Ethical Challenges in Short-Term Global Health Training
In this vignette, Ben is splashed with cerebral spinal fluid while performing a lumbar puncture. Click image to start video.
CASE 2: Ensuring Personal Safety

Vignette 3: Ben realizes that the best way to determine how to distribute the N95 masks is by talking to his local supervisor, Dr. Polyakova. Initially Ben thinks the N95 masks should be distributed randomly, so all workers have a chance to receive one. But, with the input of many local workers in the prison, they determine that those “most at risk” of being exposed to TB will have the first opportunity to receive a mask.

Ben and Dr. Polyakova later visit a patient who requires a lumbar puncture for possible meningitis. As Ben watches closely, he is splashed in the eyes with cerebrospinal fluid. Ben is concerned that he might be at risk for contracting HIV or hepatitis due to the splash, but the patient's chart doesn’t include any information about whether he has been tested for these infections.

Ben was observing a procedure that has exposed him to a risk of serious harm and raises numerous ethical issues.

Which of the following represents the best course of action as a result of this incident?

Trainees should no longer be allowed to observe even low-risk procedures to minimize their risk of harm.
Although not being involved in any procedures would eliminate the risk of harm, this would hinder learning opportunities for trainees. In this case, Ben could have minimized his risk of being splashed by wearing eye protection or observing the procedure from a greater distance. Refraining from participating is one option, but not the only one. Choose a different answer.
Ben should try to conceal the incident; bringing it up might offend his local advisor or make him look incompetent.
This is not the best choice. Ben is at real risk of harm in this case. Although his emotions are understandable, he should feel comfortable in reporting the incident to his local advisor and sending institution. Choose a different answer.
Ben should report the splash to his advisors, both locally and at-home, to develop a plan for dealing with the incident and arrange for blood testing.
This is correct. Sending and host institutions should encourage trainees to report such incidents when they occur. Moreover, even though this testing could be expensive, they have an obligation to assist trainees in arranging for the necessary testing and follow-up.
Ben should arrange for testing on his own and pay for it out-of-pocket; in this setting, testing would otherwise not occur and would be too expensive.
It may be true that testing would not ordinarily occur in this setting, even though it would at home. Nonetheless it would be unreasonable to expect trainees to pay out of pocket. In addition, sending and host institutions, as well as sponsors, should be aware of these incidents for monitoring purposes and to help develop strategies to prevent them. 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)