In Reply to Ventres

Abstract

I thank Dr. Ventres for his comments on my recent commentary. In particular, I appreciate his point that it is not only trainees and students who benefit from comprehensive ethical guidelines in international health service, but also practicing physicians, who might be tempted to practice outside their specialty or beyond their regular capabilities. As outlined in my commentary, it is my point of view that an overemphasis on the service aspects of such work contributes to the risk that short-term health interventions in underresourced countries may do more harm than good. Sustainability, which should be a primary concern of any intervention,1 may become an afterthought if visiting learners and physicians calculate the benefit of short-term international educational experiences according to procedures conducted or medicines distributed during their stay. Visitors should instead give serious consideration to the costs of their visit in terms of the potential undermining of local infrastructure and negative outcomes in the community due to lack of follow-up, both of which are indicators that are likely to be visible only after the visitors have packed up and gone home.2 Dr. Ventres writes eloquently of humility, echoing my concern that the pride one may feel in having “served” risks blinding visitors to the benefits that they themselves seek or obtain from the experience.3 Roberts points out that a better framework for evaluating ethical conduct in service, including outreach, may be found in guidelines governing clinical trials,3 whereby the burden rests on the researcher to document, even when some benefit to participants is evident, that the harm to those “served” does not exceed those benefits and that due diligence has been taken to protect their interests.