Author: Humanitarian Health Ethics Research Network

Humanitarian Healthcare Ethics is a place to find practical and educational material for humanitarian healthcare workers as well as students and scholars of humanitarian healthcare ethics. The website developed out of empirical research on the ethical dilemmas faced by humanitarian healthcare professionals working in humanitarian crises, disasters or areas of extreme poverty.

Publication: “As It Is Africa, It Is Ok”? Ethical Considerations of Development Use of Drones for Delivery in Malawi

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PhD candidate Ning Wang at the Institute of Biomedical Ethics and History of Medicine (IBME), University of Zurich, recently published an articles in the IEEE Transactions on Technology and Society entitled: “As It Is Africa, It Is Ok”? Ethical Considerations of Development Use of Drones for Delivery in Malawi. This work results from a four-week field study in the Lake Malawi region, where drones were used to help address the medical supply delivery challenges faced by the Government of Malawi. The article focuses on the ethical considerations associated with the use of technology for health development purposes, and raises awareness for the need of critical analysis in the deployment of technology in the aid sector.

Full text can be accessed here. A related live talk regarding this case study is available here. The author can be contacted at: ning.wang@ibme.uzh.ch.

Citation

Wang, N. (2021). “As It Is Africa, It Is Ok”? Ethical Considerations of Development Use of Drones for Delivery in Malawi. IEEE Transactions on Technology and Society, 2(1), 20-30.

Abstract

Since 2016, drones have been deployed in various development projects in sub-Saharan Africa, where trials, tests, and studies have been rolled out in countries, including Tanzania, Uganda, Rwanda, Malawi, Ghana, and the Democratic Republic of the Congo. The use cases of drones vary, ranging from imagery collection to transportation of vaccines, lab samples, blood products, and other medical supplies. A wide range of stakeholders is involved, including governments, international organizations, educational institutions, as well as industry. Based on a field study conducted in 2019, this article investigates how drones are used for medical supply delivery in Malawi—a country where the community is underserved for healthcare and related infrastructure underdeveloped, while airspace is largely open and regulations generally relaxed. The objective of presenting this case study is to contribute to the evidence regarding the rapid deployment of medical cargo drones across the African continent, and to spark critical reflections over the utility, suitability, and impacts of incorporating drones in the existing health supply chain systems in resource-poor settings. The discussion revolves around two aspects: 1) the emergent “African Drone Rise”—is it ok “as it is Africa”? and 2) the normative role of technology in the aid sector—is it “a solution looking for a problem”? In conclusion, a call for more structured guidance for the systematic examination and evaluation of the medical cargo drone case is raised.

Keywords

Health supply chain system, humanitarian drone, medical cargo drone, medical supply delivery, public interest technology.

New Publication: Culturally sensitive palliative care in humanitarian action

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READ THE FULL ARTICLE AT: https://www.doi.org/10.1017/S1478951521000894. 

Suggested Citation: Schuster-Wallace, C., Nouvet, E., Rigby, I., Krishnaraj, G., De Laat, S., Schwartz, L., & Hunt, M. (2021). Culturally sensitive palliative care in humanitarian action: Lessons from a critical interpretive synthesis of culture in palliative care literature. Palliative and Supportive Care, 1-11. doi:10.1017/S1478951521000894

Abstract
Objective
There is growing recognition of the importance of increasing preparedness for and the provision of palliative care in humanitarian crises. The primary objective of this review is to interpret the existing literature on culture and palliative care to query the recommendation that humanitarian healthcare providers, teams, and organizations integrate palliative care into their practice in ways that are attentive to and respectful of cultural differences.

Methods
A critical interpretive synthesis was applied to a systematic literature review guided by the PRISMA framework. Analysis was based on directed data extraction and was team based, to ensure rigor and consistency.

Results
In total, 112 articles covering 51 countries and 9 major worldviews met inclusion criteria. This literature describes culture as it influences perspectives on death and dying, expectations of palliative care, and challenges to providing culturally sensitive care. A key pattern highlighted in articles with respect to the culture and palliative care literature is that culture is invoked in this literature as a sort of catch-all for non-white, non-Christian, indigenous practices, and preferences for palliative care. It is important that humanitarian healthcare providers and organizations aiming to enact their commitment of respect for all persons through attention to potential culturally specific approaches to pain management, suffering, and dying in specific crisis settings do so without reproducing Othering and reductionistic understandings of what culturally sensitive care in humanitarian crises settings involves.

Significance of results
This paper clarifies and unpacks the diverse influences of culture in palliative care with the goal of supporting the preparedness and capacity of humanitarian healthcare providers to provide palliative care. In doing so, it aids in thinking through what constitutes culturally sensitive practice when it comes to palliative care needs in humanitarian crises. Providing such care is particularly challenging but also tremendously important given that healthcare providers from diverse cultures are brought together under high stress conditions

WEBINAR: REFLECTIONS ON PALLIATIVE CARE FROM EBOLA TO COVID-19

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Watch the recording: https://youtu.be/U5OU5oEp4nk

Watch HHE’s Dr. Kevin Bezanson and Prof. Elysée Nouvet’s webinar, hosted with the World Association for Disaster and Emergency Medicine (WADEM), entitled Life, Death, and Isolation: Reflections on Palliative Care from Ebola to COVID-19. From JUNE 22 2021 – 12:00 HRS EDT.

New Publication: Dying in Honor: experiences of end-of-life palliative care during the 2013-2016 Ebola outbreak in Guinea

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LINK: https://rdcu.be/ckfTE

CITATION: Nouvet et al. Dying in Honor: experiences of end-of-life palliative care during the 2013-2016 Ebola outbreak in Guinea. Journal of International Humanitarian Action 2021 6(10): 1-17.  Open access link

ABSTRACT: With no cure and a high mortality rate, Ebola virus disease (EVD) outbreaks require preparedness for the provision of end-of-life palliative care. This qualitative study is part of a larger project on palliative care in humanitarian contexts. Its goal was to document and deepen understanding of experiences and expectations related to end-oflife palliative care for patients infected with Ebola virus disease (EVD) in West African Ebola treatment centres (ETCs) during the 2013–2016 epidemic. It consisted of 15 in-depth semi-structured interviews with individuals impacted by EVD in a Guinean ETC: either as patients in an ETC, healthcare providers, healthcare providers who were also EVD patients at one point, family relations who visited patients who died in an ETC, or providers of spiritual support to patients and family. Analysis was team based and applied an interpretive descriptive approach. Healthcare delivery in humanitarian emergencies must remain respectful of patient preferences but also local and contextual values and norms. Of key importance in the Guinean context is the culturally valued experience of “dying in honour”. This involves accompaniment to facilitate a peaceful death, the possibility of passing on final messages to family members, prayer, and particular practices to enact respect for the bodies of the deceased. Participants emphasized several challenges to such death in Ebola treatment centres (ETCs), as well as practices they deemed helpful to alleviating dying patients’ suffering. An overarching message in participants’ accounts was that ideally more would have been done for the dying in ETCs. Building on participants’ accounts, we outline a number of considerations for optimizing end-of-life palliative care during current and future public health emergencies, including for COVID19.

May 17-20 Virtual Event: Lessons from the Field: Confronting the Challenges of Health Research in Humanitarian Crises

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Event Description and Registration Details: https://www.fic.nih.gov/About/center-global-health-studies/Pages/health-research-humanitarian-crises-lessons-launch-event.aspx

In association with the “Lessons from the field: Confronting the challenges of health research in humanitarian crises” collection in BMC Public Health and Conflict and Health, Fogarty’s Center for Global Health Studies (CGHS) will host an online launch event May 17 – 20, 2021.

This virtual event will take place in four sessions over four days. Each session will be 90 minutes, and participants will have the option of joining an additional 30-minute breakout discussion and networking session at the end. The events will feature case study authors, Steering Committee members, and experts in the field. The events will help audiences understand best how to utilize the case studies for educational, training and other purposes, as well as highlight the importance of conducting research in the context of humanitarian crises and share some common themes, strategies and lessons learned.

Each session will be held at 9 am EDT (Washington, D.C.) | 4 pm (Nairobi) | 7 pm (Dhaka) to accommodate as many time zones as possible. This event is open to the public. Participants must register in advance for each session individually.

Webinar (Mar 31) – Humanitarian ethics: moral purpose and moral hazard (Transformative Disaster Risk Governance Series)

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Transformative Disaster Risk Governance Webinar Series: Humanitarianism
Panel InfoDownload

The Transformative Disaster Risk Governance Webinar Series at York University is continuing with a session on Humanitarian ethics: moral purpose and moral hazard. The keynote is Prof. Hugo Slim, followed by a panel discussion with Professors Peter Timmerman and Nergis Canefe from York University, as well as a Q&A session with the audience.

Jan 27 Webinar: MSF’s Stories of Change as a health promotion method in humanitarian settings

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Join the Canadian Coalition for Global Health Research and Western University (London, Canada) on Wednesday January 27 @ noon for a webinar on “MSF’s Stories of Change as a health promotion method in humanitarian settings”

Webinar link is (no registration needed or password): https://westernuniversity.zoom.us/j/94114166799

Abstract

Health-care decisions, such as changing practices to reduce the risk of the transmission of an illness, are not only based on biomedical knowledge but also on local knowledge, perspectives and experiences. Health promotion (HP) strategies should therefore both disseminate biomedical illness information and information that includes local knowledge and experiences. Yet, in practice it remains challenging to move away from the more ‘traditional’ health education approaches to participatory approaches that include local knowledge.

In 2019, MSF provided medical support in Goma responding to a cholera outbreak. A pilot of a participatory storytelling intervention was carried out to support the HP team in their efforts to encourage people to adapt protective hygiene practices. This interactive storytelling method presented an alternative to the traditional HP approach of top-down one-way communication. This webinar brings four individuals with front line experience using MSF’s Story of Change as a simple, sustainable, cost effective method for health promotion.

“We Live on Hope…”: Ethical Considerations of Humanitarian Use of Drones in Post-Disaster Nepal

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PhD candidate Ning Wang at the Institute of Biomedical Ethics and History of Medicine (IBME), University of Zurich recently published an articles in the IEEE Technology and Society Magazine  entitled: “We Live on Hope…”: Ethical Considerations of Humanitarian Use of Drones in Post-Disaster Nepal. This work results from a three-week field study in rural Nepal, where local population’s livelihood was affected by the 2015 earthquake, and where drones were used in assisting disaster relief work. The article focuses on the ethical considerations associated with the use of technology for humanitarian purposes, and raises awareness for the need of critical analysis in the deployment of technology in the aid sector.

Full text can be accessed here. A related live talk regarding this case study is available here. The author can be contacted at: ning.wang@ibme.uzh.ch.

Abstract
The noticeable turn to technology in humanitarian action raises issues related to humanitarianism, sovereignty, as well as equality and access for at-risk populations in disaster zones or remote areas lacking sufficient healthcare services. On a technical level, practical challenges include heightened risks of data safety and security, and the potential malicious use of technology. On a societal level, humanitarian innovation may disrupt relations between different stakeholders, may widen inequality between those with access and those without, and may threaten privacy, disproportionately affecting the vulnerable population. Drawing on the empirical findings of a case study of the 2015 Nepal earthquake, this paper presents an in-depth normative analysis to identify contextualised ethical considerations, and illuminate the wider debate about how technological innovation in the aid sector should be operationalised. In conclusion, on the normative level, a prudent attitude in adopting novel technology in the aid sector is required; while on the operational level, proposals for actionable ethical standards to guide and safeguard sector-wide innovation practices are needed.

Keywords
Humanitarian technology; community consent; technology assessment; data safety and security; regulation deficit; stakeholder accountability

New Publication – Closing well: national and international humanitarian workers’ perspectives on the ethics of closing humanitarian health projects

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Read the full paper: https://jhumanitarianaction.springeropen.com/articles/10.1186/s41018-020-00082-4

Abstract excerpt: We identified six recurrent ethical concerns highlighted by interviewees regarding closure of humanitarian projects: respectfully engaging with partners and stakeholders, planning responsively, communicating transparently, demonstrating care for local communities and staff during project closure, anticipating and acting to minimize harms, and attending to sustainability and project legacy. We present these ethical concerns according to the temporal horizon of humanitarian action, that is, arising across five phases of a project’s timeline: design, implementation, deciding whether to close, implementing closure, and post-closure. This exploratory study contributes to discussions concerning the ethics of project closure by illuminating how they are experienced and understood from the perspectives of national and international humanitarian workers. The interview findings contributed to the development of an ethics guidance note that aims to support project closures that minimize harms and uphold values, while being mindful of the limits of ethical ideals in non-ideal circumstances.

Hunt, M., Eckenwiler, L., Hyppolite, SR. et al. Closing well: national and international humanitarian workers’ perspectives on the ethics of closing humanitarian health projects. Int J Humanitarian Action 5, 16 (2020). https://doi.org/10.1186/s41018-020-00082-4