Rwanda Day 7: Doing good when you’re trying to do good

It’s done. Day 7 of the trip (day 6 of the surgery) and 18 operations are done. We are OK with this.

Our local colleagues doing the heavy lifting during the final operation.

Our local colleagues doing the heavy lifting during the final operation.

It’s not the end of the work for everyone. There’s plenty of nursing still to come and some more work for the physic for starters and it will be days before the last of the team move on. We do try to get out of the way of the operations of the hospital as much as possible though. One hour after the end of that operation, this was the operating theatre …

2 hours later, it was being used for someone else's operation.

2 hours later, it was being used for someone else’s operation.

In a few spare moments today I had the chance to talk to an anaesthetist from Utah (sorry, anesthesiologist) who has been working around Africa for the last 3 years. He spent a year in Guinea working with the Mercy Ships organisation (and wow for the work they do). He’s been in Rwanda for a couple of years now.

At one point he used a very revealing turn of phrase.

“I’ve been on the receiving end of quite a few of these aid trips now …”

Hear that? “on the receiving end”. What? The presence of aid trips isn’t an unqualified story of joy, peace and goodwill?

Terrible Package Tourists

Turning up to do surgery in a less equipped place on the other side of the planet causes lots of problems if not done right. The hospital we’re at in Rwanda sees up to 5 aid groups in any one year.  If you’ve had a chance to read a few of these posts, you have probably noticed that we generate plenty of work. It doesn’t take long to figure out that that could lead to issues.

These short, sharp surgical trips have a particular reputation for sweeping in, doing some ego-boosting do-gooding and flying out into a sunset that blinds them from the reality of what they’ve left behind. Disaster situations are another example where well meaning but misguided aid workers, or worse, can cause real disruption. All sorts of people turn up promising to help, but turn out to be a liability as they buzz about like drunk bees. Useless helpers have a sting.

If you turn up to provide help and end up just leaving a different burden, that qualifies as pretty inappropriate and unethical. There are a few key things the aid trips I’ve been on have endeavoured to address. (Here’s the bit where I do a list to break up the reading monotony.)

1. Make Plans

Not just for surgery. As an aid group you need to tread as lightly as possible on the health system you’ve come to help. Every thing you don’t bring is something you’ll take off them. Preventable complications will probably fall to the locals to fix. Planning at first sounds like the sort of thing you’d discuss in “Financial Advisers Without Borders”. It really is the thing that guarantees mission success.

2. Don’t Let it Slide

You might be in a place without your usual stuff. You may have to work in with a system with different expectations. That doesn’t mean you can go easy on your own standards. If you can’t provide an acceptable level of care for a particular thing then it’s important to recognise that it is beyond even adjusted means of getting things done safely and appropriately. The manner in which this is weighed up will differ in each scenario and is very different in a disaster, but standards matter.

3. Make Sure It’s Not About Those on the Aid Trip

The reason you turn up is to offer some sort of care that the local health system can’t provide themselves. That means the job of those on the trip is to provide the care right now for the kids in a way which fits in to the health system you’ll leave behind. The locals are there before you arrive and still there when you leave. The aid trip is about 1% of the story. It’s about the kids and the locals, not making yourselves look good, or getting through as many cases as possible.

4. Choose Wisely

You have to set some form of limit. If you turn up to do orthopaedics, doing plastic surgery isn’t appropriate. Likewise you want to do the sort of operations that provide benefit but don’t require weeks of intensive care. You can’t tread lightly in an intensive care unit. If you do work on the absolute sickest with minimal chance of success, you end up leaving untreated many more who would be much more likely to gain benefit.

There will also be complications on these trips and that has to be taken into consideration or the local teams end up dealing with chronic long-term issues that may sap resources better used elsewhere.

5. Leave More Than The Sutures

This is not so much about the equipment you should also leave where you can. There have been those who used to go on aid trips and didn’t engage beyond the specific stuff placed in front of them. It is more important to help build a system than it is to just turn up. What happens for the other 350 days of the year you aren’t there?

We’ve been invited to come to provide something that isn’t feasible right now in Rwanda. We would hope at some point we’ll be given the job of hanging out in the corner while the locals get straight into it. Through education, services or modelling, aid teams should be able to have people feeling like they can kick us out of the room. Then at some point they will and that would be the best we could ask for.

6. The Next Trip Starts Yesterday

Each trip has to develop expertise in your team and in those you’re helping. The moment we finished operating yesterday we packed. We packed equipment for the ongoing trip to Tanzania but we started packing and planning for the next Rwanda team. Better supplies of equipment left at the hospital. A review of things that could be done better. Not doing it better is just a lot of treading water.


You may have had the joy of a young kid offering to help in the kitchen. It can go well. It can get pretty messy and that kid will be likely to notice the greater joys of the lizard in the back yard when it’s time to clean up.

Aid trips can be their own disaster. Do-gooders are good at not doing good. It’s not enough that the kids are now smiling at us on the ward and planning to fly kites on the lawn in the morning. We need to have more kids and our hosts smiling when we come back.


Interested in reading other bits on ethics and aid work? You could try this thing by Wolfberg  or this thing on the early Haiti disaster response.


I’ll be leaving Rwanda today but other members of the team (plus new members) are off to Tanzania. The guys from Open Heart International will be sharing more from this trip over at where you can also consider donating or volunteering (which is easier if you are in Oz).

If you’ve dropped by any of these posts and had a read or shared them with others, a very sincere thank you.  




One thought on “Rwanda Day 7: Doing good when you’re trying to do good

  1. Pingback: What can the world give you? | Songs or Stories

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