Programs that send American students to developing countries for practical service in the health sciences and medicine are proliferating, both under the auspices of universities and in connection with commercial organizations such as Projects Abroad, which advertises among its offerings, "Exciting opportunities at Ho Leprosy Village, Ghana." Examples abound of students or volunteers "practicing" medicine beyond the limits of their own training or good sense in underresourced communities.
On a recent visit to Cape Coast, Ghana, with my family, I was greeted in a restaurant by an American high-school student who, having embraced one of those exciting opportunities, said he was in Ghana for two weeks, "treating lepers and painting houses."
Myriad regulations, conventions, and guidelines address patients’ rights to privacy in health care, and these have evolved rapidly to include the widespread use of social media by health-care workers and trainees. While there is ample documentation that students violate these guidelines both at home and abroad, recent findings by researchers at the University of Florida suggest that these lapses may be more likely to occur on foreign medical "missions" in developing countries.
We agree that social-media narratives exert a powerful tug on would-be volunteers to seek their own versions of the images they’ve seen; they might even be a factor not just in medical trainees’ violating patient privacy but also in their temptation to operate above their level of training while overseas. After all, health education is not nearly as photogenic as giving an injection or drawing blood.
Research in health humanities suggests that narrative strategies can be useful in prompting students to reflect on ethical and professional questions. So rather than discourage health-sciences students from bringing their cameras on study abroad, my colleagues and I at the University of Missouri have begun incorporating student picture-taking into our discussions of social and cultural factors in health and health equity.
I begin before the students’ departure with an examination of the photos they already have on their phones. Choosing photos to represent both positive and negative aspects of their own lives, they write captions from their own point of view, with the background knowledge that implies, and again from the point of view of an imagined character of a different gender, age, race, or economic situation. This is an example of what social psychologists call "perspective taking." Students going to India in our pilot course began to understand an important fact about the pictures they might choose to post from there: The perception of something as "negative" or "positive" largely depends on the assumptions that the viewer holds.
In India recently, one of my colleagues asked the students to reflect further on their picture taking — for example, to consider how a caption might be written by someone in the photograph itself. Asking for permission before photographing someone is a minimum requirement, but does that level of consent precipitate ethical engagement? Did the students know the names of the people they photographed? Did they engage with them enough to be able to see if any assumptions the students held were true? Do students realize how their photos may be reinforcing stereotypes about developing nations and about other cultures within their own communities?
Travel is a powerful teacher, and photography is a potent storytelling tool. Young people in the health sciences are unlikely to abandon either one in the near future. Nor do we believe they should. That said, it is not necessary that the narratives they travel with and build from their experiences represent what Teju Cole calls the "White Savior Industrial Complex."
Not a health-sciences teacher? Instructing students in the principles of ethical photography — including the right of potential subjects to decline to be photographed; and the responsibility to avoid harm to the subjects as a result of the photographs, to avoid misrepresentation of the photographs, and to respect individuals and communities abroad — might lead them to consider principles of equity that they have not considered before. We are all engaged in telling stories to others through our pictures when we travel. It would serve us well to consider what stories we are telling ourselves.