DIY global health: Informality, privilege and ideologies that drive short-term medical missions.

This article draws attention to Do-It-Yourself (DIY) global health, a concept that highlights global health activities that are unmoored from organizational structures and accountabilities typically constraining global health work. I use this conceptual orientation to examine short-term medical missions (STMMs), where clinicians briefly travel from the global North to the South to volunteer in pop-up clinics. I draw on theoretical frameworks that bring to the fore how privileged social positions in global hierarchies enable volunteers in DIY global health to evaluate their actions based on their intent rather than on outcomes. Drawing on ethnographic research in Guatemala (2000-2014), I analyze how the combination of privilege + informality characterizing DIY global health has created foundational ideologies driving STMMs: that people attending STMMs lack access to care; that the impact of STMMs is immediately evident; and that saving just one life makes everything worthwhile. These enable volunteers to judge success via intent/feelings, not outcomes, creating a self-perpetuating cycle where fulfilling experiences convince volunteers of impact and spur recruitment, while harms remain untracked. Technical reforms (e.g., partnerships, best practices) fall short of addressing deficits of DIY global health, because problems are ideological, not technical. Privilege insulates volunteers from reckoning with claims that lack evidence, making DIY global health appear morally self-evident despite the clear absence of accountability. Recognizing DIY global health reveals why reformist approaches cannot resolve the foundational flaws inherent to this set of practices.