The Low Down on Creating Sustainable, Ethical ISL Programs


I pursued Travel PT as a new grad to afford me the flexibility to continue with international service learning trips in my career.  From my experience, students and clinicians are interested in serving domestically and internationally, but are often unsure on how to start and how to create a sustainable impact in a global community.  In 2015, I had the pleasure of serving as the Global Health Project Committee (GHPC) Co-Chair with Josh Greensweig to create the first International Service Learning (ISL) Manual.  The 2016 Global Outreach Committee further developed this ISL manual to include robust research on the ethical implications of ISL.


What is the purpose of the manual?

Christina and Kelsie:

This manual is intended to be a resource for students considering international service trips, with the aim of providing evidence and resources to help students plan and execute the most successful and meaningful trips possible. Prior to the creation of this manual, there were very few resources specifically for PT and PTA students to help them navigate the process of finding and choosing the best international experiences for their needs and skills.

The Global Health Project Committee (GHPC) of 2015 published the first draft of this manual last year, which provided very strong resources about the logistics of planning a trip and provided wonderful resources on where to find opportunities for international service. This year, the re-named Global Outreach Project Committee (GOPC) wanted to expand upon this resource, with advice and guidance from the APTA’s Global Health Special Interest Group leadership, to include even more resources and evidence on ethics, sustainability and community engagement to supplement what was created last year. We wanted students to have the most up-to-date information regarding global health/service opportunities available in one place.


Why did we personally want to work on the manual? Why did we think it was important to create this type of resource?


To be completely honest, before becoming involved in the GHPC last year and becoming chair of the GOPC this year, I did not have a particularly positive view of short-term international service trips.

Prior to beginning PT school, I served as a Peace Corps volunteer in Burkina Faso for 2 years. During that amazing and life-changing experience, I saw many short term service groups from a variety of disciplines come and go from my village and, from my unique vantage point as both a foreigner and a steady member of my community, I saw very mixed results.

Some groups were indeed very successful at providing medical services or helping to develop sustainable programming, but most the groups I experienced had minimal lasting impacts on the community- or worse yet- some of them had negative impacts on the community. I knew that all of the short-term volunteers I met had the best of intentions and it was hard for me to watch them work so hard towards such admirable goals, only to have minimal lasting effects. It was also hard for me to watch members of my community suffer the consequences of poorly executed service trips. Due to all of these experiences, I left Burkina Faso after 2 years feeling jaded about short term service trips and feeling very unsure as to whether it was possible for these negative impacts I had seen to be minimized. I felt as though a long-term commitment- such as the 2 years I spent in Burkina Faso- was a requisite for truly having a positive impact on a community.


Based on my experience, it may be surprising that I chose to work on this resource at all. However when the opportunity to work on this manual was presented to me, I was thrilled. I suspected that researching, writing and collaborating with the GOPC members on this resource would validate many of my concerns (which it did), but most of all I was hoping that searching and synthesizing the literature would prove my suspicion that these negative impacts could not be mitigated to be wrong! I was hoping that we would be able to find evidence-based strategies to avoid many of the pitfalls I had seen during my time abroad, while ensuring that students had a thorough understanding of the ethical implications of working in a resource-limited international setting. Working on this manual gave me the opportunity to explore and share the literature about community experiences and impacts from international service, and allowed me to collaborate with the committee to find evidence on how to make these experiences more positive and productive for all involved; including students, professionals and, most importantly to me, the host communities. The more I delved into the research and listened to the experiences of my fellow committee members, the more I realized that with proper research, preparation and skills, short-term service trips could indeed be tremendously successful for both students and communities. I believe that having this knowledge is immensely powerful and important in allowing students to make thoughtful choices about how and where to serve in order to prevent other students from making the same mistakes I had seen in the past.


e0a19e7e-eebd-41f0-aa56-8edaf5f032baI love opportunities that combine the things i’m passionate about – particularly therapy/rehabilitation, international experiences, and education – and with an increased student interest in global health the need for a resource like this was apparent. After spending a year in Indonesia as a Fulbright English Teaching Assistant prior to beginning PT school, I knew I wanted international service to be a part of my future career as a physical therapist, but like many students did not know where to find these opportunities. This led to my involvement in the Global Health Project Committee and the Global Outreach Project Committee, where I had the opportunity to contribute to this resource- an evidenced-based document answering many of the questions I originally had regarding international service experiences while a student and beyond.

Similar to Christina, I really wanted to stress the importance of ethics and sustainability which are often missing in short-term service trips. You will see this theme echoed throughout this blog post and the manual, as we are both passionate about serving and respecting the local communities we have the opportunity to serve. Education is one of the most powerful tools we have to promote mutual respect and cultural understanding, and I believe this manual is our best effort to promote this theme and create meaningful experiences for both volunteers and host communities.

Why did our committee want to expand upon the manual?

Christina and Kelsie:

The members of the 2015 GHPC wrote the first version of this manual in its first year as a committee, which is quite remarkable. In a very short amount of time, they developed a database of available international service opportunities across the country and created a tremendous resource. As we mentioned above, the first version was very robust in terms of providing thorough information on the logistical aspects of planning a trip; these included finding service opportunities, funding, and obtaining travel documents as well as safety precautions including health requirements and resources to help find safety information about the country of interest among many other resources. However, only so much can be accomplished in a year! When Christina took over as chair of the committee this year, April suggested adding more evidence on sections they had not been able to fully expand upon, including sustainability and ethics. When we decided to seek endorsement from the Global Health SIG to get this resource published on their website- the leadership of the GHSIG agreed that these areas should be our areas of focus. Because we are both passionate about sustainability, ethics, and community engagement in global health and service, we were thrilled to have the opportunity to work with our fellow GOPC members to research and expand upon these areas in the manual. We also had several committee members with expertise in various languages, so were able to add to the existing language resources from the first version of the manual, including new language appendices in French, Swahili and Portuguese.

What do we hope students will get from reading the manual?

Christina and Kelsie:

We hope that after reading the International Service Manual for Students, students will have many of their questions about global health and involvement answered and come away with a passion for ethical and sustainable global service. We want students to understand that it is possible to expand their knowledge, practice their clinical skills and fulfill their desire to serve, all while making sure that the experience is as positive as possible for the people in the communities in which they serve. Students should feel empowered with resources and knowledge to find service trips and organizations with ethical, community-based and sustainable models so they can choose the best possible service experiences. Additionally, we hope this manual encourages students to reflect on their experience and to stay involved with global health and community service while a student and a professional.

What did we learn from the experience of working on this manual?


As I said above, I started the process feeling less than enthusiastic about short-term international service. I am happy to say that working on this manual changed my views! Throughout this process of researching and writing, my opinions were consistently challenged and I was pleasantly surprised by the amount of research looking at short-term service and how positive the impacts can be.

I learned that with proper planning, research and community partnerships it really is possible to have a mutually beneficial experience for all parties involved in an international service experience.

I feel so fortunate to have had this opportunity to expand my knowledge base, change my biases and develop a more holistic view of international service. I also learned so much from the other contributors to the manual.

As the Chair of the committee, I had the unique privilege of dividing up work tasks and reading/editing everything that other committee members created. I was always amazed with what my colleagues would come up with- whether it was research I hadn’t considered before or a way of writing that communicated their passion for service- it was an amazing experience to see what such a small but dedicated group could come up with together.


We started this year’s update to the manual with a comprehensive literature review and I was pleasantly surprised to learn how much evidence was available regarding student involvement in international service/global health as well as the impacts on host communities. Thresearch-2is is still a growing area of research, and I look forward to seeing how the manual and international service trips evolve as more evidence becomes available. The experience of writing this manual went hand-in-hand with being apart of the GOPC this year, and I gained so much from collaborating and talking with my other committee members. As anyone who has ever traveled and served abroad, we love to share our experiences and inspire others. Not only did I learn about my fellow students’ international experiences and passion for global health, but I learned about their research interests, the structure of other PT programs, and time management. We bonded over stressful test/project/practical weeks, while working together towards a common goal. This experience expanded my #PTfam and introduced me to an incredible group of people who were supportive both in- and outside of the responsibilities of this project.

What are our future plans?



Working on this manual has made me even more passionate about global health and service- especially now that I feel like I have many of the tools and resources to do it right! I would like to use many of the skills I developed while serving internationally to be more involved in global health and service here at home because serving those in need in our own neighborhoods is so important. But I also still plan to work abroad in some capacity and am taking advantage of every opportunity to gain more experience and expertise in this area. Right now I am completing my DPT practicum project, under the tutelage of some amazing PTs who specialize in women’s health in low-income settings, to develop a group exercise intervention for survivors of conflict-related sexual trauma in Democratic Republic of Congo.

Our goal is to help develop a trauma-sensitive program that will be carried out by local healthcare providers, that can help meet some of the rehabilitative needs of these amazing women without the need for a lot of medical staff (which is unrealistic in this particular setting). I honestly had never considered the role of PT in serving this specific population, but it makes so much sense that we should be involved in treating many of the resultant issues like pelvic pain, pelvic floor dysfunction and functional training. So I hope to continue to have opportunities like this to expand both my clinical and global health skills to develop into a well-rounded PT. But for now- I am just hoping to pass the boards and get a job following my graduation in May!


Similar to most 3rd year DPT students my immediate future plans are to study for boards, finish clinicals, pass boards, graduate, and get a job. My plans following graduation are to spend the month of June in Africa starting with two weeks in Nairobi, Kenya volunteering 3fab65b7092ba06159de9cc3fecbac8ein a clinic, a few weeks of traveling, and ending in South Africa at the World Confederation of Physical Therapy (WCPT) congress. The idea of a post-graduation service trip to Kenya was brought to me by a classmate early in our 2nd year and we have been working with the organization ever since to make it a reality while best serving the needs of their community. The organization only employs local Kenyans so our role will largely be providing education for families and local PTs. Our secondary goal is to assess the feasibility of leading future trips for students and/or professionals. Since I was already planning to travel in Africa for a few weeks, I decided at the last minute to round-out my post-grad travels at the WCPT congress in South Africa! Whether I end up leading international service trips, working abroad, teaching, or contributing to research, I look forward to seeing where where my love of global health and physical therapy takes me in my professional career.


We will both be at CSM in San Antonio along with several other members of the GOPC. Feel free to contact us – we would love to meet you!


Click here to read the International Service Learning Manual.


Special Thanks to the 2015 & 2016 Global Outreach Project Committee Members:

  • Ashley Alagna, SPT Carroll University
  • Rachel Buckner, PT, DPT University of Southern California
  • Tessa Comstock, SPT The College of St. Scholastica
  • April Fajardo, PT, DPT Southwest Baptist University
  • Randy Kaw, SPTA Oakton Community College
  • Christina Machaby Lee, SPT Boston University
  • Monica Lee, SPT Maryville University of St. Louis
  • Kelsie Miller, SPT Mayo School of Health Sciences
  • Brittney Townsend, SPT Southwest Baptist University
  • Michael Weinand, SPT Northern Arizona University
  • Samantha Weng, SPT California State University Long Beach



screen-shot-2016-12-16-at-1-37-25-pmChristina Machaby Lee, SPT: Christina Lee is a third year student in the DPT program at Boston University in Boston, MA. Christina’s passion for global health was sparked during her 2 year service as a Peace Corps volunteer in Burkina Faso from 2012-2014. She served in the Education and Health sectors and served as President of the Community Health and AIDS Taskforce, during which time she oversaw country-wide efforts focused on Malaria and HIV/AIDs prevention. Christina was a member the Global Health Project Committee in 2015 and is thrilled to be serving as the Chair of the Global Health Outreach Committee in 2016. She is also a student liaison to HPA the Catalyst’s Global Health Special Interest Group for the APTA. Christina’s passion in global health revolves around helping students and professionals to promote culturally appropriate, sustainable and community-based solutions to health problems around the world. Christina can be reached at


Kelsie Miller, SPT: Kelsie Miller is a 3rd year DPT student at Mayo Clinic School of Health Sciences in Rochester, Minnesota. She was a Fulbright English Teaching Assistant in Gorontalo, Indonesia during the 2013-2014 academic year and studied abroad at the University of Otago in Dunedin, New Zealand in 2011. She was a local ambassador for Global PT Day of Service in 2015 and 2016, and currently serves as the Mayo DPT Class of 2017 Class President and as a student liaison to HPA the Catalyst’s Global Health Special Interest Group for the APTA. Miller participated in an ISL experience in Honduras in March 2016 on a team with American PT students, physiatrists, physical therapists, and Honduran functional therapy students and residents. Her goal is to provide similar international opportunities for students in the future and to explore rehabilitation concepts and beliefs in other cultures. Kelsie can be reached at

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