Case 8.2 Ethics and Humanitarian Aid: Vertical Aid Programs
Background:
Dr. Asadour is a physician working for a non-governmental organization (NGO) whose mandate is to “participate in a global vertical aid anti-cholera program”. (Thomas 267). He travels to a town in South Sudan containing thousands of refugees from the internecine war. These refugees have a variety of health issues and Cholera has also broken out. The purpose of the NGO was to treat patients with Cholera only and other patients must be sent to the local hospital, which presents a problem as the local hospital is already beyond capacity. The dilemma is whether or not Dr. Asadour will admit patients who are in need that don’t have Cholera.
Analysis/Argument:
“Cholera is an often fatal bacteria disease of the small intestine, typically contracted from infected water supplies and causing severe vomiting and diarrhea” (CDC). The illness is not as clear cut to tell compared to other illnesses. Especially given the conditions of the patients in South Sudan, many of them exhibit symptoms that are similar to cholera. Therefore, admittance into the NGO is something that is already of a hassle and Dr. Asadour faces the moral dilemma of rationing resources. Should he stick by the litigation and only admit those with Cholera?
I would want Dr. Asadour to treat the illnesses within the community based on urgency and the severity of the symptoms rather than rationing to those with Cholera. One of the main reasons would be due to a time frame. With numerous patients who needs admittance, taking the time out to reject those that don’t display the symptoms of cholera could result in wasted time in saving lives. However, Dr. Asadour and his staff should not completely reject the idea of only admitting patient with Cholera. They should keep it in the back of the heads that Cholera is highly contagious and facilitative matters should be handled in order to prevent any type of contamination. Admitting patients with severe symptoms would also result in less patients being sent to the local hospital, which is already beyond capacity. If a patient is in a very severe state of health, then they should be admitted immediately to Dr. Asadour’s care. This has a higher potential to save the patient’s life.
The idea of vertical aid programs is also something that should be considered when taking this case into account. Dr. Asadour’s mission was funded primarily from wealthy philanthropists who are in hope of eradicating the disease Cholera. However, having that one disease aim seems to bring upon some issues. These western donors and NGOs often “overlook the voices and priorities of local communities” (Thomas 268). As we see with this case, there are many different illnesses in South Sudan with many levels of severity and urgency. Therefore, if the moral obligation was to just save as many lives as possible, then rationing to those individuals only with Cholera negates the moral purpose. According to an article published by Dr. Levine in the Center for Global Development, vertical aid programs “risk diverting attention from, or even undermining, broader “horizontal” health systems established to prevent and treat all forms of ill-health”. In global health, targeting a specific illness or area of health is very difficult and ineffective because health is in a sense, on a spectrum. Especially in an area like Southern Sudan, with ongoing wars, corruption, and rivalries of power, a broader approach to health seems to be a much more favorable one than a one track vertical aid program.
What do you guys think about what Dr. Asadour should have done in this specific instance? Furthermore, do you guys think that vertical aid programs should continue? I’d love to hear from you all!
Works Cited
“Cholera – Vibrio Cholerae Infection.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 09 Nov. 2016. Web. 11 Apr. 2017.
Levine, Ruth. “Should All Vertical Programs Just Lie Down?” Center For Global Development. CGD, 05 Oct. 2007. Web. 11 Apr. 2017.
Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 8.2: “Ethics and Humanitarian Aid: Vertical Aid Programs.” Well and Good: a Case Study Approach to Health Care Ethics. 4th ed. Canada: Broadview, 2014. 131-138. Print.
James,
I agree with the argument that you presented here. The situation on hand does create a huge moral dilemma for Dr. Asadour as to which patients he should treat, despite the fact that he received funding from a donor whose main goal is to treat and eradicate cholera. In the grand scheme of things though, it doesn’t make a lot of sense to send the more severely ill patients to an overcrowded hospital. It almost seems like these severely ill patients would be better off at an under resources clinic than an overcrowded one.
I think it is an important point to take into account the comment by Thomas that western donors and NGOs often “over-look the voices and priorities of local communities”. I find it very unlikely that this donor who wants to treat and eradicate cholera is on the same page as the members of the local community that are being treated. While cholera is still a dangerous and highly contagious disease, to members of the community it may not take precedence over other, more life-threatening illnesses that they would rather be treated for in Dr. Asadour’s clinic.
My best plan would be, like you said, to treat patients by severity of their illness, whether they have cholera or not. This would help these patients quicker since they wouldn’t have to go to an overcrowded hospital and would even help lower the amount of people entering the hospital with this extra clinic available. Obviously, cholera patients would still be able to be treated by Dr. Asadour, as that was the initial purpose of his clinic, but they would not get priority over the sicker patients. Even though this is not necessarily exactly what the donor to Dr. Asadour’s clinic intended, the needs and priorities of the locals are far more important than that of the donor. Like you said, targeting a specific illness is a bit of a lost cause and I think it’s more beneficial to treat illnesses in patients as they arise.
Works Cited:
Levine, Ruth. “Should All Vertical Programs Just Lie Down?” Center For Global Development. CGD, 05 Oct. 2007. Web. 14 Apr. 2017.
Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 8.2: “Ethics and Humanitarian Aid: Vertical Aid Programs.” Well and Good: a Case Study Approach to Health Care Ethics. 4th ed. Canada: Broadview, 2014. 131-138. Print.
Hi James,
I really appreciated the fact that you mentioned the nature of vertical aid programs. In my opinion, it is rather detrimental to focus solely on treating one disease. These communities require a diverse range of medical care, as there are many other diseases impacting individuals.
However, it is also important to note that medical demand exceeds supply within this community. Therefore, I believe that the NGO is justified in caring solely for cholera patients, as the doctor’s time is a scare resource. Essentially, the program needs a way to allocate medical resources–as a solution, they have chosen to pick patients based on their type of illness. I believe that this allocation method will maximize the NGOs impact, as the doctor will be able to see and treat more patients. Although the NGO has to screen people, once individuals are admitted the organization will be able to streamline the process due the doctor’s expertise in dealing with cholera patients.
Hi James,
I enjoyed your post on vertical aid programs and their effectiveness and ineffectiveness in treating communities infected with multiple diseases. I agree with you that a physician has a moral obligation to treat all those in need so vertical aid programs cause a moral dilemma for medical professionals who participate in these programs. I also agree with the notion that these programs tend to “overlook the voices and priorities of local communities” (Thomas 268). While it may be morally permissible to overlook the other sick individuals of the community, I think that Dr. Asadour should primarily focus on treating the cholera patients. For one he is a part of a vertical aid program that has given him the supplies and resources to treat solely cholera. Cholera is also a communicable disease therefore putting other admitted patients at risk of contracting the disease. In this specific situation these are the reasons why I think Dr. Asadour should limit himself to treating cholera patients but in the broader scheme of things I agree that a broader approach to healthcare would be much more favorable.
Vertical aid programs are designed to only handle a specific disease or outbreak but realistically many areas that are ravaged by a certain disease are also infested with others. I think programs such as this should shift to a more universal system that allows the ability to handle a multitude of disease at one time. I think this would be more widely beneficial to communities in need.
References:
Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 8.2: “Ethics and Humanitarian Aid: Vertical Aid Programs.” Well and Good: a Case Study Approach to Health Care Ethics. 4th ed. Canada: Broadview, 2014. 131-138. Print.