Humanitarian Health Ethics Trainee and McMaster Global Health student Gautham Krishnaraj competed in the McMaster University 3 Minute Thesis Contest last week at the David Braley Health Sciences Centre in downtown Hamilton, Ontario. Krishnaraj came away successful, receiving second place and the Dean’s Award for Excellence in Communicating Research, for his presentation entitled “Nothing Left To Offer”. A full transcript of his speech is below, and a video will be shared as soon as available – congratulations Gautham!
“At the peak of the 1994 Rwandan genocide, Canadian Physician James Orbinski, was frantically taping numbers to patient’s foreheads outside of a Medecins Sans Frontieres field hospital. The code was simple: 1 meant treat immediately, 2: treat within 24 hrs, 3; leave to die. What did this mean? Patients quickly realized that the Number 3 signified that for them, the humanitarians simply had nothing left to offer. Imagine dying alone, in excruciating pain, just meters away from care – in a hospital hallway or parking lot, with a Number 3 taped to your head.
What should be provided to the Number 3’s? My name is Gautham Krishnaraj and this is the central question of my Masters research with Humanitarian Health Ethics Research Group at McMaster University. The save-only ideology exhibited by Dr. Orbinski is reflective of a deep scarcity of resources and undeniably good intentions, but does not represent the historical and foundational principles of humanitarian healthcare. These principles were set forth by Red Cross Founder Henri Dunant in 1864, when he galvanized the citizens of a small northern Italian town to provide impartial care to over 23,000 dying soldiers. The call to humanitarian action was bifold; the citizens were to save lives and alleviate suffering… however this second ideal has slowly fallen by the wayside.
The alleviation of suffering, also known palliative care, is what is offered to those whom we cannot save. It ranges from pain and symptom management to the provision of psychological, social and even spiritual support. The aim of my research is to identify some of the perceived barriers to providing palliative care in humanitarian contexts, and we have begun to do so through a series of hour long, semi-structured interviews with humanitarian healthcare providers and a globally disseminated survey. The topic of funding arose early and often; donors prefer to see the number of lives saved rather than deaths eased. The early interviews have also yielded potential venues for the re-integration of a palliative approach into humanitarian healthcare, including the very triage model that was pushed to its extreme in Rwanda. This research will provide critical insight into the field and inform the development of new organizational policies that will better equip humanitarians for their daily reality of dealing with death.
In one of the most recent interviews, a respondent recalled the story of a Haitian orphan who died while seeking pain medication in the aftermath of the earthquake. She was turned away the first time, because she was an orphan. The second, because she was disabled. She died in the parking lot of the third attempt, where palliative care was not offered. No one should have to die like this, as the right to to dignity remains even in death, and if our initial findings hold true, they suggest that there is always something left to offer.”
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