This paper argues that participants and locals should be seen as at the centre of all development, including international and health development work. Consequently, in contexts of health and wellbeing, patients should be seen as active participants, which also implies the need for the independence and freedom of all and the development of dialogical spaces in which all may negotiate what counts as a life worth living. 'Impact', on this view, should be seen from a lifeworld perspective of evaluating the effects of dynamic evolving practices where all are seen potentially as donors and beneficiaries within contexts of mutually negotiated reciprocal relationships. Data drawn from extensive fieldwork with local trauma surgeons, midwives and healthcare personnel in rural Cambodia provide the basis of new perceptions about processes of 'passing on' knowledge and expertise. The ideas presented have potential implications for normative understandings of the social organisation of healthcare in domestic and international settings.