Ethical Challenges in Short-Term Global Health Training

Qing is a PhD student who has received a research fellowship to spend eight weeks in South America. Click image to start video.

CASE 6: Recognizing Burdens

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Vignette 1: Qing is a PhD student in medical sociology who has received a research fellowship to spend 8 weeks in South America. She will be doing a needs assessment for a new clinic. Qing has been in contact with the medical director, Dr. Gonzalez, who has been helping her with the logistical planning surrounding her trip. In addition to obtaining the necessary documentation for her visa application, Dr. Gonzalez has been busy getting the new volunteer residence ready. Qing’s funding only covers her travel to the site, but she has made an agreement with the clinic that they will provide housing in exchange for her research assistance.

The clinic hired a car to drive Qing six hours from the airport to the site where she will be working. She is the first foreign volunteer to visit the clinic, and the staff has prepared lovely dinners for her. Qing feels guilty about the resources being used on her behalf. How should she deal with these emotions?

While Qing is in-country, she should simply accept what the locals provide; they want her to be comfortable, and she might offend the pride they take in their efforts.
This strategy would respect the local community’s and Dr. Gonzalez’s efforts, which could be important in building a collaboration (particularly because Qing is the first foreign volunteer with this clinic). However such an approach does not recognize the possible burden it could be causing. Choose a different answer.
Do nothing – Qing is used to higher standards of living; she should not be expected to lower her standards.
Qing may indeed be used to higher standards of living, and in some cases, personal safety might require that her living condition be “higher” than the local community in general (for example, in terms of drinking purified water). In pursuing a global health training experience, however, she, her sending institution, and her sponsor probably see value in having her live within the community. Qing should not unquestioningly assume she deserves higher standards. Choose a different answer.
Ask the locals to stop preparing her dinners or treat her at all differently.
If Qing were to pursue this course of action, she would in some respect reduce the burden on the host community. She would also risk offending them and could hurt long-term collaborative efforts. Choose a different answer.
Discuss the situation with her local advisor, then consider bringing the issue up in the local community and discuss how to compensate appropriately.
This is the best approach. Because Qing is new in the community, she should first seek counseling from someone who might add insight into the reasons behind the community’s actions. Her advisor might also know how the locals might respond to bringing up the issue. Qing is right to worry about the burden she might be causing; the key issue is how to deal with this recognition without offending.
© Stanford University Center for Global Health and the Johns Hopkins University Berman Institute of Bioethics.

Project funding provided by Doris Duke Charitable Foundation (DDCF)