Residency Advisor
You’re three days into a short-term medical mission. Morning “devotionals” run long, clinic starts late, and when it finally does, the pattern is obvious: the foreign docs sit, patients line up, translators hustle, and the local clinicians are either sidelined as “helpers” or not even invited into the main room.
You watch a US-trained FP “correct” a local nurse on malaria dosing. He’s wrong. She’s right. She goes quiet. He keeps talking. Later, you hear someone on the team say, “They’re so grateful we’re here; they don’t really have systems.” You’ve seen the systems. They exist. They’re just not being respected.
You’re not the team leader. You might be a student, resident, junior doc, or other health professional. You flew here with good intentions and now you’re stuck in a mission group that is clearly ignoring or overruling local clinicians.
Now what? Walk out? Keep your head down and finish the week? Say something and become “the difficult one”?
Here’s how to think through this and what to actually do, step by step.
Step 1: Get Clear on What’s Actually Happening
First, you need to stop hand-waving it as “a bit awkward” and name what you’re seeing. That changes how you respond.
Look for concrete behaviors, not vibes:
- Are local clinicians being excluded from decision-making (e.g., treatment protocols, triage, referrals)?
- Is the mission team overriding local standards of care without discussion?
- Are local staff being used as translators or “runners” only, while foreign clinicians make all medical decisions?
- Are local clinicians being publicly corrected, dismissed, or ignored?
- Are foreign team members speaking about local clinicians instead of with them?
You’re not looking for perfection. You’re looking for patterns. One clumsy comment is human. A week of sidelining is a structural problem.
Start building a quiet mental log:
- What was done or said?
- Who was present?
- What was the clinical impact?
- How did the local clinicians respond?
You’ll use this later if you decide to push back. “You keep ignoring them” is useless. “In yesterday’s asthma case, Dr. X overruled the local physician’s plan in front of the patient without discussion” is specific and hard to dodge.
And be honest with yourself: are you contributing to the problem? Catch your own reflexes—automatically turning to the US/European attending for answers instead of the local doc; asking the translator instead of asking the local nurse directly by name.
You can’t fix the whole system. But you can stop being part of the steamroller.
Step 2: Re-anchor Your Ethical Priorities
This is the part where you decide what matters more to you: group harmony or ethical practice.
You are juggling:
- Duty to the patient
- Respect for local clinicians and systems
- Your own safety and ability to keep working
- The reality that you’re a guest, not the hero
There’s a simple test I use and I recommend you use here: “If this interaction was filmed and played back to a panel of local clinicians from this region and global health faculty from my home institution, would I be okay with my role in it?”
Not the group’s role. Yours.
If the answer is no, then you need to adjust what you do, regardless of whether the rest of the team changes.
You’re not here to “save” patients from both poverty and your own mission group. But you do have a responsibility not to participate in harm or disrespect.
In plain language: your loyalty is first to the patient and to professional ethics, not to a dysfunctional team culture.
Step 3: Use Small, Immediate Moves to Center Local Clinicians
You don’t start by calling out the team leader in front of everyone. You start by changing how you interact today.
Here are moves that are low-drama but high-impact.
In clinical encounters
Start explicitly deferring to local clinicians in front of patients. Out loud.
Examples you can adapt on the fly:
- “Dr. [Local Name] knows the usual practice here. Doctor, what do you recommend in this case?”
- “Nurse [Name] manages this condition here all the time. I’d like to hear your approach.”
- To a patient (through the translator): “I’m here temporarily. Your doctor here is the one who will keep caring for you after we leave.”
Then shut up and actually listen. If you disagree, ask questions instead of correcting:
- “I use a slightly different protocol at home. Can you walk me through how you do it here?”
- “What’s available in your pharmacy usually? I don’t want to prescribe something you can’t get next month.”
You’re sending two signals at once: to the local clinician (“I see you as the authority here”) and to your team (“this person is not our assistant; they’re our colleague”).
In hallway or table conversations
When the team starts debriefing cases without any local voices:
- “Have we asked Dr. [Local] what they think about this approach? They’re the one who will see these patients after we’re gone.”
If someone complains about “how they do things here”:
- “Have we actually asked them why they do it that way? They may have constraints or data we don’t know.”
Don’t give a sermon. One clean sentence, then redirect: “Can we ask them now?”
This sounds small. It isn’t. I’ve watched whole team dynamics shift because one person keeps asking, “What do the local clinicians think?” every single time a decision comes up.
Step 4: Have a Targeted, Private Conversation with Leadership
At some point, if this is more than a one-off annoyance, you’ll need to talk to someone with authority on your team. Not as an angry whistleblower. As a professional raising a concrete concern.
The formula that works best is boring but effective:
- Describe specific behaviors.
- Name the impact on care or relationships.
- Make a simple, doable request.
Something like:
“Dr. Smith, can I run something by you?
I’ve noticed in several clinics that local clinicians are mostly being used as translators or runners, and we’re making treatment plans without their input. Yesterday, for example, when Dr. Lopez suggested the standard local antibiotic regimen, he was overruled in front of the patient without discussion. He went quiet afterwards and stayed in the back.
I’m concerned we’re undermining their authority with their own patients and might also be missing their knowledge of what’s available and sustainable here. Would you be open to us explicitly inviting local clinicians to present their plan first in each case, and then discussing any differences in private or as a group?”
You’re not accusing them of being colonizers. You’re giving them a way to save face and shift behavior.
If they get defensive (“We’re the ones with better training,” “They’re grateful we’re here”), do not get sucked into a philosophical debate. Bring it back to pragmatics:
- “I get that we bring different training. I’m just worried about continuity of care when we leave.”
- “I’ve seen that when we override them openly, they stop speaking up. That’s dangerous if they see something we miss.”
If they refuse to budge, that’s information. Now you know how much you can realistically change during this trip.
Step 5: Decide How Far You’re Willing to Go
You have three basic options once you’ve tried quiet, internal fixes:
- Stay, adapt your own conduct, keep pushing gently.
- Stay and go along with the status quo.
- Pull back (from certain activities) or leave, and document what happened.
Let’s be blunt: sometimes walking away is ethically right but practically impossible. You’re in a remote area, the team holds your passport, or leaving would abandon patients mid-care. So you make a damage-control plan instead.
But at least ask yourself honestly: “Where is my red line?”
Some examples of red lines that justify drastic action:
- Team members actively undermining or insulting local clinicians in front of patients.
- Dangerous care because local standards are being ignored (e.g., using banned meds, ignoring local resistance patterns).
- Refusal to involve local clinicians at all, even when they’re present and willing.
If you hit that line:
Short term:
- Quietly increase your reliance on local clinicians. Ask them directly what they want you to do in specific cases.
- Opt out of the worst practices if you can: “I’m not comfortable running this clinic without Dr. [Local] present; I’ll join the pharmacy/triage instead.”
- Document key events for after the trip: keep a dated note on your phone (offline if needed).
Long term:
- Do not come back with this group.
- Consider reporting concerns to your home institution, church, or professional organization once you’re home and safe.
Step 6: Build Direct Relationships with Local Clinicians
One of the most powerful things you can do is simple: step out of the mission team bubble.
Eat with the local staff if possible. Sit with them, not just with your own group. Ask normal professional questions:
- “How long have you been working here?”
- “What are the hardest parts of your job?”
- “What do visiting groups usually get wrong?”
Listen more than you talk. You’re not mining them for quotes; you’re trying to understand how they see your presence.
You can also quietly ask:
- “What would be most helpful from me this week?”
- “Is there anything our team is doing that makes your work harder?”
You’ll get filtered answers at first. That’s fine. Over a few days, if you’re consistent and respectful, people open up. That’s when you learn the real story: which meds they can actually stock, which patients they worry about after teams leave, which past groups did real damage.
That information should change how you personally practice on this trip:
- Prescribe only what they can reliably provide.
- Suggest follow-up that fits their system, not yours.
- Offer to teach or share skills only when they ask or show interest.
You are one person. But one foreign clinician visibly deferring to local colleagues, eating with them, and treating them as equals sends a message that not all visitors are here to dominate.
Step 7: Adjust What You Do in the Clinical Space Right Now
Forget fixing the mission organization’s philosophy. What can you actually change this week? Quite a bit.
Practical, concrete shifts:
When a local clinician enters the room, introduce them to the patient as the primary clinician, not as “helper.”
“This is Nurse Aisha. She’s the one who runs this clinic and will follow up with you after I leave.”
Before giving your plan, ask:
“Doctor, how would you usually treat this here?”
If your plan differs, say:
“At home I might add X because of Y, but I don’t want to suggest anything that isn’t standard here. How do you feel about this option?”
If you see a foreign colleague dismiss a local clinician in front of a patient, gently re-balance the power:
“I want to make sure we’re not overlooking Dr. [Local]’s experience with these patients. Doctor, can you share how you usually approach this?”
You’re not publicly shaming your teammate. You’re modeling an alternative.
And if the team tries to run a parallel clinic without local involvement (“we’ll just be faster”), you can say:
“I’m not comfortable running a clinic without someone from this facility involved. I’ll help with triage/education/pharmacy instead.”
Notice: you’re taking responsibility for your decision, not telling them what they have to do. That matters both ethically and for your own safety.
Step 8: Plan Your After-Action Response When You Get Home
This trip will end. How you handle what you saw after you return is where you can make a bigger dent.
Within a week of getting back, sit down and write a clear, factual narrative while details are fresh:
- When/where was the trip?
- Who led it (organization, key leaders)?
- What specific patterns of ignoring or undermining local clinicians did you observe?
- What did you try (conversations, suggestions) and how did leadership respond?
- Any clear examples of harm or near-misses?
Strip out the venting. Keep the story tight. Dates, people, events.
Then decide who needs to see this, depending on your role:
- If you’re a student or resident: your global health office, program director, or a trusted faculty with global health ethics experience.
- If you went through a church or NGO: whoever oversees partnerships or missions.
- If you’re independent: consider sharing anonymized concerns with professional bodies that publish on global health ethics or with colleagues who are considering this group.
The message you send should not be “Cancel all missions.” It should be:
“This organization shows repeated patterns of sidelining local clinicians, ignoring local standards, and undermining continuity of care. I recommend our institution not endorse or send trainees with them unless there are concrete changes.”
You will annoy some people. That’s fine. Protecting your future educational opportunities is not more important than not propping up a harmful model of care.
Step 9: Choose Better Missions Next Time
The best way to respond long-term is to stop feeding bad organizations your time, skills, and reputation.
Before you ever sign up again, interrogate the group. If they can’t answer basic questions about how they work with local clinicians, that’s an answer.
Here’s a quick comparison of red-flag vs green-flag behaviors:
| Area | Red Flag Behavior | Green Flag Behavior |
|---|---|---|
| Role of locals | “They help us translate and register.” | “They lead care; we support and learn.” |
| Decision-making | Protocols imported from abroad without discussion | Protocols adapted with local clinicians before clinic starts |
| Continuity | No plan once team leaves | Clear handoff process with local staff |
| Teaching | Foreigners teaching unrequested content | Bidirectional teaching based on local requests |
| Attitude | “They’re lucky we’re here.” | “We’re guests, here to strengthen what’s already built.” |
When you talk to a potential mission sponsor, ask bluntly:
- “Who are your local clinical partners, by name and role?”
- “Who decides what services we provide?”
- “How do you ensure we don’t undermine local clinicians’ authority with their own patients?”
- “What changes have you made in the last 3 years based on local clinician feedback?”
If they waffle or get defensive, pass. I don’t care how inspiring their slideshow is.
A Quick Visual: Your Decision Flow in This Situation
| Step | Description |
|---|---|
| Step 1 | Notice locals being sidelined |
| Step 2 | Document specific examples |
| Step 3 | Adjust your own conduct to center locals |
| Step 4 | Continue, model respect, debrief later |
| Step 5 | Talk privately with team leader |
| Step 6 | Support changes, keep monitoring |
| Step 7 | Set personal red lines, opt out of worst practices |
| Step 8 | Complete trip as safely as possible |
| Step 9 | After return, document and report |
| Step 10 | Still serious problems? |
| Step 11 | Leader receptive? |
Watch the Emotional Traps
One more thing nobody tells you: this stuff messes with your head.
Common traps:
- Paralysis by guilt – You realize your group is acting like colonial tourists and start hating yourself. That doesn’t help anyone. Acknowledge the guilt, convert it into different behavior, move on.
- Savior complex 2.0 – You try to “save” local clinicians from your own team. Careful. You are not the protagonist in their story either. Ask them what they actually want, and respect it if they prefer you keep things quieter.
- Cynicism – You go home and decide all missions are trash and nobody can ever do this right. That’s lazy. There are ethical models out there. They just take more work and less ego.
If you’re a trainee, debrief with someone who actually understands global health ethics. Not just your most enthusiastic mission-Trip veteran. An infectious disease doc with long-term partnerships, a family physician who’s done multi-year work with a single site, a global health faculty member—people who’ve seen both the damage and the good.
Two Final Anchors
If you’ve read this far, you’re already taking the situation more seriously than most people on your plane. Good.
Hold onto these:
- Your obligation is not to be “nice” to a broken mission culture. Your obligation is to practice medicine ethically, respect local colleagues, and avoid doing harm in the name of help.
- You control more than you think: how you speak in front of patients, how you defer to local clinicians, how you choose future trips, and whether you quietly endorse organizations that ignore the very people they claim to serve.
You probably cannot fix this trip. You absolutely can refuse to join the problem—and you can make it a lot harder for this kind of mission work to keep pretending no one notices.
