Global Health Ethics: Perceptions, Privilege, and Priorities

July 20, 2015
Post-survey group picture with a distance learning student in Koforidua and her hospital's medical director.

By Jenny Li

Concepts of global health ethics presented in the classroom and workshops have always seemed abstract to me. Even as a student pursuing the Ethics Certificate from the Kenan Institute, I have only gained theoretical knowledge and philosophical ways of thinking throughout the school year.

Navigating real ethical boundaries on the ground this summer has been eye opening and more complicated than I ever imagined. Each week, we have faced ethical challenges that we had to deeply reflect upon individually and as a group. Most of the difficult situations we encountered have revolved around our identity from the community’s perspective, when people have looked up to us as foreign ambassadors, health professionals, or philanthropists who have influence over their hospitals and health system.

Because of who people perceive us to be, they may be more likely to prioritize our work over their own. 

Most people we meet are so welcoming and are more than happy to take time out of their busy schedules to speak with us, and we are truly grateful for their hospitality. But at the same time, we have to check that our work is not prioritized over patient care.

Particularly in hospitals settings, where there are many urgent patient needs with few providers, we must ensure that our presence as foreign visitors does not disrupt a healthcare worker’s rounds in a ward or participation in an important surgery. Even the few minutes we take away from a patient could be dangerous, if we were to conduct a community member survey with the only anesthetist on duty, for example.

After coming to terms with this dynamic, we have been talking with workers when they were not busy with work or had finished for the day. We have been careful that workers would not subconsciously prioritize us over their assigned duties, which would be unfair to the patients. A quote I read on a large poster in a municipal hospital sums up this point nicely: “A patient is the most important person in our hospital. He is not an intruder to our work; he is the purpose of it. He is not an outsider in our hospital; he is part of it.”

Because of who people perceive us to be, we are invited into situations that might upset the privacy of patients and hospital staff. 

When we visit hospitals, we are sometimes led through wards that are crowded with patients. Occasionally, we are invited to observe surgeries being performed.

The amount of privacy in most hospitals in Ghana is very different than what we are accustomed to in the United States. The establishment of privacy measures possibly goes back to our fundamental cultural characteristics, but I strongly believe that we should respect every human being's need for privacy in sensitive situations, particularly those pertaining to medical conditions of the body and mind. 

In our hospital visits here in Ghana, it’s safest to observe the golden rule of not doing something to others that we would not like to have done to ourselves. Just because we are allowed to see or do something in a healthcare facility, such as walk in on a caesarean section, does not mean it would be ethical for us to do so. 

Furthermore, we must try our best to observe the rules and regulations present in the Ghana health system without infringing on ethical guidelines from our society.

Because of who people perceive us to be, they might look up to us as foreign donors with power over decisions of resource allocation and sponsorship. 

Each day, we have plenty of opportunities to explain our SRT project to members of the healthcare community. Although we emphasize the research component of our work, people occasionally see in us some avenue to financial and human resources because of our association with a wealthy American university.

External aid is indeed an important component for fueling big projects in health systems strengthening and improving other infrastructure. However, we must be careful to prevent giver-receiver relationships from being established or reinforced with the people we encounter.

This matter is not easy to discuss with people on the ground because this particular dynamic is deeply rooted and universal. We cannot do much about being treated differently because of others’ perception of our socioeconomic standing. Yet, we can at least endeavor to be completely truthful about the purpose of our work and not make any promises that we do not have the capability to fulfill. For now, I am just an undergraduate student conducting global health research—no more and no less.

Starting from the first days of our fieldwork up to now, we have come to better understand the implications of our identity as seen by others and developed some strategies to use when certain perceptions become problematic.

I am grateful to have come to know myself more, to see the world from another cultural perspective, and to grow in wisdom through identifying and navigating ethical challenges during our time here in Ghana. Putting ethical considerations at the forefront of our work is the key to establishing healthy, productive, and proper relationships with the people we have the privilege of working with.