Ethical Challenges in Short-Term Global Health Training

Sam is a medical public health trainee in Africa. He must consider whether to give a dose of an antibiotic. Click image to start video.

CASE 4: Ensuring Sustainable and Appropriate Benefits

If you have not yet told us about yourself, please consider doing so now. Click here >>

Vignette 1: Sam is a medical public health trainee who is spending 10 days at a clinic and working on a clean water project in the meningitis belt of Sub-Saharan Africa. One day, a local community member with whom he has worked on the water project brings her two-year old son to clinic. The child has a high fever, is irritable, and resists any neck movement. Sam and his advisor suspect meningitis – the third case in two days.

Sam’s team brought with them a donated antibiotic, ciprofloxacin. While not the recommended treatment for meningitis, it has activity against Neisseria meningitis, the bacterium which could be causing this child’s problem. Oral administration is not recommended for meningitis; but, it could have some activity, and this is the only antibiotic Sam has. Sam also knows the receiving hospital cannot perform blood or spinal fluid cultures, so starting treatment will not interfere with the diagnosis.

In this case, Sam is considering giving this toddler a dose of an antibiotic to "tide him over" for a life-threatening infection until he can get to the hospital which is three hours away.

Do you think Sam should give a dose of this medicine?

Yes. Anything might help, even if ciprofloxacin is not the standard treatment for this condition.
Even if anything might help, Sam should consider whether giving a non-standard therapy now might take doses away from others who may need a more appropriate use of this antibiotic later. The fair distribution of the drug relates to distributive justice. Choose a different answer.
Yes. Sam knows this woman’s family, and he owes them this.
Having close relationships with local colleagues is important. However, if items are in short supply, Sam might want to consider whether personal attachment should guide his decision. The fair distribution of the drug relates to distributive justice. Choose a different answer.
No. Because the treatment is non-standard, he should not give it.
This reasoning can be compelling, but can be difficult to answer. Sometimes a non-standard treatment might be lifesaving; other times a nonstandard treatment (such as this oral medication) might harm the child or prompt the parents to keep the child at home rather than take him to the hospital. Choose a different answer.
It depends. Before deciding, Sam should consult his local colleagues, take stock of the available supplies, and consider what future needs might exist for the ciprofloxacin.
It is difficult to give a single answer to challenging situations like this one. In some circumstances, giving a non-standard treatment could be reasonable; in others it might not.
© Stanford University Center for Global Health and the Johns Hopkins University Berman Institute of Bioethics.

Project funding provided by Doris Duke Charitable Foundation (DDCF)