moral conflicts and responsibility

Unfortunately, I tend to write when I feel emotionally overwhelmed. It serves the purpose of putting my thoughts down on electronic paper so I don't have to carry them in my head; however, it also means that I typically try to cram too much meaning into my writing. As I am no accomplished master of nuance, the result is disappointing and usually does not reflect the depth or angle of my thoughts very well. And it can be even more disappointing when I see comments on my writing, that prove how poorly I try to communicate my thoughts.

Today, what I wanted to talk about is the moral conflict that I experience about volunteering in the Downtown Eastside (DTES) with CHIUS (Community Health Initiative by University Students). Typically, people are surprised and exhibit general acceptance and avoidance behaviour when I express my feelings about this issue. Or at least I call it avoidance behaviour. You might call it justification.

What brought on my impulse of wishing to write about this topic, even after spending an hour on the phone and having planned to finish some LIs tonight, was (surprise) even more moral conflict at the clinic today than usual. See, today was the orientation for the new CHIUS students (yay!). I will certainly admit that I was irritated that I signed up to volunteer, and for both the morning and afternoon shift. Irritated because I felt the other execs were shirking their duties, and because I felt compelled to help out for some reason that is not clear to me. On top of that, when I went to the clinic, I was told that I was now doing both clinic and DTES community tours, even though I had signed up for the clinic tour only on the Excel document. Perhaps I wasn't irritated that I had to do both, so much as the fact that I was told what I was going to do rather than being asked politely to help with an additional task, when I already felt that I was going above and beyond expectations just by being there. Then again, perhaps I am being overly confrontational about a small matter.

Then, the orientation tours happened. Overall they went well and I enjoyed walking around outside and showing people the clinic. Maybe I was already in a bad mood, but one piece that irritated me was during the tours, the students discussed why they were interested in CHIUS. "I wanted to do something clinical," they say. "I want to volunteer often so that I'll get to see lots of cool things," they say. And perhaps I share their wishes, in that yes, in fact, I want to have the opportunity to see interesting medical scenarios and to contribute some of the pharmacy knowledge and skills that I've worked so hard to attain. But I did not hear a student mention he or she was passionate about connecting with DTES residents.

To me, it's not only disappointing, but it's also frustrating and ethically challenging. I spent hours poring over essays, trying to pick out students who had a genuine interest in listening to and caring for the DTES population. More than that - I find that I'm the only person who feels that having health professional students volunteer in the DCHC clinic is detrimental to DTES residents. Yes, students are respectful, avoid trying to interview patients that explicitly state they do not want to see students, and typically ask appropriate questions. But the fact of the matter is that getting interviewed by two students before seeing the doctor is slower than just seeing the doctor directly. And clients end up needing to re-explain their situation most times anyway to the doctor.

Maybe I'm wrong. Maybe I'm less competent or confident of a clinic volunteer, and other students feel that they actually contribute to the care of the clients that they see. I will then put forward the argument that the benefit ratio is incredibly skewed in favour of the student. Regardless of any marginal benefit the client may receive from seeing a student, think about what the student gets out of it. The student gets an opportunity to practice and learn clinical skills, to network with other health care professionals and students, and to wax poetic about their experiences and theoretical benefits to the patients they've served on resumes, interviews and conversations.

So why don't more people feel morally compelled to find ways to give back to the DTES community?

I do. As a CHIUS volunteer for about three years now, I have only ever done about five shifts in the clinic. I've volunteered far more time organizing and participating in Programming events. I don't want to get into a discussion of how the Brown Bag event was previously structured, but suffice it to say that I feel far more satisfied when I volunteer for one of our Brown Bag events today. At these events, we serve coffee or hot chocolate to our clients and discuss whatever issues they are concerned about, whether it is a new relationship, a side effect with a medication, housing difficulties, a job idea, or someone trying to get me to guess their favourite baseball team (when I only know about three in total). At these events, we're there FIRST to give - we're offering a small token of refreshment and our time and willingness to participate in conversation with our clients. And THEN we derive not just satisfaction, but also a deeper and richer understanding of the varied and complex backgrounds that our clients have.

I realize I am being overly harsh and judgmental with people. I don't know too many people who wince internally when they hear "I'm extremely interested in volunteering in the DTES with CHIUS, mostly because of the clinic opportunities" or "I was interested in the Brown Bag event, but I felt that we didn't really get any questions about medications." I should be excited that people care about the DTES population, that they recognize the unique needs of DTES residents, and that they feel compelled enough to help that 58 pharmacy students sat down to write 400 word essays in an attempt to get an orientation spot. I should feel motivated to try and support my fellow pharmacy students in deriving maximal learning opportunity from their volunteerism. But I don't, nearly as much as I should.

In my humble opinion, as CHIUS volunteers, because of all that our opportunity to work with DTES residents has done for us, we have a moral responsibility to give back to the DTES community. There are many ways that that can happen. We can volunteer in Programming events where the focus is client needs, rather than student needs. We can volunteer in other initiatives in the DTES, such as community outreach services, counselling and support, or (as I will be starting on Thursday) needle exchange programs. We can be certain to fully utilize the knowledge and skills we learn from CHIUS in our practices as health care professionals - to accept nothing less than optimal health care provision from our standpoint for all of our clients, regardless of reimbursement, and to advocate for community health.