Dr. Asadour is a physician in a vertical aid program to treat cholera in South Sudan where many refugees have come to escape war. A vertical aid program only targets one disease instead multiple and because of this, it is mandated to send away anyone who does not have that particular disease of interest. The refugees are poor, tired, and many are very sick with various diseases, not just cholera. Dr. Asadour is conflicted because the program only allows him to treat cholera patients but people with other diseases and illnesses come to his work station because the hospitals are beyond capacity or do not have enough or the right resources. He knows that most of the illnesses that the people have can be easily treated in his work station under the program, however he also realizes that this could cause further problems as cholera is communicable and could be passed to the people who do not have cholera in the first place or the people who do not have cholera but are treated at his workstation could tell other people in the community resulting in over capacity at the workstation. (Thomas, et. al., 267-268).
How Should Dr. Asadour Decide Which Patients to Treat?
On the same terms as his employer, I would say that Dr. Asadour should turn away the non-cholera patients as his only job for that program is to treat those with cholera. Furthermore, it would cause more problems than needed, especially if he mixes cholera patients with non-cholera patients or if his work station gets filled because then that would not be beneficial for anyone. On the other hand, in the ethical sense, Dr. Asadour should treat the patients that have easily treatable illnesses if he has the right resources to do so. As a physician his duty is to treat and turning away patients goes against this duty.
“Diagonal” Aid Program
Vertical aid programs are beneficial because they have the potential to eradicate a specific disease, they receive sufficient funding, and it is easy to measure the results (Thomas, et. al., 267). The case mentions that, “Dr, Asadour wonders whether vertical aid programs simply undermine efforts by local authorities to develop sustainable health responses for their own communities and for health broadly” (Thomas, et. al., 267). After some research I found an article that talks about the advantages and also the disadvantages of not only vertical aid programs but also horizontal aid programs. Horizontal aid programs have the goal of treating all of the “underlying issues of a population that cause various diseases and health problems” (Jimenez). Although this seems like the perfect fix to Dr. Asadour’s worries, there are still drawbacks to how cost-effective this type of program is and the long length of time it takes to see successful, measurable results (Jimenez). Because of these two independent programs that both have their ups and downs, the article proposes that they be combined to be “diagonal” where the new program “aims for disease-specific results but through improved health systems” (Jimenez). If this new type of program was implemented, Dr. Asadour would not have to be so conflicted about the right thing to do because he would be helping the community as whole instead of focusing on just one part of the community.
Works Cited:
Jimenez, Yilena B. “Vertical Vs. Horizontal Approach: The Drawbacks of Each and a Need For a Merging or “Diagonal” Approach.” ANTH 1310 S01 International Health Anthropological Perspectives. Brown University, 22 Oct. 2015. Web. Apr. 2017.
Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well and Good: A Case Study Approach to Health Care Ethics. Peterborough, Ontario: Broadview, 2014. Print.
Hi Morgan,
Like you I was conflicted about which approach, horizontal or vertical aid programs, would save more lives. I too felt that Dr. Asadour should maximize the number of lives saved and treat patients with “easily” treatable illnesses. That being said, by saving such individuals, he would be unable to treat individuals diagnosed with cholera putting the entire community at greater risk. I was interested in your proposal of a diagonal program. I am interested in your understanding of the program, but from my research a diagonal program is one that utilizes the strength of both horizontal and vertical aid programs. According to MR Reich “the diagonal approach is beginning to make an appearance on the world stage and allows for the benefits of both the vertical and horizontal strategies to be utilized in strengthening health systems.” Is this your understanding?
Noa
Reich, MR, Takemi, K, Roberts, MJ, Hsiao, WC. (2008) \Global action on health systems: a proposal for the Toyako G8 summit.” Lancet 371: 865-869.
Hi Noa,
That is exactly my understanding of a diagonal approach. It takes both of the benefits of horizontal and vertical aid programs and combines them to be effective in the whole of the community instead of focusing on one part like a vertical program does or not being able to measure the success of a horizontal program.
Morgan
Hi Morgan!
I couldn’t agree more with your interpretation of the case examining vertical aid programs. While legally Dr. Asadour is not required to treat non-cholera patients under the specific program guidelines, morally as a physician I believe he has a duty to help these patients if he has the resources to do so. As you referenced, there are benefits and drawbacks to both vertical and horizontal healthcare programs; therefore the hybrid “diagonal” healthcare approach could be the solution. In a response to a paper by Gorik Ooms, Mead Over form the Center of Global Development indicated that in order to sustain the proposed diagonal program, certain aspects of both vertical and horizontal programs would have to be strengthened while others would have to be excluded. Through island metaphors, Ooms presented the more traditional horizontal healthcare program as a failure, with the idea that “in a ‘horizontal’ health system, fish may swim, but patients will drown” (Over 2008). While horizontal programs may be able to benefit a wide range of patients, the lack of specificity of treatments may not be as beneficial to some patients as a more specialized approach, as seen in vertical aid programs. In contrast, Ooms’ presentation of vertical aid programs suggests that they can be supported temporarily, but eventually the “inadequate funded health care system and the relatively luxurious funding of the vertical program lead to the eventual destruction of the vertical program” (Over 2008). As mentioned in Well and Good, vertical aid programs often receive more than sufficient funding from wealthy philanthropists in order to try and eliminate a particular disease; however would this funding be more beneficial overall if it was allocated out to horizontal programs instead (Thomas, Waluchow, Gedge 267)? I agree that both programs have their flaws; however both also have benefits that combined may be the solution to the healthcare program debate. I’m unsure how exactly to combine these two programs in a way that is cost effective and beneficial to patients; however it appears that horizontal programs are in need of more funding and if given more resources, they may be able to specialize more than they are now, but not be as restrictive as vertical aid programs. Overall I think that there needs to be a common ground between the two programs, so hopefully an actual diagonal program will be put into practice and not just be a hypothetical solution!
References:
Over, Mead. “Diagonal Health Care: Clever Cartoons Hide the Benefits of Complementarity and the Costs of Unbalanced Provider Incentives.” Center For Global Development. N.p., 22 Apr. 2008. Web. 23 Apr. 2017.
Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well And Good: A Case Study Approach to Health Care Ethics. N.p.: Broadview, 2014. Print
Hi Morgan,
I really enjoyed your post and especially the way you critiqued the two approaches and brought in a solution. When reading this article, I felt similarly that there had to be a better way to help the community as a whole. When an area is suffering as much as this area is, there must be more that one can do then just treating an individual disease. Dr. Asadour must have been conflicted seeing as he was been sent there to treat solely cholera patients but as a physician he feels morally obligated to help all those in need. There are clearly issues with both vertical and horizontal aid programs and while the both have the intention to help out a community in need, a diagonal approach seems to better utilize the strengths of both agendas.
In terms of this specific situation, I agree that Dr. Asadour should restrict his patients to only cholera patients for the health of the other people in the community as well as issues of the resources he is provided with. Cholera being a communicable disease puts other individuals in the community at risk even in a hospital setting. It also seems as though Dr. Asadour is mostly equipped with cholera treating medicines, therefore restricting his ability to treat patients with other diseases.
Overall I agree with you on the need for diagonal aid programs as well as the decision for Dr. Asadour to limit his treatment to cholera patients.
References:
Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well And Good: A Case Study Approach to Health Care Ethics. N.p.: Broadview, 2014. Print