When it comes to international volunteerism, what defines an ethical, impactful service program? In 2018, CMMB joined Advocacy for Global Health Partnerships, a coalition dedicated to asking this kind of question and more. The coalition’s Brocher Principles were designed to guide policy for global health engagements, like international volunteerism.

When Anabelle Bunis, a pre-med student at New York University started working with CMMB’s volunteer program, she wanted to learn more about ethical and impactful volunteering in practice. In the Q&A below, Anabelle engages Jesse Kihuha, program manager and volunteer point person with CMMB Kenya. His reflections draw from over 9 years of coordinating volunteer positions in Kenya—and lessons learned along the way.

“We’re at a point of reflection. Are we heading in the right direction? How can we ensure our volunteer program is as impactful as possible?”– Jesse Kihuha, CMMB Kenya

What first comes to mind when we say ethical volunteerism?

There is no simple answer. But what I think of first is placing the target communities at the center of the deployment. It comes down to understanding the need and doing due diligence when recruiting. For instance, what happens if a volunteer arrives at a health facility to fill a role that is already successfully filled by a local health worker? This serves neither the volunteer nor the health facility.

The other piece that comes to mind is flexibility, from the perspective of the volunteer. Volunteers who commit to service must also commit to listen, learn, and adapt. This is what my colleagues and I do every day—adapt and learn as we move along.

What can organizations do to help volunteers prepare to be as effective as possible?

The orientation is important. During this process, volunteers should hear from former or current volunteers who have worked in settings that are extremely limited in resources—where you make the most of almost nothing. I think that kind of perspective is especially helpful to incoming clinical volunteers.

At the same time, there are differences in how various parts of the world view care. While the principles of medicine are universal, the practice is driven by context. Volunteers need to be aware and accepting of this. For instance, if a patient is not given all four standard doses of an antibiotic, are they treated? In the context of a low-resource hospital, it’s likely that the staff have found a way to manage this patient without all four because the patient simply can’t afford the full dosage. Facilitating open discussions about this reality during a pre-departure orientation could be of value to our volunteers, and the communities they go on to serve.

From your experience, what are the advantages of international volunteerism?

One is capacity building. At one time we had a group of medical residents volunteering with us in Kenya. They had a focus on newborn care and facilitated specific trainings to build skill and confidence in staff managing newborn emergencies. This was a capacity that our program never had, and it continues to be a cornerstone of our program today.

The second advantage is research. Medical and public health research is an important part of our work, and volunteers have helped us enhance and sharpen those efforts. For example, an MPH volunteer worked with us on a study documenting important barriers to antenatal care. The paper has remained a key reference for designing interventions towards accelerating uptake of maternal and newborn care in underserved communities, located in difficult geographies. CMMB Kenya also has a long-standing partnership with St. Catherine University. That relationship has fostered collaboration between the university, CMMB, and the local ministry of health. Together, we have published a number of research papers that are engaging others in conversations about ongoing barriers to health.

What are potential disadvantages of international volunteerism?

First, I think of duplicate roles. It is disruptive if a volunteer arrives to fill a gap that is not actually a gap. In many parts of Kenya, we have more trained nurses than there are job opportunities. So, to send a nurse, who does not bring with them any sort of specialized care, could be viewed as a lost opportunity.

I also think of volunteers who struggle to adapt. If a volunteer arrives and it’s not what they expect, maybe they should return home after a short time. This is disruptive to our work in so many ways. Similarly, if a volunteer arrives wanting to work independently or without the ability to learn from their colleagues, everyone loses out on the potential impact.

If you demand anything from a volunteer experience, demand from yourself that you adapt, learn, and listen to your colleagues. They know best what kind of support is needed.

Can you talk about what organizations and or volunteers can do to ensure their impact is sustainable?

From my perspective, a volunteer’s overall success is in their ability to understand the context of the place they are working in. For instance, a volunteer who proposes a long-term intervention or process that originated in a hospital in Chicago, for practice at a hospital in Mutomo, will not find great success. Not only will they face a lot of resistance from the local clinicians, but it will likely not last long after they leave.

The second factor is time. A volunteer is limited by the amount of time they have to spend in the facility, getting to know their colleagues, and learning how it all operates together. The idea is always to do something that has a lasting impact, but you can’t really do that in a few weeks. At CMMB, we have found that six months is, ideally, the minimum amount of time we like to place volunteers. It allows people to really become part of the team.

How do you measure the impact of a volunteer? 

This is very critical to me. One of the ways I assess the impact of a volunteer is based on how I answer this question once they depart: What did they add to the conversation here?

For example, years ago we had a volunteer who was very interested in the digitization of public health. He observed our approach to community health and the importance of community health workers in that approach. He worked with us to develop a tool that took what they were already doing but made it more efficient. When he returned home, community health workers were using a SMS-based platform to track pregnant women and manage hospital referrals. Later we took that platform he helped build and evolved it into an app-based platform. Today, lessons from this digital implementation resulted in the creatioational tool, launched by the president just a few months ago.

Is there anything else you would like to share?

First, I have experience as a volunteer. I served in a government facility in Nairobi for 11 months. It was perhaps one of the most fulfilling experiences and an important foundation in my clinical and public health career. Today, my past volunteering experience makes me appreciate the sacrifices and commitments the volunteers that join our team in Kitui make.

Secondly, an effective volunteer program comes down to the principles and values through which it is built. CMMB is committed to ensuring our volunteer program remains accountable to ethical principles rooted in respect, sustainability, and mutual learning. This does not mean we are not still learning every day. It does mean we are not afraid to ask ourselves the challenging questions.

We are at a point of reflection. Are we heading in the right direction? How can we ensure our volunteer program is as impactful as possible? These are the questions that keep our program accountable, and it is this kind of mindset that we expect from our volunteers as well.