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

Transformative Learning Can’t go back to seeing the world in the same way… Never being able to be in 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…

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

What kind of learning do students need to meet emerging challenges in the workplace, in a diverse democracy, and in an interconnected world?

“ Higher education needs to engage in developing responsible learners whose sense of social responsibility and ethical judgment is marked by intellectual honesty, social justice, and a discernment of ethical consequences of various decisions and actions “

Can social responsibility be taught / learned? What about honesty and ethics? Is it too late to learn this by the time you get to university? If this can be taught and learned, then how?

Can social responsibility be taught / learned?

What about honesty and ethics?

Is it too late to learn this by the time you get to university?

If this can be taught and learned, then how?

UBC's Vision for the 21st Century “ The University of British Columbia will prepare students to become exceptional global citizens promote the values of a civil and sustainable society serve the people of British Columbia, Canada, and the world.

“ The University of British Columbia will prepare students to

become exceptional global citizens

promote the values of a civil and sustainable society

serve the people of British Columbia, Canada, and the world.

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

As responsible members of society, the graduates of UBC will:

value diversity,

work with and for their communities, and

be agents for positive change.

They will acknowledge their obligations as global citizens, and strive to secure a sustainable and equitable future for all.

The Development Set by Ross Coggins Excuse me, friends, I must catch my jet I’m off to join the Development Set My bags are packed, and I’ve had all my shots I have travelers’ checks, and pills for the trots

Excuse me, friends, I must catch my jet

I’m off to join the Development Set

My bags are packed, and I’ve had all my shots

I have travelers’ checks, and pills for the trots

The Development Set is bright and noble, Our thoughts are deep and our vision global Although we move with the better classes, Our thoughts are always with the masses In Sheraton hotels in scattered nations, We damn multinational corporations

The Development Set is bright and noble,

Our thoughts are deep and our vision global

Although we move with the better classes, Our thoughts are always with the masses

In Sheraton hotels in scattered nations,

We damn multinational corporations

Injustice seems so easy to protest, In such seething hotbeds of social rest We discuss malnutrition over steaks, And plan hunger talks during coffee breaks Whether Asian floods or African drought, We face each issue with an open mouth

Injustice seems so easy to protest,

In such seething hotbeds of social rest

We discuss malnutrition over steaks,

And plan hunger talks during coffee breaks

Whether Asian floods or African drought,

We face each issue with an open mouth

We bring in consultants whose circumlocution Raises difficulties for every solution- Thus guaranteeing continued good eating By showing the need for another meeting. The language of the Development Set Stretches the English alphabet; We use swell words like 'epigenetic', 'Micro', 'Macro'. and 'logarithmetic'.

We bring in consultants whose circumlocution

Raises difficulties for every solution-

Thus guaranteeing continued good eating By showing the need for another meeting.

The language of the Development Set

Stretches the English alphabet;

We use swell words like 'epigenetic',

'Micro', 'Macro'. and 'logarithmetic'.

Development Set homes are extremely chic, Full of carvings, curios and draped with batik. Eye-level photographs subtly assure that your host is at home with the rich and the poor. Enough of these verses -- on with the mission! Our task is as broad as the human condition! Just parry to God the biblical promise is true: The poor ye shall always have with you.

Development Set homes are extremely chic, Full of carvings, curios and draped with batik.

Eye-level photographs subtly assure that your host is at home with the rich and the poor.

Enough of these verses -- on with the mission!

Our task is as broad as the human condition!

Just parry to God the biblical promise is true:

The poor ye shall always have with you.

Why do international service? ______medical students and professionals describe what motivates them to do medical service in developing countries: To experience cultures To find yourself To save lives For adventure

______medical students and professionals describe what motivates them to do medical service in developing countries:

To experience cultures

To find yourself

To save lives

For adventure

“ This is Africa”

Shah S, Wu T. The Medical Student Global Health Experience: Professionalism and Ethical Implications Med. Ethics 2008;34;375-378 After finishing my first year of medical school, I participated in a mission trip to Mexico. Before flying to Mexico, I was not given any cultural, medical, or other training, nor could I speak Spanish. Upon arriving, I was assigned to a clinic where there were hundreds of patients but only one physician. I remember vividly seeing a frail 11–year–old boy with polyuria, polydipsia and nocturia. My lack of medical training limited my differential. With only a scattered history and no other tests, I told him to limit caffeine intake and see if that helps. Thinking back, he could have had a urinary tract infection, any number of renal abnormalities, or worse, I sent him out without ruling out diabetic ketoacidosis. And while I was seeing patients by myself, other first year medical students were performing surgeries in the other clinics and later bragging about it. (Anonymous student, personal communication, 2 January 2006)

After finishing my first year of medical school, I participated in a mission trip to Mexico. Before flying to Mexico, I was not given any cultural, medical, or other training, nor could I speak Spanish. Upon arriving, I was assigned to a clinic where there were hundreds of patients but only one physician. I remember vividly seeing a frail 11–year–old boy with polyuria, polydipsia and nocturia.

My lack of medical training limited my differential. With only a scattered history and no other tests, I told him to limit caffeine intake and see if that helps. Thinking back, he could have had a urinary tract infection, any number of renal abnormalities, or worse, I sent him out without ruling out diabetic ketoacidosis.

And while I was seeing patients by myself, other first year medical students were performing surgeries in the other clinics and later bragging about it.

(Anonymous student, personal communication, 2 January 2006)

The Business of Volunteer Abroad Programs

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

“ After two months, I had observed many unforgettable surgeries, like the removal of a giant breast tumor, the removal of an intestinal tumor, and even a few plastic surgeries. Most importantly, I had met many caring and intelligent people and learned a lot about medicine, Argentina, the world and myself”

Medicine & Healthcare Intern in Argentina

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

The crisis of our time relates to the disastrous divorce of competence from conscience.

Once professionals begin to practice, they stop thinking beyond the technical aspects of their work.

Professionals must be able to make judgments that are not only technically correct but also ethically and socially considerate .

Ernest Boyer

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

Unfortunately, Professionals often see themselves and their services as the solution to people’s problems and the means for achieving progress.

This thinking has even influenced their public who come to believe that their own development is really the responsibility of professionals.

Training in the professions contributes to this dependency by preparing future practitioners to fix the problem over affecting change in global systemic inequities.

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

Our professional solutions often ignore the complexity of the human condition and importance of self-determination and empowerment.

Professional training tends to nurture a certain arrogance in which knowledge and skills are seen as the prerogative of professionals, giving us a certain superiority.

Poor people are perceived as uninformed and backward, having only themselves to blame for both their poverty and their poor health.

Inevitably, most services tend to ignore vulnerable, poor populations.”

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!”

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!”

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

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

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

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

Respect for Human Dignity: A Moral Imperative A fundamental ethic of service-learning: 1. The selection and achievement of morally acceptable ends; and 2. morally acceptable means to those ends. It is unacceptable to treat persons solely as means, (mere objects or things), because doing so fails to respect their intrinsic human dignity and thus impoverishes all of humanity. The welfare and integrity of the individual must remain paramount in all human relationships

A fundamental ethic of service-learning:

1. The selection and achievement of morally acceptable ends;

and

2. morally acceptable means to those ends.

It is unacceptable to treat persons solely as means, (mere objects or things), because doing so fails to respect their intrinsic human dignity and thus impoverishes all of humanity.

The welfare and integrity of the individual must remain paramount in all human relationships

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

Ensuring that ethical considerations have a permanent place in our work through critical self-reflection

Not a singular focus on the self, but a stepping back to understand one’s own assumptions, biases, and values, and a shifting of one’s gaze from self to others and conditions of injustice in the world. This process, coupled with the resultant action, is at the core of the idea of critical consciousness .

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

“ We see these situations which appear so appalling to us - where there is no justice, little hope, and overwhelming hardship - and we want to do whatever we can to assist people…

We want to offer our skills, our knowledge, our solutions. Sometimes it is welcomed, seldom is it refused, but we never know if what we are offering is best. Is our work disempowering? Is our message culturally inappropriate so that it will not be heard or will even cause social harm? Is it a drop in the bucket when a fire hose is needed? Does it even create dependence?”

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

“ In some cases, we are not reflective and our actions are inappropriate because we haven't thought them through. In many cases, we have the best of intentions, but incomplete knowledge and understanding…

So to those who have questioned the value of international volunteers, I would ask the following:

What do you want from us? What should we, as concerned individuals with a variety of skills and interests, be doing? Should we stay out? Get active politically in our own countries? Support economic reform? Simply support the concept of empowerment? Or something else?”

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

“ I pose these questions because I feel that the huge number of well-meaning outsiders represent a tremendously valuable force for positive change, and that it would be a shame to waste the potential contribution of this group.

What is more, I feel that to tell this group that their contributions to date have been useless (or even that they have done more harm than good) without offering some alternative mode of engagement, would be to overlook an important potential ally in the struggle for change.”