Thoughts on interaction with ‘global health’

In an attempt to prepare for an upcoming ethics presentation I’m facilitating with a friend, this is a (very) short summary of the gradual ethical obstacles I encountered in a recent international experience. I tend to look back on this trip and consider it with incredible regret that I ever participated.

I think it is unfortunate that our northern stereotypes make us think that we are supposed to play a role in directly ‘intervening’ in the lives of others, rather than instead looking carefully at our own lives, communities and how they relate to the rest of the world.

If only as humans we were more able to consider our own actions deeply, to imagine that they may not be right, to wonder whether we should be different… and then, most importantly, try to be different. And repeat the process of self-inquiry, with an open heart and without a premise of negativity.

Scenario: 8 multidisciplinary health professional students travelling for 7 weeks to a site in East Africa, with plans to provide free screening physical exams to both persons living with HIV and related disease, as well as orphans and vulnerable children.

Initial impression:
– An annual project, each year raising over $50,000 for travel and local contributions, with continuity between student teams.
– Faculty oversight from an infectious disease specialist.
– A local (in-country) physician involved and paid by the student team to provide care to the same screened individuals between each summer student visit.
– Students spend six months learning the local language before departure.
– The physical exams are conducted in the local language, with referrals for additional care made to the local physician.
– Scholarships provided for screened children to attend primary school.

Initial concerns throughout the planning year, and on arrival:
– Student capacity to perform exams for PLWHA is extremely limited.
– The true benefit of screening exams questionable for multiple reasons; dozens of unneccessary referrals made to local physician.
– Local physician ill and likely unable to continue supporting this project into the future.

Further concerns:
– Local orphanage/shelter accused of child abuse (x3 years ongoing), local Board of Directors recently disbanded for fraud and subsequent extreme debt.
– At the screenings, it becomes clear that the children and PLWHA told (by local physician and nurses) they were being screened by physicians, not students.
– PLWHA receiving screenings found to have multiple care providers and adequate healthcare already; came to screenings mostly to receive travel stipend.
– Students did not adequately prepare for HIV screenings; had never knowingly met an individual living with HIV. Unable to recognize local clinical problems. No supervision.
– No translators available due to confidentiality concerns; nurses end up translating for students and neglecting care for other hospital inpatients, as well as neglecting teaching local nursing students.
– Extreme disagreement on the team regarding the benefits and risks of our involvement; team considers shutting down the project.

18 months later:
– In Italy, I meet the Dean of the local medical school. He describes the ethical and practical problems surrounding too many visiting medical students.
– In 2007, 120 local medical students; 120 visiting medical students.
– Likely due to hospitable culture and sociopolicial/financial agreements with sending institutions, visiting medical students are given absolute learning priority.
– Local healthcare infrastructure failing in part due to inability to teach local medical students.
– Receiving institution feels hard pressed to decline additional visiting medical elective students.

– A new team preparing to leave, with little continuity in knowledge from team-to-team. Little to no faculty oversight at home institution.

Global Health Ethics Wiki


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