When ‘saviours’ blindly swoop in… Clinic stint in Cambodia a confronting experience

Voluntourism can be ethically dubious, particularly when involving children

Peering into the cupboard, I took a mental stocktake. One Ventolin inhaler, no spacer; an open packet of paracetamol; some intravenous cimetidine; a bottle of betadine and 30 atorvastatin tablets.

Had a previous volunteer left these here thinking they would somehow be helpful? “Do you have any dressings?” I ask. The doctor reaches under his desk and opens a box. “All expired,” he says sadly. The newest packet has an expiry date of 2017.

Driven by a motivation I did not stop to examine too deeply, I found myself during my sabbatical at a clinic in Cambodia. The clinic is attached to a school run by an Australian-led charitable foundation; I signed up to be a volunteer for three weeks.

Communication with the organisation that helped me coordinate the opportunity was a little vague.

I knew only that the clinic has two staff, that they look after the children attending the school and their families, and that they felt my skills would be useful, particularly in women’s health.

I was already a little uneasy before opening the medicine cupboard. The previous evening, I had met three Australians. Old hands – they had, before the COVID-19 pandemic, travelled to Cambodia at least once a year to keep an eye on “their projects” for the South Australian Rotary Club.

“Our members need to know where their money is going – and, of course, we love our cocktails,” they said. I asked did they volunteer at any of the projects they visited; yes, they loved to teach, and knew the school at which I was to be based. Did they have a background in teaching? “Oh! No. Graham and I are farmers, and Cathy’s last job was on a Disney cruise ship.”

Back at the school, on my first morning I was introduced to the leadership team. Ally had seven of the school’s children and employees living in her home, and visibly shook as she described some of the traumas that had led her to become their guardian. John was in his 70s and proudly told me he came over from Canberra to help Ally out twice a year. At home, single and retired, he helped out on a Meals on Wheels programme; here, he felt, he could really add value.

“Their lives…they are boring. The same every day. And we come along and add something. You go to the market, they see you and they know you…‘Hello, Teacher John!’ Quite sweet, really.”

“And do you have a background in teaching?” “No – I was a civil servant in Canberra for years. Policy, documents, that sort of thing.”

The charity school, one of hundreds of similar projects in Siem Reap, was funded entirely by donations and the money brought in by paying volunteers.

With no volunteers since before the pandemic, Ally told me the school had no money whatsoever, hence the empty cupboard in the clinic.

We discussed how I could contribute. Perhaps some teaching? “Yes, why don’t you do some talks about sex education, contraception, that kind of thing. They don’t know anything, they have all these questions…”

I pondered this. I imagined myself standing in front of a class of impoverished Cambodian teenagers, many of whom had difficulties in their lives I had no way of comprehending, and a culture of which I knew little.

I asked whether there was someone I could talk to, to guide me on what I could and could not say. Ally gave me a blank look. I tried again. “I’m just thinking: is it appropriate to come in and talk about these things? Maybe I could sit and talk with some of the students first and ask what sort of things they would like to know about?”

“But. They know nothing. So anything you can tell them will be better than nothing.”

Then there was the bicycle. I had been told I would have the use of a bike to get to and from the school. What had not been made clear was that I was to buy this bicycle, and then present it with great ceremony to a deserving child on my exit. “You can choose – choose a child you particularly like, or who you think deserves a bicycle,” explained John.

“I – I can’t. How can I choose one of these children?”

“Well, we can do it for you, if you don’t want to.”

The realisation dawned: my ideal of being of some use as a medically trained volunteer in a low-resource environment had strayed into the realm of voluntourism.

Controversial and potentially harmful, voluntourism describes an activity where the main component is a holiday with a little light helping of helping on the side. Organisations such as World Vision have described how this can be ethically dubious, particularly when involving children.

In the absence of a functioning state, NGOs in Cambodia are doing their level best to provide the basics we take for granted – education, healthcare, and a safety net for underprivileged families. It may be that when these basics are so hard to cover, aspects such as cultural safety are seen as a luxury rather than a necessity

From my perspective as a New Zealand GP, this was confronting. Many times over the past few months I have been humbled to see how others live, and have been reminded to practise gratitude for the way we live in Aotearoa New Zealand. We do not always get it right; our health system, still under construction, is not perfect, but we are trying.

Back at the clinic, it was time for me to move on. I made a cash donation which would enable the clinic to restock – of far more practical use than my time – and decided to head home.

Note: names have been changed

Orna McGinn is an Auckland-based specialist GP and chair of the New Zealand Women in Medicine Charitable Trust