Ethical Challenges in Short-Term Global Health Training

Sam now discusses the medicine with his advisor. Click image to start video.

CASE 4: Ensuring Sustainable and Appropriate Benefits

Vignette 2: After sending the mother and son to the nearest hospital, Sam asks his advisor about the available antibiotics. He tells Sam that their team is limited to what is contained in their donated "travel packs."

"Travel packs" are pre-packaged collections of medications and supplies designed for medical outreach teams, often at greatly reduced cost. By design, they intend to cover most, though not all, of the commonly encountered clinical conditions teams might encounter in developing country settings. By collecting supplies (often through the donation of pharmaceutical and medical supply companies), packing, and shipping them, providers of travel packs can help program teams efficiently obtain needed items, ensure the supplies are not expired, and even reduce environmental impact through standardized packing. They can be customized to varying degrees, and several different suppliers of packs exist.

In this case, Sam’s team has travel packs that contain only ciprofloxacin, a powerful antibiotic with multiple uses, including treatment of some urinary tract infections, some forms of infectious diarrhea, and some bone and joint infections. However, it cannot cover all infections seen in the community (for example, meningitis, as in this case).

Sam is troubled. Which of the following best expresses an ethical challenge with the donated items – in this case, drugs?

The local community had little say in what was contained in the travel pack and should be involved choosing what is donated.
This is partially correct. Prospective donations should respect the desires of the local community in terms of which items are appropriate. This does not, however, completely answer the question. Choose a different answer.
The content of the travel pack did not meet the needs of the local community.
This is partially correct. Prospective donations should respect the priorities of the local community in terms of which items are needed. Some pre-packaged travel packs, while covering many common conditions, might not contain all necessary or appropriate items for a particular location. When this occurs, programs have an obligation to consider more customized packs or bring additional supplies. Sam’s team, by being in the meningitis belt of Sub-Saharan Africa, should know that meningitis is likely there and consider how they might treat it. Choose a different answer.
The program should ensure that they will never run out of needed drugs or supplies; this way, Sam will not have to worry about whether they have enough drugs for future patients.
Holding training programs to this high a standard seems unreasonable. Those involved in short-term training programs abroad have an obligation to minimize the chance of shortages, but instances can occur when they need to decide in collaboration who gets particular drugs or supplies when not all in need can. Choose a different answer.
A and B.
This is correct. Prospective donations should respect the priorities of the local community in terms of which items are needed and appropriate.
© Stanford University Center for Global Health and the Johns Hopkins University Berman Institute of Bioethics.

Project funding provided by Doris Duke Charitable Foundation (DDCF)