Going for the right reasons: Is an ICI right for you?

You may have arrived at this page because you’re interested in doing a clinical internship in a low-and-middle-income country (LMIC). At first thought, these opportunities may seem very exciting and like great learning experiences. And they certainly are! The danger is when students plan to embark on such an experience without an understanding of possible ethical considerations, impact that students can have on a community and potential for harm.

The following information and links are meant to help you begin to reflect on your motivation to take part in an international clinical internship and whether this kind of experience is right for you.

What are some “right” reasons for going?

To learn

  • If you’re approaching an international clinical internship as primarily an educational opportunity, then you would be right on track.
  • You may be interested in learning about how healthcare provision differs between a state-of-the-art hospital in an urban centre and resource-limited or remote settings. You may want to appreciate how a nation’s unique history and sociopolitical context influences a person’s health. Moreover, you may want to immerse yourself in a community and learn about the people there.

To form partnerships

  • A genuine desire to collaborate with and serve the community in which you are placed means your presence is more likely to benefit that community. International clinical internships are great opportunities for mutual learning and strengthening a global community.

To gain insight into the role of rehab professionals in global health

  • Now, more than ever, there are opportunities for PTs, SLPs and OTs to be involved in and contribute to global health in several capacities!

What are some “less-right” reasons for going?

To change the way that people do things

  • A lot of innovation is taking place in the rehabilitation programs in Canada. Perhaps, you want to show healthcare providers in LMICs how we do things here. It’s important to bear in mind that different practices work in difference contexts.
  • Similarly, when abroad, you may see some things that “should” be better from your perspective as someone from North America. However, the host community or clinic may have very different priorities given their intimate knowledge of their own community.
  • Sometimes, no matter how well-intentioned we are, when we try to “help”, there may actually be negative consequences for people or a host community. This is something that is very important to keep in mind.

To have an exotic vacation

  • Many LMICs offer immensely beautiful landscapes and encounters with ways of life that you would not experience otherwise. If the desire to “experience the exotic” is the greatest motivator, there exists the potential to do harm.
  • Read the following “Truth in the Spoof: Medical Voluntourism in The Onion”

To do things you wouldn’t be able to do at home

  • Undoubtedly, international clinical internships afford unique learning opportunities. It becomes problematic when these unique learning opportunities involve performing assessments or interventions that you wouldn’t be allowed to do in Canada.

To beef up your resume

  •  This one is pretty self-explanatory.

To have some amazing photo-ops

So, what now?

Maybe you recognize some of your motivations being reflected in the previous paragraphs. Maybe some of this discussion has impassioned you to learn more about global health. Either way, we hope that this page has stimulated some self-inquiry and raised your awareness of some important issues to consider before going on an international clinical internship.

There are a lot of great references to help you continue to look at international clinical internships more critically. Here is just a handful to get you started:

  • “First, Do No Harm: A Qualitative Research Documentary” created by Alyson and Timothy Holland
  • “Global Citizenship” by Oxfam
  • Gilbert, J. (2005). ‘Self-knowledge is the prerequisite of humanity’: personal development and self-awareness for aid workers. Development in Practice, 15(1): 64-69.
  • Hanson, L., Harms, S. & Plamondon, K. (2011). Undergraduate international medical electives: some ethical and pedagogical considerations. Journal of Studies in International Education,15(2): 171-185.
  • Cassady, C., Meru, R., Chan, N. M., Engelhardt, J., Fraser, M. & Nixon, S. (2014). Physiotherapy beyond our borders: investigating ideal competencies for Canadian physiotherapists working in resource-poor countries. Physiotherapy Canada, 66(1): 15-23.
  • “Africa for Norway” Video
  • “The white tourist’s burden” by Aljazeera America