Grs Lecture Oct 14 2009

1. Dr. Shafik Dharamsi, PhDDr. Shafik Dharamsi, PhD
Assistant Professor, Faculty of MedicineAssistant Professor, Faculty of Medicine
&&
Associate Director, Centre for International HealthAssociate Director, Centre for International Health
College of Health DisciplinesCollege of Health Disciplines
Ethics, Service-Learning, &Ethics, Service-Learning, &
Social ResponsibilitySocial Responsibility

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

3. Association of American Colleges andAssociation of American Colleges and
Universities (AAC&U)Universities (AAC&U)
What kind of learning do students need to meet emergingWhat kind of learning do students need to meet emerging
challenges in the workplace, in a diverse democracy, and inchallenges in the workplace, in a diverse democracy, and in
an interconnected world?an interconnected world?
““Higher education needs to engage in developing responsibleHigher education needs to engage in developing responsible
learners whose sense of social responsibility and ethicallearners whose sense of social responsibility and ethical
judgment is marked by intellectual honesty, social justice, andjudgment is marked by intellectual honesty, social justice, and
a discernment of ethical consequences of various decisionsa discernment of ethical consequences of various decisions
and actions “and actions “

4. Can socialCan social
responsibility beresponsibility be
taught / learned?taught / learned?
What about honestyWhat about honesty
and ethics?and ethics?
Is it too late to learnIs it too late to learn
this by the time youthis by the time you
get to university?get to university?
If this can be taughtIf this can be taught
and learned, thenand learned, then
how?how?

5. UBC's Vision for the 21st CenturyUBC's Vision for the 21st Century
““The University of British Columbia will prepare students toThe University of British Columbia will prepare students to
 becomebecome exceptional global citizensexceptional global citizens
 promote thepromote the values of a civil and sustainablevalues of a civil and sustainable
societysociety
 serve the peopleserve the people of British Columbia, Canada, and theof British Columbia, Canada, and the
world.world.

6. Our Mission…Our Mission…
As responsible members of society, the graduates of UBCAs responsible members of society, the graduates of UBC
will:will:
 value diversity,value diversity,
 work with and for their communities, andwork with and for their communities, and
 be agents for positive change.be agents for positive change.
They will acknowledge their obligations as global citizens, andThey will acknowledge their obligations as global citizens, and
strive to secure a sustainable and equitable future for all.strive to secure a sustainable and equitable future for all.

7. The Development SetThe Development Set
by 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 trotsI have travelers’ checks, and pills for the trots

8. 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, OurAlthough we move with the better classes, Our
thoughts are always with the massesthoughts are always with the masses
In Sheraton hotels in scattered nations,In Sheraton hotels in scattered nations,
We damn multinational corporationsWe damn multinational corporations

9. 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

10. We bring in consultants whose circumlocutionWe bring in consultants whose circumlocution
Raises difficulties for every solution-Raises difficulties for every solution-
Thus guaranteeing continued good eating ByThus 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'.

11. Development Set homes are extremely chic, FullDevelopment Set homes are extremely chic, Full
of carvings, curios and draped with batik.of carvings, curios and draped with batik.
Eye-level photographs subtly assure that yourEye-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.

12. Why do international service?Why do international service?
______medical students and professionals______medical students and professionals
describe what motivates them to dodescribe what motivates them to do
medical service in developing countries:medical 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

13. ““This is Africa”This is Africa”

14. 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 aAfter finishing my first year of medical school, I participated in a
mission trip to Mexico. Before flying to Mexico, I was not given anymission trip to Mexico. Before flying to Mexico, I was not given any
cultural, medical, or other training, nor could I speak Spanish.cultural, medical, or other training, nor could I speak Spanish.
Upon arriving, I was assigned to a clinic where there wereUpon arriving, I was assigned to a clinic where there were
hundreds of patients but only one physician. I remember vividlyhundreds of patients but only one physician. I remember vividly
seeing a frail 11–year–old boy with polyuria, polydipsia andseeing a frail 11–year–old boy with polyuria, polydipsia and
nocturia.nocturia.
My lack of medical training limited my differential. With only aMy lack of medical training limited my differential. With only a
scattered history and no other tests, I told him to limit caffeinescattered history and no other tests, I told him to limit caffeine
intake and see if that helps. Thinking back, he could have had aintake and see if that helps. Thinking back, he could have had a
urinary tract infection, any number of renal abnormalities, orurinary 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 medicalAnd while I was seeing patients by myself, other first year medical
students were performing surgeries in the other clinics and laterstudents were performing surgeries in the other clinics and later
bragging about it.bragging about it.
(Anonymous student, personal communication, 2 January 2006)(Anonymous student, personal communication, 2 January 2006)

15. The Business of Volunteer Abroad ProgramsThe Business of Volunteer Abroad Programs
Mongolia 2 Week Trips1 Month2 Months3 MonthsExtra 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

16. ““After two months, I had observed many unforgettableAfter two months, I had observed many unforgettable
surgeries, like the removal of a giant breast tumor, thesurgeries, like the removal of a giant breast tumor, the
removal of an intestinal tumor, and even a few plasticremoval of an intestinal tumor, and even a few plastic
surgeries. Most importantly, I had met many caring andsurgeries. Most importantly, I had met many caring and
intelligent people and learned a lot about medicine,intelligent people and learned a lot about medicine,
Argentina, the world and myself”Argentina, the world and myself”
Medicine & Healthcare Intern in ArgentinaMedicine & Healthcare Intern in Argentina

17. Competence & ConscienceCompetence & Conscience
The crisis of our time relates to the disastrousThe crisis of our time relates to the disastrous
divorce of competence from conscience.divorce of competence from conscience.
Once professionals begin to practice, they stopOnce professionals begin to practice, they stop
thinking beyond the technical aspects of theirthinking beyond the technical aspects of their
work.work.
Professionals must be able to make judgmentsProfessionals must be able to make judgments
that are not only technically correct but alsothat are not only technically correct but also
ethically and socially considerateethically and socially considerate ..
Ernest BoyerErnest Boyer

18. We’ve come to helpWe’ve come to help
Adapted from Dickson, M 1993Adapted from Dickson, M 1993
Unfortunately, Professionals often see themselves and theirUnfortunately, Professionals often see themselves and their
services as the solution to people’s problems and theservices as the solution to people’s problems and the
means for achieving progress.means for achieving progress.
This thinking has even influenced their public who come toThis thinking has even influenced their public who come to
believe that their own development is really thebelieve that their own development is really the
responsibility of professionals.responsibility of professionals.
Training in the professions contributes to this dependencyTraining in the professions contributes to this dependency
by preparing future practitioners to fix the problem overby preparing future practitioners to fix the problem over
affecting change in global systemic inequities.affecting change in global systemic inequities.

19. Our professional solutions often ignore the complexity ofOur professional solutions often ignore the complexity of
the human condition and importance of self-the human condition and importance of self-
determination and empowerment.determination and empowerment.
Professional training tends to nurture a certain arrogance inProfessional training tends to nurture a certain arrogance in
which knowledge and skills are seen as the prerogativewhich knowledge and skills are seen as the prerogative
of professionals, giving us a certain superiority.of professionals, giving us a certain superiority.
Poor people are perceived as uninformed and backward,Poor people are perceived as uninformed and backward,
having only themselves to blame for both their povertyhaving only themselves to blame for both their poverty
and their poor health.and their poor health.
Inevitably, most services tend to ignore vulnerable, poorInevitably, most services tend to ignore vulnerable, poor
populations.”populations.”

20. 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!”

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

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

23. 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 objectsIt is unacceptable to treat persons solely as means, (mere objects
or things), because doing so fails to respect their intrinsicor things), because doing so fails to respect their intrinsic
human dignity and thus impoverishes all of humanity.human dignity and thus impoverishes all of humanity.
The welfare and integrity of the individual must remain paramountThe welfare and integrity of the individual must remain paramount
in all human relationshipsin all human relationships

24. Critical ConsciousnessCritical Consciousness
 Ensuring that ethical considerations have a permanentEnsuring that ethical considerations have a permanent
place in our work through critical self-reflectionplace in our work through critical self-reflection
 Not a singular focus on the self, but a stepping back toNot a singular focus on the self, but a stepping back to
understand one’s own assumptions, biases, and values,understand one’s own assumptions, biases, and values,
and a shifting of one’s gaze from self to others andand a shifting of one’s gaze from self to others and
conditions of injustice in the world. This process, coupledconditions of injustice in the world. This process, coupled
with the resultant action, is at the core of the idea ofwith the resultant action, is at the core of the idea of
critical consciousnesscritical consciousness..

25. ““We see these situations which appear soWe see these situations which appear so
appalling to us - where there is no justice,appalling to us - where there is no justice,
little hope, and overwhelming hardship - andlittle hope, and overwhelming hardship - and
we want to do whatever we can to assistwe want to do whatever we can to assist
people…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 ifseldom is it refused, but we never know if
what we are offering is best. Is our workwhat we are offering is best. Is our work
disempowering? Is our message culturallydisempowering? Is our message culturally
inappropriate so that it will not be heard orinappropriate so that it will not be heard or
will even cause social harm? Is it a drop inwill even cause social harm? Is it a drop in
the bucket when a fire hose is needed?the bucket when a fire hose is needed?
Does it even create dependence?”Does it even create dependence?”

26. ““In some cases, we are not reflective and ourIn some cases, we are not reflective and our
actions are inappropriate because we haven'tactions are inappropriate because we haven't
thought them through. In many cases, we havethought them through. In many cases, we have
the best of intentions, but incompletethe best of intentions, but incomplete
knowledge and understanding…knowledge and understanding…
So to those who have questioned the value ofSo to those who have questioned the value of
international volunteers, I would ask theinternational volunteers, I would ask the
following:following:
What do you want from us? What should we, asWhat do you want from us? What should we, as
concerned individuals with a variety of skillsconcerned individuals with a variety of skills
and interests, be doing? Should we stay out?and interests, be doing? Should we stay out?
Get active politically in our own countries?Get active politically in our own countries?
Support economic reform? Simply support theSupport economic reform? Simply support the
concept of empowerment? Or something else?”concept of empowerment? Or something else?”

27. ““I pose these questions because I feel thatI pose these questions because I feel that
the huge number of well-meaningthe huge number of well-meaning
outsiders represent a tremendouslyoutsiders represent a tremendously
valuable force for positive change, andvaluable force for positive change, and
that it would be a shame to waste thethat it would be a shame to waste the
potential contribution of this group.potential contribution of this group.
What is more, I feel that to tell this groupWhat is more, I feel that to tell this group
that their contributions to date have beenthat their contributions to date have been
useless (or even that they have doneuseless (or even that they have done
more harm than good) without offeringmore harm than good) without offering
some alternative mode of engagement,some alternative mode of engagement,
would be to overlook an importantwould be to overlook an important
potential ally in the struggle for change.”potential ally in the struggle for change.”