Ethical Challenges in Short-Term Global Health Training

Later in the day, a patient arrives with labored breathing, a fast heart rate, and a high fever. Click image to start video.

CASE 5: Addressing "Ancillary Benefits"

Vignette 3: Later in the day, an individual arrives with labored breathing, a fast heart rate, and a high fever. Dara and her advisor examine the patient, and realize she needs to be transferred to the hospital – a 90-minute car ride away.

Dara has learned from her prior experience. Though she considered offering money for her to hire a car, she instead asks a local advisor how to proceed. She strongly advises against offering money as she feels this is a never-ending issue. Moreover, the local community does not have a system for transporting patients to the hospital. Luckily, someone volunteers to take her. This is the third time this has happened this week.

Which of the following is the best take-home message from this incident?

Dara should always ask her local advisor for advice in these difficult situations.
Dara was correct to ask her local advisor for advice. However that is not the most important lesson from this incident. Choose a different answer.
The local community has a lot of helpful volunteers whose services can be used thoughtfully.
Although a volunteer helped in this case, Dara should be aware that this may create a burden on that individual, and perhaps the community as a whole. She should consider a different approach. Choose a different answer.
Dara should consider working with the local community to develop a solution for this, since these situations are apparently common.
As the vignette suggests, this community frequently needs to send people to a hospital, which is a lengthy drive away. For the future, Dara could consider developing a solution to this issue with the local community. This might help avoid such situations in the first place.
In hindsight, just giving her the money to hire someone might have been faster.
Such an approach might have been faster. However, many cultures and communities might consider a direct transfer of money inappropriate, so Dara should ask her local advisor about this first. More importantly, while it helps this individual, it may set a bad precedent that could be difficult or impossible to meet and does not solve this problem in the future.
© Stanford University Center for Global Health and the Johns Hopkins University Berman Institute of Bioethics.

Project funding provided by Doris Duke Charitable Foundation (DDCF)