Ethical Challenges in Short-Term Global Health Training

After returning home, Qing meets with a friend to discuss "giving back." Click image to start video.

CASE 6: Recognizing Burdens

In this vignette, Dr. Gonzalez was diverted from certain clinical responsibilities while supporting Qing’s project. Qing recognized this, and importantly, discussed this situation with her local advisor. Recognizing when this situation occurs, and discussing it openly among trainees, sending and host institutions, and sponsors is an important first step to help minimize these sometimes unforeseen burdens. Other examples of this might include the time necessary to orient trainees to an unfamiliar environment (e.g., food, housing, and transportation); the personnel necessary for formal or informal translation services; or the diversion of financial resources to support the trainee’s project.

Qing’s situation, because it involves a research project, raises an additional set of ethical issues not discussed here. For example, many believe researchers have an obligation to ensure local health resources are not inappropriately diverted or result in worsening disparities. Practically, this may be accomplished by increasing the duration of time trainees spend at sites, and transferring more significant, long-term resources for administrative and support costs associated with the trainee’s presence.

Vignette 3: After returning home from her training program, Qing feels badly that she has not given money to the clinic to cover her housing and other costs of having her. She mentions these issues to a friend at home, who implies that Qing has served as a “free consultant” since she was not paid and “her work was more than enough.” Qing wonders about her obligation to “give back.”

What do you think Qing should do?

Qing has an obligation to send some of her expendable money in the form of a check back to the clinic.
Directly sending money to the clinic might not be the best approach. Monetary gifts can have different cultural meanings, and no mechanism might exist for using such donations effectively. It would also be unreasonable to expect trainees to have a strict obligation regarding their expendable income. Choose a different answer.
Qing should discuss her feelings with her advisor and sponsor to help her decide what could be appropriate.
This is the best approach. Before Qing makes promises she cannot keep, sends money to the clinic, or ignores her emotions altogether, she should discuss the situation with her advisor. Together with the local community, they might find a way for Qing to give back in a culturally appropriate, effective, and reasonable manner.
Qing has no obligation whatsoever to the clinic because she has volunteered enough of her time already.
This is not the best answer. Qing certainly feels an obligation to the community as a result of her experience, and she should not ignore this. 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)