Unprecedented numbers of health care professionals are volunteering their services in poorer nations. But their altruistic motives are often quickly tempered by the reality of novel and daunting questions connected with very limited resources, and further complicated by unfamiliar cultural context. For example:
• Is it acceptable to diagnose a person’s hypertension, but be able to only supply 30 days of therapeutic medication and provide no follow up care?
• Is it ethical to prevent malaria among children by providing bed nets, but not to provide them adequate nutrition?
• Is it justifiable to treat an HIV positive mother to prevent transmission of HIV to her newborn child, but then not provide continued HIV treatment to the mother, realizing that she will likely die and leave that newborn orphaned?
• Is it ethical to allow medical or nursing students to care for people in poor countries without the benefit of supervision they would receive when caring for patients in their home nations?
Such questions have plagued mission-minded health care leaders for decades. But only recently have these ethical issues begun to receive broader attention. Leading the way in this field is Nancy Crigger, PhD, ARNP. Dr. Crigger is an associate professor of nursing at William Jewell College. She is also presenting the topic Ethical Issues in International Medicine at this year’s International Medicine Intensive Course and at the Exploring Medical Missions Conference.
Dr. Crigger implores volunteer medical professionals to carefully examine their actions. “We must assure that we’re not just providing care that makes us feel good, yet is not really helping the nation or its people in the long run. Sustainable change and safety are two most important considerations. For example, our healthcare team recently saw a Honduran lady who was treated for her chronic neuropathic pain with a newly marketed and expensive medication by an American physician. After the physician left, the lady developed severe adverse effects. While well intended, the physician’s care was neither sustainable nor safe. Even if the drug had been effective, she would never be able to obtain this medication in Honduras. Using prudence in prescribing, limiting prescriptions to medications that are on the World Health Organization Essential Drug List, and making sure that a local community-based followup was in place may have helped the physician avoid this precarious situation.”