5 Considerations for Volunteers

Maximise your impact, minimise your harm.

Apart from the trepidation of my family allowing me to spend three months volunteering in Nepal as a relatively new-graduate physiotherapist (at a time where the country was still searching for political stability), I was met with positive encouragement from teachers and colleagues alike. In reality I was quite unprepared for my adventure. For those considering volunteering in another country, this article is for you.

Are you a Voluntourist?

I wasn’t aware of the phenomenon of ‘voluntourism’ when I left Australia in the build-up to the Australian summer in November 2007 to spend 3 months living and working in Nepal as a Physiotherapist. Voluntourism is a concept I’ve spent many hours thinking about in the years since.

“Voluntourism” describes a volunteer involvement attached to holiday experience in a typically very short term engagement of one or two weeks (Cleaver 2016). The motivation is almost always altruistic, when a person of relative privilege donates their time and skills to help those in need. Unfortunately, due to the structure and short-term nature of these programs, there is often a lack of long-term outcomes and the value for the recipient community is disproportionately low compared with the investment required on behalf of the volunteer.

While I had committed a reasonable about of time (three months), what I didn’t appreciate was that for voluntourism to exist in the first place, there must be an imbalance in privilege and power, usually due to racism and inequity in resources.

Consider a Global Health Perspective

Global health has been defined as “collaborative trans-national research and action for promoting health for all.” (Beaglehole and Bonita 2010, as cited by PhysioPedia ND). Global health is essentially about equity in availability and access to resources. If we continue to think that we can make an impact in a problem simply by providing a temporary workforce then we are missing the point.

How this played out for me is that I thought I was doing the right thing toward sustainable change by selecting a program through an Australian based NGO with a long history in Nepal. While their main programs did not initially include Physiotherapy placements, on further discussion I found they regularly created individualised programs. Great (for me), and my philosophy of “I make a positive change in one person’s life, it will all be worth it”…

But in reality it’s not that simple.

What happens when you leave?

Case in point:

I treated one gentleman daily as an inpatient after a fall out of a tree left him with spinal cord injuries. His accident happened a couple weeks before I was due to leave. We made some good initial progress and he was hopeful of a good recovery, in part because of the care and attention I showed him (he was likely over-optimistic because of this). As my time was drawing to a close, I knew there was no-one to take over. I didn’t have the communication or understanding of the health system to organise a proper handover or long term needs. (My energy and resourcefulness to do this was also being worn down with my own developing gut and health issues, unaccustomed to living in the dirty city of Kathmandu, which along with the tragic sudden death of my host brother had increased my personal mental load). I started to feel growing sense sadness and shame that perhaps I had done little more in the long term than provide him a window into what he is missing out on.

Had his injury happened in Australia, his access to resources and long term support and financial assistance would have been vastly different. I felt (and still do feel) terrible about the situation and how I handled it.

I couldn’t face him. It’s hard to admit it here – but in all honesty, I didn’t even say goodbye.

Voluntourism vs Global Health

VoluntourismGlobal Health
Short term (1-2 weeks)3 – 6 months to years
Engage with community as a tourist or visitorEngage with the community as a citizen
Usually profit drivenNon-profit
Participant largely stays within comfort zone.Challenges the participant outside their comfort zone

(summarized from Cleaver 2016)

Global Health Crises at Home

Where inequity exists, health will suffer. A Global Health approach promotes equity in access and provision of health services to make positive changes. Katjia Ferrera’s presentation (Australian Physiotherapy Conference, Adelaide 2019) described the difference between equity and equality which she illustrated with this image (from the Interaction Institute for Social Change).

Equality vs Equity: If we believe the issues is inequality, we address it by giving everyone the exact same thing, irrespective of their needs. If we recognise inequity is the issue, we will respond to the different circumstances of each individual that require extra or different support for some to reach the same state of health and wellbeing as others in a relative position of advantage.

Inequity Exists Here

There are huge inequalities in health on our doorstep – our indigenous communities, the homeless, refugees and the LGBTIQ suffer poorer health than the wider community.

My study of public health prior to my Physiotherapy degree meant I was aware of these issues before I left for Nepal, but for some reason I chose to ignore them and instead spend time in Nepal. I’m certainly not alone in this. And I reflect now on this over ten years later – why was this?

Perhaps our problems weren’t exotic or glamorous enough. Perhaps I felt that the issues we face at home were so systemic, that a place like Australia should be able to fix it without me. After all, we have an arguably functional government with public health system funding. Australia didn’t need me. Or I didn’t feel I could make a big enough difference at home. Maybe I felt it wasn’t my place to try?

Voluntourism Can Be Damaging

It’s not just a case of bruised ego when you don’t feel you’ve actually been as helpful as you would have liked to have been. It is a case that you can do serious harm through your participation in certain programs.

Tina Rosenberg’s article “The Business of Voluntourism” reveals that over 90% of the children in Orphanages have at least one living parent. She highlights the continued institutionalisation of children through the industry of westerners visiting orphanages when back home, we have pretty well abolished orphanages and institutions. The Australian Government has launched campaigns to address child exploitation and discourages Australians in participating in so called “Orphanage Tourism

Other Ways to Contribute

Depending on your desired location, each physiotherapy community has individual challenges it faces. Connecting with the local physiotherapists to understand their issues is a powerful way to start.

I urge you to consider your own country’s local health challenges and issues of inequity and how you might be able to be involved.

It’s valid to just be a tourist. Travel to the places that interest you – it doesn’t have to be as a volunteer. Save the money on program fees, and instead spend the money on taking more time in the location, attending local language and culture classes (The Lonely Planet books are a fantastic resource for travelers). Contribute money to the local economy through your tourist dollars, choosing sustainable travel practices. You may be able to build contacts and relationships that create ideas for collaboration down the track.

The world is increasingly a global community, connected by the internet and social media in particular. It has never been easier to reach out and connect with like-minded people working in this space. Be informed and inspired by stories from the Global Physio Podcast. Read widely on the Global Health topic.

The value of your ability to contribute meaningfully increases as your expertise and experience does. Expert clinicians can provide skills in a “train the trainer” capacity. Consider that donating your time regularly over a longer period may mean you can contribute to a cause thousands of miles away right here or right now – editing journal article submissions for example.

The World Confederation for Physical Therapy has a list of work and study resources as well as international work opportunities along with the Database of Volunteers and Experts (DOVE) program.

You may have existing relationships which you can use to connect to the right people. Here’s five tips for volunteering:

5 Key Tips for People Considering Volunteering

  1. Consider what financial investment you need to make, and who benefits.
  2. Are you a Voluntourist or taking a Global Health Approach?
  3. Where inequity exists, health will suffer. What inequity is leading to the issue you are trying to address? How is your proposed program addressing this?Consider if you are perpetuating inequality and if your participation is harmful.
  4. Who are you taking over from? What happens when you leave?
  5. Are there other ways to be involved. Connect to the Global Health community.

Uncomfortable Truth

These topics are uncomfortable to discuss, and reveal my own naiveté and prejudice at the time. But I hope by sharing these challenges and concepts that it may help others in their quest to make a difference in the world.

Many great things happened from my time in Nepal: I have a love of the country and I feel a connection to its people. I received so much more out of the experience than I was able to contribute, which continues to fuel my need to ‘pay it back’. Volunteering overseas is not a bad thing – there are many positives that come out of building relationships, collaborations, greater understanding and connections in this world.

What I hope I have done here is to open a discussion and offer an alternative view-point that wasn’t presented to me when I set off. I’m simply suggesting that we need to pause and take an honest look at the situation we are entering into and what we hope to gain out of it. Consider what a ‘successful’ outcome would look like for all parties and build a program around that.

I wish you all the very best in your volunteering adventures!

Note: The planned late 2020 Nepal study tour is under review due to the developing Coronavirus outbreak. This trip aims to connect a global network of physiotherapists to the local physiotherapy community. Join the mailing list or reach me at hello@emilyeglitis.com.au if you’d like to know more about developments. I would love for you to join me. 

Join Emily on a study to to Nepal in 2020. Join the mailing list for more details as they are released.


Explore these resources for more details.

Australian Volunteers. Australian Government support of locally developed opportunities for skilled Australians. https://www.australianvolunteers.com/

Catherine Hamlin Fistula Association. An example of long-term commitment to making a real change. https://hamlin.org.au/

Cleaver, S (2016) Voluntourism: vlog with Shaun Clever. Global Health Division of the Canadian Physiotherapy Association. Accessed 21st April 2019 from https://www.youtube.com/watch?v=wNFKYdnXU3M

Global Physio Podcast. https://globalphysio.ca/

Illich, I (1968). To Hell With Good Intentions (Speech). Accessed 19/12/2019 from: http://www.uvm.edu/~jashman/CDAE195_ESCI375/To%20Hell%20with%20Good%20Intentions.pdf

Rosenberg, T (2018). The business of voluntourism: do western do-gooders actually do harm? The Guardian. Accessed 19/12/2019. https://www.theguardian.com/news/2018/sep/13/the-business-of-voluntourism-do-western-do-gooders-actually-do-harm

University of South Australia (2017) UniSA pioneers health clinic to help Adelaide’s homeless. Accessed 19/12/2019 from: https://www.unisa.edu.au/Media-Centre/Releases/2017-Media-Releases/UniSA-pioneers-health-clinic-to-help-Adelaides-homeless/

World Confederation of Physical Therapists. Lists many international work, study and volunteering abroad opportunities:




Australian Physiotherapist Perspective: Volunteering in Nepal

This Blog entry is a copy of the article I wrote for the official publication of the Australian Physiotherapy Association ‘InMotion’. Published in 2009, it is a summary of my experiences as a new graduate volunteer to Nepal in 2007/2008.


Volunteering to the max

In writing about her three-month stint in Nepal, physiotherapist Emily Smith (now Emily Eglitis) ponders the issue of Volunteers maximising their positive impact while minimising the negative consequences for host communities.

Committing your energy, emotions and sometimes even your health and safety to be a volunteer is a big task. It makes sense to find the most beneficial way to spend your time and resources, as it is not just for the duration of your time as a volunteer that you want a positive impact to be felt, but long after as well.

But in our quest to make things better, do we sometimes risk making the overall situation worse? If we help now, does it matter that the change may not last in the long run?

I am by no means expert on the subject of aid work, but while on my own quest to ‘change the world’ as a new-grad physiotherapist, I was confronted by a recurring question: How could I maximize my positive impact and minimise negative side effects from my work? Just as we try to practise physiotherapy holistically, maybe we can consider roles such as volunteering holistically as well.

Emily, client and family at Kanti Children’s hospital Kathmandu

After graduating from the University of South Australia in 2006, I worked for ten months in a private practice in Victor Harbor on the south coast, gaining valuable experience – and money to finance the whole venture. I decided to turn my combined desire to travel developing countries and my curiosity about volunteering into a round-the-world holiday that started in Nepal as a volunteer physiotherapist for three months in Kathmandu.

I worked at Tribhuvan Teaching Hospital (Neurology/Neurosurgery ward), Kanti Children’s Hospital (the only dedicated children’s hospital in the country) and a privately run rehabilitation centre – Sahara Care Home. My placement was organized through a local Australian non-government organisation (NGO).

As can be expected with any developing country, the healthcare system is under strain in Nepal. Delivering services to the estimated 86 per cent of the 29.5 million people who live rurally is a challenge made more difficult by the fact that in addition to Nepali, over 20 other dialects are spoken; even three months of study and practice in the Nepali language did not guarantee effective communication with those Nepalese, usually from smaller remote villages, who spoke another dialect. The sheer number of people is also demanding – population density equates to around 206 people per square kilometre, meaning that there are 5000 people per hospital bed. (By comparison, Australia’s population density is less than three people per square kilometre and an estimated 135 people per hospital bed.) Putting all this on top of a long and convoluted history of instability and corruption, you find a nation in need of assistance in many areas not limited to the healthcare system.

Petrol station nepal

In terms of physiotherapy, there are approximately 150 people working in the field and most are fully qualified. Unfortunately there are even fewer other allied health professionals, especially occupational and speech therapists. I was incredibly fortunate to meet and work under the guidance of the Associate Professor of Neurosurgery at Tribhuvan University Teaching Hospital, Dr. Mohan R. Sharma. Dr. Sharma became a good friend and mentor to me and involved me in the medical and grand-rounds of his neurosurgery interns and registrars. He appreciated that his patients were able to be assessed, treated and mobilised consistently during their stay.

The neurological patients I worked with very rarely received physiotherapy treatment unless they were gravely ill with chest complications. A large part of this was likely due to the under-referral of patients by medical team, which perhaps do not fully appreciate the benefits of physiotherapy in early mobilisation. There is also a lack of resources to treat all cases in need.

While my work was no doubt appreciated by patients and staff alike, Dr. Sharma and I realised that the benefits I was bringing to my patients were not going to last. as the saying goes: ‘Give a man a fish and you feed him for a day, teach a man how to fish and you feed him for a lifetime’.

In a ‘treatment’ role, it was pretty tough to contribute significantly early on. Because of the language barrier, I couldn’t treat patients safely and effectively without the help of someone to translate. I started to feel little useless and that I was absorbing more time and energy from the placement than I was giving back. This is an important consideration to take into account in the planning stage, as you want it to be worth the while of your hosts to orient you and help you settle in. this especially so when language is a barrier, which is why many institutions will strongly recommend a duration of at least three months.

On day I was feeling particularly unconstructive when one of my Nepali colleagues was working with a middle-aged woman with a degenerative brain condition causing severe ataxic gait. The physiotherapist had again tried the standard recipe of ROM exercises and that retraining that consisted mainly of steering the patient awkwardly across the room, accumulating two falls and more than a few near misses.

Nearing the end of the treatment session while giving the patient a rest, the physiotherapist dejectedly declared to me, ‘I just don’t know what to do with her!’ I realised an avenue through which I could really help – the physiotherapist was smart and eager to learn and could obviously communicate in her native tongue to the patient. I was able to jump in and help, brainstorming ideas from my not-so-distant university days for further assessment, outcome measures and goal setting. I helped her to break the treatment session down from the complex task of walking into smaller task components of postural control and stages of the gait.

That day, we all left with a sense of achievement. I realised that encouraging and stimulating physiotherapists already there, and who will stay long after my departure, will benefit the local community the most. Continuity is the key – finding a method to help that will mean your contribution is felt by many more people long after you leave.

As Australian physiotherapists we are privileged to receive such a high standard of training and ongoing support and development from our professional body, the APA. Committing where possible to well-organised projects where there will be support and continuity in your contribution (such as in further training and education of physiotherapists in developing countries) means that we can use our unique skills to immeasurably benefit many other people. If there are no projects of this sort already in progress, you may be able to assist local people at a preparatory level toward this goal. Combining with established aid organisations and researching them well is one method of doing this.

Furthermore, there was a noticeable difference to the multidisciplinary approach to healthcare I have experienced working in Australia compared with Nepal, where doctors seem to be the first and last port of call for health. Advocacy for physiotherapy and its many benefits aimed directly at the medical community might improve service provision of physiotherapy and encourage outlets for professional development. Physiotherapy potentially could have a massive impact in primary and preventative healthcare.

When you arrive in a new community with a quest to make a difference, you want to make sure it is a positive difference you are making and not a negative one. Overall, the task of minimising any negative impact comes down to commitment – being honest with yourself and determining how much time you will need to become autonomous in the role you are playing and then to carry out your duties for a reasonable period thereafter.

Trek through Langtang Village, Rasuwa region Nepal

In a broader sense, being mindful of the unique set of social, environmental, cultural and political circumstances that surrounds the community in which you intend to work can also help when attempting to be holistic in your approach as a volunteer. Working with the local community to identify and tackle issues that are important to them is essential to an effective and enduring project. As Ian Edwards (University of South Australia lecturer and aid worker in Kabul, Afghanistan) points out. ‘The learning process works best when it is genuinely a two way process.’

This principle can also be carried into daily life. There are many disadvantaged groups in the community and how you interact with them is also important. Daily in Nepal I would walk past the homeless beggars, sometimes children who would hang onto my arms as I walked along the street, forcing harsh realities of life at me. To not give a few measly rupees to the beggars feels heartless.

However, children are often pulled out of school because begging is more lucrative. To pay them may mean you perpetuate the problem. What do you do? As part of living and working in a foreign country, you may be in a position to hire locals into employment, as cooks, cleaners, porters or trekking guides. Although you may be able to do the jobs yourself, providing proper working conditions and a fair rate of pay potentially could further your positive impact.

A huge environmental problem in Nepal is waste disposal, and clean drinking water is a luxury sold in plastic bottles that are non-recyclable and clogging rivers and piling up along trekking routes all over the country. It is avoided easily by filtering or boiling your own water. Being culturally sensitive to dress and responses to religious rituals, hand gestures, eating, bathing (and more) is important also. Occasionally, volunteers treat their time as if it is a holiday, neglecting that unpaid work still requires you to show up on time, work well and show respect for co-workers.

Considering how we can best spend our time and effort as physiotherapists will assist those who take the plunge and volunteer, and may even impact on the way we practise right here at home. The process of volunteering should benefit both the volunteer and the hosting community. Finding a way to do this takes considerable awareness of ‘the big picture’ and a consideration of what will happen after you have left. You may not be earning money, but an honest contribution is incredibly valuable and may have benefits beyond those originally expected.

Langtang Region Prayer Flags