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In Focus: Gautham Krishnaraj

g-krishnaraj-for-humethnet-profileIn Focus: Gautham Krishnaraj

Gautham Krishnaraj is a MSc Candidate (Global Health), 2016 RBC Students Leading Change Scholar, Canadian Red Cross Youth Advisor and the newest trainee of the Humanitarian Health Care Ethics Research Group at McMaster University.

During his undergraduate studies at McGill University (BSc. Microbiology & Immunology), he held various federal student research assistantships in Analytical Chemistry, Microbiology, and Plant Genetics, as well as contributing to research in the Department of Chemical Engineering at McGill. Seeking to expand his perspective beyond the bench top, he was also passionately engaged with the Young Diplomats of Canada (YDC) and the International Relations Students Association of McGill University (IRSAM Inc). Within these organizations he served as Head Delegate to the OECD in Paris, and the United Nations in New York respectively, and notably co-facilitated and addressed a Civil Society Briefing Session at the 54th Commission for Social Development.

For the past three years, Gautham has worked closely with the McGill Humanitarian Studies Initiative and Montreal-based HumanitarianU. This engagement led to him actively assisting in the production of training protocols for field staff as part of the International Medical Corps’ Multi-Agency Training Collaboration to Support the Ebola Response in West Africa in 2014. Gautham continues to provide logistical support for Field-Based Humanitarian Disaster Simulations (SimEx) with HumanitarianU.

He is also an accomplished spoken word poet, and co-founded the national non-profit organization Raise Your Voice Canada in 2012, which sought to engage youth in public discourse through debate and spoken word poetry. Gautham currently serves as a Youth Advisor to the Canadian Red Cross and continues to believe in the power, and necessity, of engaging youth in civic discourse and humanitarian action.

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Justice in the Humanitarian Context – Maxwell Smith

msmithMaxwell J. Smith, PhD, MSc

Banting Postdoctoral Fellow, Institute for Health and Social Policy, McGill University

During the 2009-2010 H1N1 influenza pandemic I began working as a research coordinator with the ‘Canadian Program of Research on Ethics in a Pandemic’ (CanPREP).  Hosted at the University of Toronto’s Joint Centre for Bioethics, this program of research involved engaging the Canadian public on ethical issues in pandemic preparedness and response (e.g., the use of restrictive measures like quarantine;1 physicians’ duty to care;2 setting priorities for scarce resources;3 and issues pertaining to global governance4).  What became apparent to me when examining the ethics discourses in pandemic planning and response was that a common and unsubstantiated assumption exists; namely, that the ethics of global public health emergency preparedness and response is perceived as being distinct from the way we think about ethics in what might be considered ‘quotidian’ public health.  For example, Kirkwood suggests that “there must be an ‘escalator clause’ in the utilitarian aspect [of resource allocation] that suggests that in the event of an extensive threat to the existence of a population, the force of this utilitarian aspect becomes the primary consideration in proportion to the threat…the greater the threat, the greater the moral force of utilitarianism in making public health decisions”.5  As another example, Veatch asks whether, in public health emergency preparedness and response, we should “retreat to the utilitarian ethic, making an exception to the ethic of justice that generally prevails in American ethics”.6  Do we tend to be more utilitarian in the way we think about preparing for and responding to public health emergencies as compared to the way we make public health decisions in non-emergency contexts?

This question motivated me to focus my doctoral research on examining the extent to which the perspectives of Canadian public health policy-makers involved in public health emergency preparedness and response are similar or different than those involved in other areas of public health, like chronic disease prevention, specifically in regards to how social justice is conceptualized and negotiated in their work.  Using qualitative interview methods, I found that the perspectives of my study’s participants appeared to be influenced by the perceived goals and contextual features that belong to the programmatic area of public health in which they practiced.  For instance, policy-makers involved in public health emergency preparedness and response described this area’s principal aims as saving the most lives and producing the ‘greatest good’.  Justice-based considerations, interpreted almost entirely in terms of equity, were perceived as being external, or even as being impediments, to these consequentialist, if not utilitarian, aims.  Policy-makers involved in chronic disease prevention, on the other hand, described this area’s central aims in terms of equity and justice; its purpose involves understanding and targeting the unique needs of different populations in order to produce equitable outcomes.  On my interpretation, my study’s findings indicate that the perceived role of social justice considerations in public health emergency preparedness and response may be distinct from how their perceived role in chronic disease prevention; where justice-based considerations are perceived to be part and parcel of the aims of chronic disease prevention, they are perceived as external to, if not constraints upon, the ‘prior’ aim of public health emergency preparedness and response, which is to minimize morbidity and mortality for the greatest number.  The findings of this study have led me to consider whether the way we think about justice in the humanitarian context might be distinct from how we think about justice in public health and global health more generally, and if so, whether this is ethically justifiable.

  1. Smith MJ, Bensimon CM, Perez D, Sahni S, Upshur REG. (2012). Restrictive Measures in an Influenza Pandemic: A Qualitative Study of Public Perspectives. Canadian Journal of Public Health, 103(5): 348-352.
  2. Bensimon CM, Smith MJ, Pisartchik D, Sahni S, Upshur REG. (2012). The Duty to Care in an Influenza Pandemic: A Qualitative Study of Canadian Public Perspectives. Social Science & Medicine, 75(12): 2425-2430.
  3. Silva DS, Gibson JL, Robertson A, Bensimon C, Sahni S, Maunula L, Smith MJ. (2012). Priority Setting of ICU Resources in an Influenza Pandemic: A Qualitative Study of the Canadian Public’s Perspectives. BMC Public Health, 12: 241-252.
  4. Thompson A, Smith MJ, Bensimon CM, McDougall C, Perez DF. (2015). “With Human Health it’s a Global Thing”: Canadian Perspectives on Ethics in the Global Governance of an Influenza Pandemic. Journal of Bioethical Inquiry, 12(1): 115-127.
  5. Kirkwood, K. (2010). In the Name of the Greater Good? Emerging Health Threats Journal, 2(E12), 1-3.
  6. Veatch, R. (2005). Disaster Preparedness and Triage: Justice and the Common Good. The Mount Sinai Journal of Medicine, 72(4), 236-241.

Max Smith is a Banting Postdoctoral Fellow at the Institute for Health and Social Policy at McGill University. 

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Policy & Well Being – Leigh-Anne Gillespie

img_30091Leigh-Anne Gillespie, PhD candidate

Health Policy Program, Political Studies Stream

gilleslb@mcmaster.ca

The lasting impression of participating in a medical mission to Olongapo City, Philippines in 2008 inspired me to pursue a PhD in Health Policy. Policy is far-reaching: the ability of good health policy to improve the well-being of large groups of people – and of poor health policy to degrade it – is humbling.

Since joining the Health Policy PhD Program at McMaster University, I have been immersed in policy analysis and theory. My research, conducted under the guidance of Dr. Lisa Schwartz, focuses specifically on the nature of ethical challenges arising from humanitarian aid agency policies during disaster and conflict response. In-depth, qualitative interviews with organizational members from international aid agencies have shed light on how policy both helps and hinders in various contexts. With keen anticipation of their contributions to the humanitarian sector, I am looking forward to disseminating these findings shortly.

 The interdisciplinary nature of the Health Policy PhD Program has allowed me to flourish. It has pushed me to create my own path and transcend disciplinary boundaries, while at the same time develop a shared language by which to communicate with colleagues. I am grateful for the collaborative approach the program has instilled in me, and look forward to continued opportunities to help advance humanitarian healthcare ethics.

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Geneva & Back Again – Julia Pemberton’s Reflections on Interning at the WHO

Julia Pemberton, PhD candidate
Health Research Methodology Program, Field of Interest: Global Health
pemberj@mcmaster.ca

img_8967This past summer I had the incredible opportunity to join the World Health Organization (WHO) as a Research Intern for three months. At WHO I joined the Global Health Ethics Unit, which is part of the larger Research, Ethics, Knowledge Management Department. The majority of my internship focused on the creation and execution of a qualitative descriptive research study. Entitled “Ethical Issues Associated with Implementation Research: A Descriptive Qualitative Analysis of the WHO Experience from 2005-2015,” this study consists of a document analysis followed by two focus group sessions, one with WHO Technical Officers, and one with past and present WHO Ethics Research Committee (ERC) members. The purpose of this study is to identify and understand the ethical issues identified by the WHO ERC in its review of  Implementation Research (IR) projects submitted for ethical review at WHO. The results from this study will be used to raise awareness on the ethical issues arising in IR and to build capacity of researchers and ethics committees involved in the conduct and review of IR, respectively. The results will also potentially be used to inform a global guidance document on ethical review of IR. In addition to this research project I also was a member of the WHO Intern Board as an Intern Advocate, where I helped connect interns with WHO staff to engage in professional development and networking opportunities. Finally, I was also responsible for the creation of an Intern Alumni platform for the Global Health Ethics Unit, as well as the Global Health Ethics newsletter. In summary, I used my time in Geneva to expand my professional network, and had productive meetings with the International Committee of the Red Cross, Médecins sans frontières, the Council on Health Research and Development (COHRED), and the Geneva Centre for Education and Research in Humanitarian Action (CERAH).

The research activities described above directly relate to my doctoral work. The topic of my dissertation is global health research governance. Governance, or the way political, ethical, administrative, and financial authority applies to a health research system, is an important part

of how these systems are organized and managed, and how they perform. The purpose of my doctoral thesis is to examine how global health research governance is being understood, developed and currently used in the Canadian national health research system. Briefly, my thesis will generate an inductively derived, reflexive, global health research governance model for Canada. Through this work I intend to identify specific value criteria that are indicative of good global health research governance. Foregrounded will be the contribution of global health research ethics to governance beyond research ethics review, and discerning how values are known and reflected in the governance of national health research systems. Once this model of Canadian global health research governance is known, I will be conducting a case study of a global health research partnership (Canada and Zambia) to determine the current reflexivity of the Canadian model and determine what, if any, recommendations for policy and health systems strengthening could be made.

Julia Pemberton is a 3rd year student in the Health Research Methodology PhD at McMaster University, a CIHR Banting & Best Canadian Graduate Scholar, and a recipient of both the CIHR Douglas Kinsella Award in Bioethics and the CIHR Michael Smith Foreign Study Supplement Award.

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On “Doing Ethics” – Dr. Ali Okhowat

ali-okhowat-new-photo-jpg-196x275I began my PhD, in part, for the same reason that I felt compelled to move to Montreal: to learn French. I’d scrounged up the courage to walk over to the then unpronounceable Pavillon Marguerite-d’Youville de l’Université de Montréal shortly before registration closed on an afternoon in late autumn. I’d always been interested in bioethics and dabbled in it during my schooling but the thinking tools that I’d been taught had been uniform and uninspiring, akin to using a paintbrush to solve a Rubik’s cube. As I signed the registration paper, I imagined myself graduating in record time and emerging in a couple years with a memorized copy of Candide. Oh, the plans des souris et des hommes …  

I learned a great deal as I worked through my courses and I quickly came to understand the gist of most discussions. As my readings progressed and the classes became more focused, I found myself wanting to get more experience in issues related to humanitarian and military ethics. Around the same time, my co-supervisors, Drs. Bryn Williams-Jones and Matthew Hunt, were establishing a new research project, the Ethics in Military Medicine Research Group (EMMRG), and I joined the team and eventually formulated my PhD proposal around one aspect of this larger study.

Following the proposal defence, I signed on as a doctor with the International Committee of the Red Cross (ICRC) and was assigned to work as the ICRC’s first doctor stationed in the Gaza Strip and assigned to work specifically on health care in places of detention. As I was in the thesis writing phase of my PhD at this time, I felt motivated by the idea that I would merge my goal of being deployed as a doctor in humanitarian contexts with the parallel goal of finishing my thesis. However, the prelude to and unravelling of the 2014 war in Gaza brought with it a host of unexpected events that delayed my formal writing about ethics yet was informed my understanding of how ethical issues are structured, manifest and evolve in humanitarian settings. The topics that I had until then only explored theoretically came to life with startling – and, at times, devastating – clarity. Issues relating to resource allocation and standards of care, dual-loyalty conflicts, and operational challenges in times of war interspersed with events that news reports from the period documented as mass hunger strikes, allegations of ill-treatment, forced-feeding legislation, and dual-use technologies.

During my mission in Gaza, I continued writing and remained connected to the academic ethics community. For example, I was invited to present at the 2014 International Congress of Military Medicine’s annual Ethics in Military Medicine conference regarding a project undertaken by the Ethics in Military Medicine Research Group (EMMRG), of which I and my PhD supervisors (Bryn Williams-Jones and Matthew Hunt) and other researchers are members. During the question and answer session of my presentation, one of the audience members noted that “ethics, like military training, becomes better with practice.” In the ensuing months, this statement echoed in my mind as I came to appreciate its importance through practice. I realized that while we may use conceptual frameworks, tools, and guides to help us frame ethical issues, clarify discussions and generate possible resolutions, in the absence of directed study, reflection, and debate, ethics training without practice renders us ill-equipped for the real task: to become better at ethics by ‘doing ethics’. This engagement is critical and I understood in retrospect, as my mission carried on, that my colleagues and I needed more tailored ethics training and practice to resolve the ethical issues that we were immersed in. This led to a period of reflection about professional ethics in the humanitarian sector and the drafting of several internal documents on this issue.

Following the end of my mission in Gaza, I returned to Canada and resumed working in earnest on the completion of my PhD. Yet personal events and professional opportunities took me to a country that had always fascinated me: Afghanistan. As the Health in Detention Program Manager for Afghanistan, I was tasked with overseeing all of ICRC’s health programmes in detention-related settings. In this role, I became engrossed in an environment and culture that was familiar yet foreign. Though I was familiar with the language and customs of the region, my experiences there presented me with a larger scale of professional and ethical challenges. During this time, I travelled extensively within and beyond Afghanistan’s borders, jumping on ICRC and UN flights in cramped, propeller-driven aircraft on an almost weekly basis, from Kabul and Bagram to Kandahar and Herat to Mazar-e-Sharif and Dushanbe, Tajikistan and beyond. I debated about the ethics of our programmes and the actions of the wider humanitarian community with colleagues within the humanitarian sector and friends back home. In interacting with them, I came to realize that our humanitarian space was constrained, at times shrinking, and required constant reinforcement — all issues that I came to understand better as a consequence of my ethics training.   

 Towards the end of 2015, I was recruited to work at the World Health Organization’s Eastern Mediterranean Regional Office as a member of the inaugural Emergency Operations team. Working at a regional level in contexts confronted with various categories and levels of emergencies, I travelled extensively in the region and was responsible for assisting my emergency response colleagues in countries such as Syria, Iraq, Somalia, Afghanistan, Iraq, Yemen, and Libya, among others. Throughout my work and travels, ruminations on issues that crossed boundaries between humanitarian, professional, organizational, and public health ethics swirled in the back of my mind while the foreground of my experiences framed them in vivid detail. Given my supervisor’s encouragement to join her in exploring issues using our common training in ethics, we began to increasingly include ethical considerations and analyses in our review of programs and policies.

These experiences bring me now to the present, a moment that is well beyond my original projection of how long it would take to “quickly wrap up my thesis” and far from the level of French mastery that I’d hoped to attain. Still, as I approach the final stages of this journey, I don’t find myself regretting the detours I’ve taken; instead, I realize that my writing ‘about ethics’ has been enriched by my attempts to ‘do ethics’.

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In Focus: Brett Sutton

Brett Sutton is Public Health Registrar at Burnet Institute in Melbourne, Australia. He currently works with the Department of Health and Human Services Victoria, the Macfarlane Burnet Institute for Medical Research and Public Health (Burnet Institute), and is an Adjunct Lecturer with James Cook University. He is a Fellow of the Royal Society for Public Health and the Australasian College of Tropical Medicine.

Brett is passionate about Public Health, which has both inspired and led his career trajectory. He had a 10-year career in Emergency Medicine including as deputy director of a rural Tasmanian ED. This was followed by several years of field-based international public health. He worked primarily in international public health in Afghanistan, Ethiopia, Kenya and Timor-Leste. This included work in child and maternal health, disease surveillance, TB and refugee health. On return to Australia, he has worked in the Communicable Disease Prevention & Control Unit and Office of the Chief Health Officer at the Victorian Department of Health and Human Services.

He moved to Burnet in 2016 for a 12-month secondment. He is currently assisting with the Victorian Hepatitis C elimination strategy. His expertise is in synthesising clinical work with international and local public health experience.

Recent publications and publications of interest:

The Tortoise and the Hare: Polio, Guinea Worm and the Race to Eradication http://currents.plos.org/outbreaks/article/the-tortoise-and-the-hare-guinea-worm-polio-and-the-race-to-eradication/  

How to respond to sexual transmission of ebolavirus from EVD survivors? https://www.linkedin.com/pulse/how-respond-sexual-transmission-ebolavirus-from-evd-survivors-sutton?trk=prof-post

An Afghanistan experience.
Brett A Sutton
. Med J Aust. 2003 Dec; 179(11-12):591-593

Contact: brett.sutton@burnet.edu.au

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In Focus: Christine Wang

Christine is completing her final year in the Bachelor of Health Sciences program at McMaster University. She spent the last six summers working with healthcare teams near Inner Mongolia, enabling her to gather local perceptions of poverty, power and justice within humanitarian contexts. Exploring communities’ priorities and experiences of aid has brought her into proximity with narratives of neglect, exploitation and resiliency surrounding the country’s widening ethnic inequalities and rural-urban divide. She has witnessed the region’s evolving public health landscape over the years, allowing her to investigate the sustainability and effectiveness of humanitarian practices. Christine’s field experience has fueled her interest in development economics and global health ethics, which have led to opportunities working with the Health Impact Fund and the Centre for Ethical, Social and Cultural Risk at the Li Ka Shing Knowledge Institute.

Christine also co-founded the first Student Chapter of the Canadian Coalition for Global Health Research (CCGHR) that is currently developing the Global Health Agora, an inter-professional community engagement platform. Through partnerships with key Hamilton informants, they are exploring moral themes of lust (sexual violence), pride (racism & discrimination), wrath (war & terrorism) and gluttony (obesity & hunger) as glo-cal health challenges. The CCGHR Student Chapter continues to benefit from the incredible mentorship of HumEthNet members, such as Lisa Schwartz and Elysée Nouvet, whose dedication to student learning has provided Christine with unique opportunities for academic and personal growth.

Additional member profiles on this page for:

  • Stephanie Nixon
  • Ross Upshur
  • Nyamiye Hermenegilde
  • Lisa Eckenwiler
  • Chiara Lepora
  • John Pringle
  • Dónal O’Mathúna