The article analyzes two fundamental questions that emerge as institutions of higher education seek to advance global health equity: What are the motivations driving these initiatives, and within which paradigms of engagement do they enter into collaboration with communities? An examination of the tensions and paradoxes of geopolitical paradigms such as humanitarianism, development, human rights, and voluntourism underscores the need for critical reflection as colleges and universities look across international borders to implement initiatives. The article explains the development of an adaptable tool designed to foment critical reflection, the Paradigms of Engagement Motivational Matrix (PEMM), and a pilot study focused on students' motivations for participating in international medical service trips. A mixed-methods approach was used, and the results reflected the complex movement among motivational categories and paradigms, as well as key implications for campuswide efforts to develop ethical solidarity for long-term collective action aimed at global health equity.