Conclusion
This case has introduced the general theme of “shifting resources” – i.e., the ethical issues that arise as a result of resources that flow between sending and host institutions in a global health training program. As indicated here, ethical issues can arise whether resources flow toward the host institution (as in the case of project grants and personnel) or away from it (as in the case of the migration of healthcare workers).

Providing a specific response to each of the vignettes presented in this case is not possible. For Cheyenne (and other trainees), no single best answer exists. Whether (or how) to utilize additional research funding without subtly changing the priorities of the local clinic, and how to respond to queries for referrals and recommendations, admit of no “rule of thumb.”  And while a thorough discussion of the “brain drain” is beyond the scope of this series, trainees should be aware of how their actions might fit within this broader context.

Nonetheless identifying the ethical issues that arise from “shifting resources” is a critical first step. Only by attending to these issues can trainees, their sending and host institutions, and program sponsors help ensure the ethical conduct of global health training programs abroad.

Additional Resources

• World Health Report. World Health Organization (2006).


• Human Resources for Health. Web. 31 May 2011.


• Mullan F. The metrics of the physician brain drain. N Engl J Med. 2005; 353(17):1810-8.


• Willis-Shattuck M., Bidwell P., Thomas S., Wyness L., Blaauw D., Ditlopo P. Motivation and retention of health workers in developing countries: a systematic review. BMC Health Serv Res. 2008 8:247.


• Arah O.A., Ogbu U.C., Okeke C.E. Too poor to leave, too rich to stay: developmental and global health correlates of physician migration to the United States, Canada, Australia, and the United Kingdom. Am J Public Health. 2008; 98(1):148-54.