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Impact of Global Health Volunteers in Zambia: Examining Relational Harm and Healthcare Dynamics

Every year, thousands of global health volunteers, predominantly from the United States, travel to Africa with the goal of improving health outcomes and gaining insight into “global health.” These volunteers come from diverse backgrounds and have varying levels of medical expertise, including surgeons, anesthesiologists, nurses, and medical students.

Research Overview

James Wintrup, a senior researcher, has investigated the impact of these volunteers in Zambia. Between 2014 and 2016, he conducted research at a rural hospital where medical volunteers from the US provided various forms of medical care, including eye surgeries, cesarean sections, and treatments for malaria, tuberculosis, and HIV.

Wintrup’s latest research paper delves into how the presence of these volunteers affected the lives and relationships of local Zambian healthcare professionals and patients, identifying a significant form of “relational harm.”

Key Findings: Relational Harm

Wintrup’s key finding is that the presence of medical volunteers has caused damage to the relationships between Zambian health professionals and their patients. This relational harm is crucial because effective healthcare delivery relies not only on material infrastructure—such as power, water, hospital beds, medical gloves, and technical devices—but also on strong relationships of cooperation, trust, and mutual recognition.

Impact on Local Relationships

Based on long-term ethnographic research and interviews with Zambian health workers and patients, Wintrup discovered divided local opinions about global health volunteers:

  • Patients’ Perspective: Patients often praised the volunteers, noting their dedication and perceived higher quality of care compared to local staff. For instance, one patient described a volunteer as having “a heart for patients,” indicating a lack of discrimination in their care approach. Volunteers often had the means to provide additional support, such as transport money, which endeared them to patients.
  • Health Workers’ Perspective: Many Zambian health professionals were critical of the volunteers. They felt overshadowed by the volunteers’ ability to offer extended care hours, use newer technologies, and provide financial incentives to patients. This created a perception of disparity in the quality of care, leading to feelings of inadequacy and resentment among local staff. One Zambian staff member noted that the volunteers appeared superior, not due to better skills but because they had fewer external obligations and more resources.

Consequences of Volunteer Presence

The study revealed several negative consequences of the volunteers’ presence:

  • Erosion of Trust: The preference of patients for foreign volunteers, sometimes even those with less expertise, undermined the trust and rapport between local health professionals and their patients.
  • Feelings of Alienation: Zambian health workers felt like strangers in their own country when patients explicitly requested treatment from white volunteers, exacerbating racial and professional tensions.
  • Long-term Tensions: These dynamics fostered anxiety, resentment, and division, with potential long-term impacts on the healthcare environment even after the volunteers departed.

Recommendations for the Future

Wintrup’s findings contribute to ongoing debates about the benefits and risks of global health volunteering. Critics argue that medical volunteering can reinforce inequality and paternalism and cause direct harm through medical negligence. Supporters claim that these risks can be mitigated through responsible and informed volunteer practices.

Focusing on the relational impact offers a new perspective on this debate. Wintrup suggests that global health volunteers and the organizations that promote them should critically reflect on whether their work is harming relationships within healthcare settings. In under-resourced contexts, these relationships are particularly fragile.


Volunteers must consider whether they are leaving healthcare relationships in a better or worse condition than they found them. If the aim is to improve health outcomes, they should focus on using their resources to strengthen these relationships rather than undermine them. Effective global health initiatives should prioritize building and maintaining strong, trusting relationships within local healthcare systems to ensure sustainable and positive outcomes.

Cite this article as (APA format):

AR Managing Editor (2024). Impact of Global Health Volunteers in Zambia: Examining Relational Harm and Healthcare Dynamics. Retrieved from


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