Ethical Challenges in Short-Term Global Health Training

Ben is a graduate student working in Eastern Europe.  He is about to learn that few local colleagues wear protective masks.  Click image to start video.

CASE 2: Ensuring Personal Safety

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Vignette 1: Ben is a graduate student working in Eastern Europe on an epidemiology project on tuberculosis in prisons. He comes equipped with N95 face masks to help protect him from multi-drug resistant tuberculosis, as he knows it is prevalent in the prison he will be working at. When he arrives at the prison, he notices that none of his colleagues are wearing a mask.

Ben’s advisors at his sending institution specifically instructed him to wear an N95 mask at all times when visiting the prisons. He is conflicted, however. On one hand, if he wears his mask, he feels he would not be in solidarity with his colleagues. On the other hand, if he does not wear his mask, he would be placing himself at risk – even if ventilation helps prevent the spread of TB,  it is not nearly as effective as an N95 mask.

How should Ben proceed?

Select
Ben should wear his N95 mask anyway. He cannot accept any personal risk more than he would at home.
It would be unrealistic to hold Ben to a standard where he does not accept any personal risk greater than that at home. In fact, simply being in this location, where multi-drug resistant TB is present, is more risky than being at home (even with an N95 mask). Trainees should recognize that traveling abroad frequently carries some risk. Choose a different answer.
Select
Ben should discuss this issue with his advisors. Until then, he should wear his N95 mask.
This is correct. The vignette implies that the risk of contracting TB is high, and the TB in question is multi-drug resistant. This places Ben at high risk. He needs to discuss the situation urgently with his local and sending institution advisors. Until then, he should wear his N95 mask.
Select
Ben should discuss this issue with his advisors. Until then, it is better “to fit in” and not wear his N95 mask.
It is correct that Ben should discuss the issue with his advisors. Waiting to wear his N95 mask until this discussion takes place, though, could place him at high risk for contracting TB. Choose a different answer.
Select
Ben should not wear his N95 mask. Maintaining a good collaboration requires that he act just like a local.
Although not wearing the mask might help the collaborative partnership, it is unreasonable for Ben to always act “like a local.”  In this case, not wearing a mask places Ben at significant personal risk. Choose a different answer.
Select
Ben should not have known in advance that N95 masks were not used, and should not have brought them.
It is probably true that Ben and his advisors should have known of this in advance. However, not bringing the N95 masks is probably not the best course of action. Choose a different answer.

 

 

© Stanford University Center for Global Health and the Johns Hopkins University Berman Institute of Bioethics.

Project funding provided by Doris Duke Charitable Foundation (DDCF)