be agents for positive change. be agents for positive change.

They will acknowledge their obligations as global They will acknowledge their obligations as global citizens, and strive to secure a sustainable and citizens, and strive to secure a sustainable and equitable future for all.equitable future for all.

The Development SetThe Development Setby Ross Cogginsby Ross Coggins

Excuse me, friends, I must catch my jetExcuse me, friends, I must catch my jet

I’m off to join the Development SetI’m off to join the Development Set

My bags are packed, and I’ve had all my shotsMy bags are packed, and I’ve had all my shots

I have travelers’ checks, and pills for the I have travelers’ checks, and pills for the trotstrots

The Development Set is bright and noble,The Development Set is bright and noble,Our thoughts are deep and our vision globalOur thoughts are deep and our vision global

Although we move with the better classes, Although we move with the better classes, Our thoughts are always with the massesOur thoughts are always with the masses

In Sheraton hotels in scattered nations, In Sheraton hotels in scattered nations, We damn multinational corporationsWe damn multinational corporations

Injustice seems so easy to protest,Injustice seems so easy to protest,

In such seething hotbeds of social restIn such seething hotbeds of social rest

We discuss malnutrition over steaks,We discuss malnutrition over steaks,

And plan hunger talks during coffee breaksAnd plan hunger talks during coffee breaks

Whether Asian floods or African drought,Whether Asian floods or African drought,

We face each issue with an open mouthWe face each issue with an open mouth

We bring in consultants whose circumlocution We bring in consultants whose circumlocution

Raises difficulties for every solution- Raises difficulties for every solution-

Thus guaranteeing continued good eating By Thus guaranteeing continued good eating By showing the need for another meeting.showing the need for another meeting.

The language of the Development SetThe language of the Development Set

Stretches the English alphabet;Stretches the English alphabet;

We use swell words like 'epigenetic',We use swell words like 'epigenetic',

'Micro', 'Macro'. and 'logarithmetic'.'Micro', 'Macro'. and 'logarithmetic'.

Development Set homes are extremely chic, Development Set homes are extremely chic, Full of carvings, curios and draped with Full of carvings, curios and draped with batik.batik.

Eye-level photographs subtly assure that your Eye-level photographs subtly assure that your host is at home with the rich and the poor.host is at home with the rich and the poor.

Enough of these verses -- on with the mission!Enough of these verses -- on with the mission!

Our task is as broad as the human condition!Our task is as broad as the human condition!

Just parry to God the biblical promise is true:Just parry to God the biblical promise is true:

The poor ye shall always have with you.The poor ye shall always have with you.

Why do international service?Why do international service?

______medical students and ______medical students and professionals describe what professionals describe what motivates them to do medical motivates them to do medical service in developing countries:service in developing countries:

1.1. To experience culturesTo experience cultures

2.2. To find yourselfTo find yourself

3.3. To save livesTo save lives

4.4. For adventureFor adventure

““This is Africa”This is Africa”

Shah S, Wu T. The Medical Student Global Health Experience: Shah S, Wu T. The Medical Student Global Health Experience: Professionalism and Ethical ImplicationsProfessionalism and Ethical Implications

Med. Ethics 2008;34;375-378Med. Ethics 2008;34;375-378

After finishing my first year of medical school, I participated in a After finishing my first year of medical school, I participated in a mission trip to Mexico. Before flying to Mexico, I was not given mission trip to Mexico. Before flying to Mexico, I was not given any cultural, medical, or other training, nor could I speak any cultural, medical, or other training, nor could I speak Spanish. Upon arriving, I was assigned to a clinic where there Spanish. Upon arriving, I was assigned to a clinic where there were hundreds of patients but only one physician. I remember were hundreds of patients but only one physician. I remember vividly seeing a frail 11–year–old boy with polyuria, polydipsia vividly seeing a frail 11–year–old boy with polyuria, polydipsia and nocturia. and nocturia.

My lack of medical training limited my differential. With only a My lack of medical training limited my differential. With only a scattered history and no other tests, I told him to limit caffeine scattered history and no other tests, I told him to limit caffeine intake and see if that helps. Thinking back, he could have had intake and see if that helps. Thinking back, he could have had a urinary tract infection, any number of renal abnormalities, or a urinary tract infection, any number of renal abnormalities, or worse, I sent him out without ruling out diabetic ketoacidosis. worse, I sent him out without ruling out diabetic ketoacidosis.

And while I was seeing patients by myself, other first year And while I was seeing patients by myself, other first year medical students were performing surgeries in the other medical students were performing surgeries in the other clinics and later bragging about it. clinics and later bragging about it.

(Anonymous student, personal communication, 2 January 2006)(Anonymous student, personal communication, 2 January 2006)

The Business of Volunteer Abroad ProgramsThe Business of Volunteer Abroad Programs

Mongolia 2 Week Trips 1 Month 2 Months 3 Months Extra Month Teaching Teaching English to 18 and under n/a $ 2,245 $ 2,995 $ 3,795 $ 995 Care Orphanage Work $ 1,795 $ 2,245 $ 2,995 $ 3,795 $ 995 Culture & Community Mongolia Nomad Project $ 3,045 $ 3,795 $ 4,695 $ 5,595 $ 1,545 Sports School Sports $ 1,995 $ 2,445 $ 3,195 $ 3,995 $ 995 Medicine & Healthcare Medicine $ 1,995 $ 2,445 $ 3,195 $ 3,995 $ 995 Nursing & Midwifery $ 1,995 $ 2,445 $ 3,195 $ 3,995 $ 995 Medical Electives $ 1,995 $ 2,445 $ 3,195 $ 3,995 $ 995 Journalism Print n/a $ 2,445 $ 3,195 $ 3,995 $ 995 Broadcast n/a $ 2,445 $ 3,195 $ 3,995 $ 995 Business n/a $ 2,445 $ 3,195 $ 3,995 $ 995 Law & Human Rights Law & Human Rights in Mongolia n/a $ 2,445 $ 3,195 $ 3,995 $ 995 Veterinary Medicine & Animal Care $ 1,995 $ 2,445 $ 3,195 $ 3,995 $ 995 Language Courses 14 Hour Language Course Add-On $ 345 60 Hour Language Course Add-On $ 1,345 2 Week Summer Special $ 2,195

““After two months, I had observed many After two months, I had observed many unforgettable surgeries, like the removal of a unforgettable surgeries, like the removal of a giant breast tumor, the removal of an intestinal giant breast tumor, the removal of an intestinal tumor, and even a few plastic surgeries. Most tumor, and even a few plastic surgeries. Most importantly, I had met many caring and importantly, I had met many caring and intelligent people and learned a lot about intelligent people and learned a lot about medicine, Argentina, the world and myself”medicine, Argentina, the world and myself”

Medicine & Healthcare Intern in ArgentinaMedicine & Healthcare Intern in Argentina

Competence & ConscienceCompetence & Conscience

The crisis of our time relates to the disastrous The crisis of our time relates to the disastrous divorce of competence from conscience. divorce of competence from conscience.

Once professionals begin to practice, they Once professionals begin to practice, they stop thinking beyond the technical aspects stop thinking beyond the technical aspects of their work. of their work.

Professionals must be able to make Professionals must be able to make judgments that are not only technically judgments that are not only technically correct but also ethically and socially correct but also ethically and socially considerateconsiderate..

Ernest Boyer Ernest Boyer

We’ve come to helpWe’ve come to helpAdapted from Dickson, M 1993Adapted from Dickson, M 1993

Unfortunately, Professionals often see themselves Unfortunately, Professionals often see themselves and their services as the solution to people’s and their services as the solution to people’s problems and the means for achieving progress.problems and the means for achieving progress.

This thinking has even influenced their public who This thinking has even influenced their public who come to believe that their own development is come to believe that their own development is really the responsibility of professionals.really the responsibility of professionals.

Training in the professions contributes to this Training in the professions contributes to this dependency by preparing future practitioners to dependency by preparing future practitioners to fix the problem over affecting change in global fix the problem over affecting change in global systemic inequities.systemic inequities.

Our professional solutions often ignore the Our professional solutions often ignore the complexity of the human condition and complexity of the human condition and importance of self-determination and importance of self-determination and empowerment.empowerment.

Professional training tends to nurture a certain Professional training tends to nurture a certain arrogance in which knowledge and skills are seen arrogance in which knowledge and skills are seen as the prerogative of professionals, giving us a as the prerogative of professionals, giving us a certain superiority.certain superiority.

Poor people are perceived as uninformed and Poor people are perceived as uninformed and backward, having only themselves to blame for backward, having only themselves to blame for both their poverty and their poor health. both their poverty and their poor health.

Inevitably, most services tend to ignore vulnerable, Inevitably, most services tend to ignore vulnerable, poor populations.”poor populations.”

The service approach sets up the typical paradox between solving problems and preventing problems.

Despite prominence being given to preventing problems, national expenditures continue to go toward more facilities, equipment, and technology, rather than to social change.”

Most resources are expended on the elite who are able to pay and who demand ever more sophisticated services.”

“Professionals rarely see poor people and do not know their realities or their needs…

Worse, professionals do not know that they do not know!”

“Meanwhile the greater population remains voiceless and welcomes almost any service, whether it is appropriate or not.

To think, act, speak and live ethically; To think, act, speak and live ethically; to view learning, teaching, working to view learning, teaching, working and research through an ethical lens and research through an ethical lens and to put ethics into the practice of and to put ethics into the practice of being a student, staff or faculty being a student, staff or faculty member at UBC and abroad.member at UBC and abroad.

Respect for Human Dignity: Respect for Human Dignity: A Moral ImperativeA Moral Imperative

A fundamental ethic of service-learning:A fundamental ethic of service-learning:

1. 1. The selection and achievement of morally acceptable ends;The selection and achievement of morally acceptable ends;

andand

2. 2. morally acceptable means to those ends.morally acceptable means to those ends.

It is unacceptable to treat persons solely as means, (mere It is unacceptable to treat persons solely as means, (mere objects or things), because doing so fails to respect their objects or things), because doing so fails to respect their intrinsic human dignity and thus impoverishes all of intrinsic human dignity and thus impoverishes all of humanity. humanity.

The welfare and integrity of the individual must remain The welfare and integrity of the individual must remain paramount in all human relationshipsparamount in all human relationships

Critical ConsciousnessCritical Consciousness

Ensuring that ethical considerations have a Ensuring that ethical considerations have a permanent place in our work through critical self-permanent place in our work through critical self-reflectionreflection

Not a singular focus on the self, but a stepping Not a singular focus on the self, but a stepping back to understand one’s own assumptions, back to understand one’s own assumptions, biases, and values, and a shifting of one’s gaze biases, and values, and a shifting of one’s gaze from self to others and conditions of injustice in from self to others and conditions of injustice in the world. This process, coupled with the the world. This process, coupled with the resultant action, is at the core of the idea of resultant action, is at the core of the idea of

critical consciousnesscritical consciousness..

““We see these situations which appear so We see these situations which appear so appalling to us - where there is no appalling to us - where there is no

justice, little hope, and overwhelming justice, little hope, and overwhelming hardship - and we want to do whatever hardship - and we want to do whatever

we can to assist people… we can to assist people…

We want to offer our skills, our knowledge, We want to offer our skills, our knowledge, our solutions. Sometimes it is welcomed, our solutions. Sometimes it is welcomed, seldom is it refused, but we never know if seldom is it refused, but we never know if what we are offering is best. Is our work what we are offering is best. Is our work

disempowering? Is our message disempowering? Is our message culturally inappropriate so that it will not culturally inappropriate so that it will not be heard or will even cause social harm? be heard or will even cause social harm? Is it a drop in the bucket when a fire hose Is it a drop in the bucket when a fire hose

is needed? Does it even create is needed? Does it even create dependence?”dependence?”

““In some cases, we are not reflective and our In some cases, we are not reflective and our actions are inappropriate because we actions are inappropriate because we

haven't thought them through. In many haven't thought them through. In many cases, we have the best of intentions, but cases, we have the best of intentions, but

incomplete knowledge and understanding…incomplete knowledge and understanding…

So to those who have questioned the value of So to those who have questioned the value of international volunteers, I would ask the international volunteers, I would ask the

following:following:

What do you want from us? What should we, What do you want from us? What should we, as concerned individuals with a variety of as concerned individuals with a variety of skills and interests, be doing? Should we skills and interests, be doing? Should we stay out? Get active politically in our own stay out? Get active politically in our own

countries? Support economic reform? countries? Support economic reform? Simply support the concept of Simply support the concept of

empowerment? Or something else?”empowerment? Or something else?”

““I pose these questions because I feel I pose these questions because I feel that the huge number of well-that the huge number of well-meaning outsiders represent a meaning outsiders represent a

tremendously valuable force for tremendously valuable force for positive change, and that it would be positive change, and that it would be

a shame to waste the potential a shame to waste the potential contribution of this group. contribution of this group.

What is more, I feel that to tell this What is more, I feel that to tell this group that their contributions to date group that their contributions to date have been useless (or even that they have been useless (or even that they

have done more harm than good) have done more harm than good) without offering some alternative without offering some alternative mode of engagement, would be to mode of engagement, would be to

overlook an important potential ally overlook an important potential ally in the struggle for change.”in the struggle for change.”