Ethical Challenges in Short-Term Global Health Training
Cheyenne is a medical student about to begin a six-week project abroad on tobacco use interventions. She is about to ask Dr. Siti for help. Click image to start video.

CASE 7: Shifting Resources

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Vignette 1: Cheyenne is a medical student who just arrived in Oceania to begin a six-week research and service project studying tobacco use interventions and working in a public health clinic. She, her home advisor, and her local advisor, Dr. Siti, developed an exciting collaborative project regarding a tobacco use intervention for her six-week experience. Dr. Siti knows the community well; having spent her life in the region, she is a beloved local health care worker. Dr. Siti’s research, however, relates more to water sanitation and parasitic diseases.

In this vignette, Cheyenne presents Dr. Siti with funds for research support staff. In response, Dr. Siti is considering taking a more active role in her project. Which of the following best represents an ethical concern with this situation?

Select
A. There is no concern, so long as the project is worthwhile.
Ensuring the project is worthwhile is one critical issue. However, this vignette does bring up another concern. Choose a different answer.
Select
B. The new project involves money; short-term programs should never involve money transfers.
Whether money is involved in short-term programs does not itself determine whether it is “ethical.”  Much depends on how the money is used, as in this case. Choose a different answer.
Select
C. The new project could create burdens on Dr. Siti, detracting from her other work.
This is correct, but it is not the only ethical concern. Choose a different answer.
Select
D. The new project could inappropriately shift local priorities, even if it brings new resources and occupies only "spare time."
This is correct, but it is not the only ethical concern. Choose a different answer.
Select
B and C.
Only one of these is correct. Choose a different answer.
Select
C and D.
This is correct. Short-term programs have an ethical obligation to identify and eliminate or minimize the burdens of the program on the local community. Moreover, even if the program appears to be a net gain to the community, trainees should remain vigilant for the more subtle ways their presence can inappropriately affect local priorities.
© Stanford University Center for Global Health and the Johns Hopkins University Berman Institute of Bioethics.

Project funding provided by Doris Duke Charitable Foundation (DDCF)