Tuesday, November 22, 2016

Global health porn: the case of Extreme Doctors

The last few years have seen a growing interest in the ethics of short-term medical missions in the developing world. Global health initiatives and programs in many universities often involve such missions, where medical students or faculty travel to a faraway lands (relatively resource-constrained, with high disease prevalence and fragile health infrastructure) and provide certain medical services, for awhile. These missions certainly enhance the prestige and attractiveness of Western medical institutions and schools of public health, and can improve the CV's of those who participate in them. But those working in the field know such missions, particularly when embedded in longstanding partnerships, can also do some good. They also know that such missions can raise a number of serious ethical challenges that need to be addressed in advance, carefully thought through and continuously managed.

These ethical challenges include: students or doctors practicing beyond their competence; inadequate follow-up care for interventions that are provided, particularly for chronic conditions; disruption of local health systems and patient expectations; lack of correspondence between services provided and local health priorities; cultural clashes between Western views of medical need and local conceptions of health and disease. And so on. Further, since medical care is being dispensed by wealthy individuals and organizations to patients and communities that are relatively poor, questions about exploitation are never far away: who really benefits, or benefits the most, from these 'exchanges'? How can such missions, however well-intentioned, avoid taking unfair advantage of the vulnerable? Efforts have been spent on developing ethical guidance, and while there are best practices for short-term global health missions out there, all this is clearly a work in progress. The background of massive health (and other) inequalities in the world makes the ethical conduct of short-term global health initiatives a complex, uphill battle.

There is another way of treating that background and viewing those challenges: as a basis for entertainment. Extreme Doctors is a show currently in production by the Lifetime TV Channel. As for the show's premise, I will let their website do the talking:

In season one our teams will converge on an underserved country in Central Africa that is known for its extreme contrasts from breath taking beauty to life threatening poverty. As soon as their boots hit the ground they assess needs and get to work. They only have 21 days to treat countless patients and try and make an impact. The long hours, frustrations, overwhelming need and third world conditions will test their skills and pull on their every emotion.

The show is presumably being shot in Zambia at this moment, and while no one can judge its content yet, the material posted on its website already runs the gamut from cringeworthy to appalling. The show's drama solidly centers on the medical professionals, plucked from their privileged American environments, and flown (likely premier class) to provide medical care to seriously messed up other-cultured remote people in adverse conditions (where, as one clip notes, access to a hair dryer is not guaranteed). They are interviewed before their medical mission, where they try to anticipate the magnitude and grandeur of their own personal sacrifices, and gird themselves for the mental toughness needed to 'get them through the sadness' of dealing with sick/poor Zambian people. (Suffering people can be such a downer.) One of the doctors even explicitly acknowledges that he is not prepared for the challenges ahead, apparently because that is part of the fun, though presumably will be less fun for his patients.

In typical 'reality television' style, the show plans to have medical professionals tell their own homespun personal stories, gossip about the other doctors and nurses, and express their 'fish-out-of-water' reactions. It's clearly all about them. The Zambians and their communities will seemingly play bit parts, as the suffering bodies to work 'medical miracles' on, and to provide occasions for foreigners to vent their emotions. But, as one of the doctors puts it, Africans accept death, so maybe the stakes are not that high, after all. Oh, and the flora and fauna of Africa is very photogenic, which helps to lighten things up a bit. But, you might ask, what happens after the medical mission is over? How is the impact of their 21-day intervention measured? What do locals make of these 'medical heros' helicoptering in, and whining about their feelings on camera, then heading back to their 6-figure incomes? From the entertainment perspective, those ethical questions are likely to be considered boring, and therefore irrelevant. For those concerned about the ethics of short-term medical missions, watching Extreme Doctors could be akin to watching a crime scene.

What are the likely effects of such a show? In the best case scenario, there are no grave effects, because the show is cancelled after viewers become horrified by this pretentious, neocolonial monstrosity. Or the show continues on, reinforcing the white savior complex. Or the show inadvertently manages to de-legitimize all short-term global health missions, including ethically sound ones. From an ethical point of view, it is hard to see a good case scenario. Raising awareness of global health inequality? Please.  

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