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

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

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

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

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.

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


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

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

New Publication: Addressing obstacles to the inclusion of palliative care in humanitarian health projects

Read the full paper at: https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-020-00314-9

Abstract excerpt:
Participants discussed various obstacles to the provision of palliative care in humanitarian crises. More prominent obstacles were linked to the life-saving ethos of humanitarian organizations, priority setting of scarce resources, institutional and donor funding, availability of guidance and expertise in palliative care, access to medication, and cultural specificity around death and dying. Less prominent obstacles related to continuity of care after project closure, equity, security concerns, and terminology. Opportunities exist for overcoming the obstacles to providing palliative care in humanitarian crises. Doing so is necessary to ensure that humanitarian healthcare can fulfill its objectives not only of saving lives, but also of alleviating suffering and promoting dignity of individuals who are ill or injured during a humanitarian crises, including persons who are dying or likely to die.

Hunt, M., Nouvet, E., Chénier, A. et al. Addressing obstacles to the inclusion of palliative care in humanitarian health projects: a qualitative study of humanitarian health professionals’ and policy makers’ perceptions. Confl Health 14, 70 (2020). https://doi.org/10.1186/s13031-020-00314-9

Palliative Care in Natural Disaster Response

Reports for humanitarian practitioners & policymakers

Dying alone is hard anywhere in the world”: Palliative care in natural disaster response 

“Dying alone is hard anywhere in the world” (PDF): Palliative care in natural disaster response 

Natural Disasters – Report and Recommendations”: Palliative care in natural disaster response. A research snapshot

 

Key Findings 

The following key findings emerged from the natural disasters sub-study: 

  • Participants described palliative care as a key component of comprehensive humanitarian healthcare involving companionship and psychosocial support for patients and their families, dignity in death and dying, and the management of pain and other distressing symptoms.
  • Barriers to the provision of palliative care in natural disaster settings included damage to health structures; inadequate resources; disrupted supply chains; the invisibility of patients with palliative needs; differences in local cultural norms; the prioritization of acute needs; and challenges of mobility and access to care. 
  • Despite existing limitations, respondents agreed that humanitarian aid organizations have an ethical obligation to provide palliative care.
  • Integration of palliative care may play a role in alleviating distress among disaster responders, particularly those from affected communities. 
  • Participants emphasized that palliative care must be integrated into disaster planning from the beginning; otherwise, it is likely to be neglected during a crisis. 
  • There was a clear consensus concerning the need for palliative care training and protocols to guide practice in natural disaster settings. 

 

Overview: Focus on Natural Disasters Settings  

According to the World Health Organization, a natural disaster is “an act of nature of such magnitude as to create a catastrophic situation in which the day-to-day patterns of life are suddenly disrupted and people are plunged into helplessness and suffering, and, as a result, need food, clothing, shelter, medical and nursing care and other necessities of life, and protection against unfavourable environmental actors and conditions.” [1] While we use the term “natural disasters” in this sub-study, it is widely recognized that the impacts of natural disasters such as earthquakes and tsunamis are shaped by human activity, degrees of vulnerability of certain communities, and action or inaction to mitigate natural hazards. [2] The annual death rate due to natural disasters is around 90,000 people worldwide, with approximately 160 million others also affected. [3] Over the last 10 years, 95% of the nearly two billion people affected by natural disasters were affected by a weather-related event. [4] 

Like conflict settings and public health emergencies, natural disasters can overwhelm the capacity of health systems to meet the needs of the general population. This constitutes a humanitarian crisis, wherein the health and well-being of large groups of people are threatened due to factors such as lack of access to care, infrastructure damage, and resource scarcity. In recent years, many nations, including Haiti, Nepal, Pakistan, India, and Japan have experienced significant losses of life and devastation to infrastructure due to natural disasters. 

Natural disasters, including famine, can exacerbate conditions in regions experiencing conflict, and are often a factor in the development or escalation of violence. Likewise, ongoing conflict in disaster-affected countries can further limit or hinder disaster response. This perpetuates a continuous cycle of poverty and instability for such countries and constrains the possibilities for disaster preparedness and response by local and international care providers.

 

Natural Disasters Sub-Study Objectives 

  1. To develop evidence clarifying the ethical and practical possibilities, challenges, and consequences of palliative care needs following natural disasters. 
  2. To inform realistic, context-sensitive guidance, education, and practices for the provision of palliative care during natural disaster response. 

 

Summary of our Approach

In-depth, semi-structured interviews (N = 20) were conducted with international and local healthcare providers who had responded to a variety of natural disasters. For this sub-study, we included natural disasters that often strike without warning (earthquakes, landslides, and flash floods); those with a short warning time frame (tsunamis, hurricanes, typhoons and flooding); and protracted or foreseeable disasters (famine). The relationship between conflict and natural disasters was also explored. 

Natural Disasters Team 

Team Lead:  

RYantzi_photo

 

Rachel Yantzi RN, MSN/MPH – PhD student in Health Research Methodology, McMaster University, Hamilton, Canada 

 

IMG_7773.jpeg

 

Takhliq Amir, BHSc – MD student at the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada 

 

Matthew Hunt, PhD, PPT – Professor, School of Physical and Occupational Therapy, McGill University, Montreal, Canada  

Lisa Schwartz,PhD – Professor & Arnold L. Johnson Chair in Healthcare Ethics, McMaster University, Hamilton Canada 

Sonya de Laat, PhD – Academic Advisor & Global Health Scholar, Global Health Program, McMaster University, Hamilton, Canada 

Carrie Bernard MD MPH CCFP FCFP – Assistant Professor, Department of Family and Community Medicine, University of Toronto, Toronto, Canada 

Laurie Elit, MD – Professor of Obstetrics and Gynecology, McMaster University, Gynecologic Oncologist, Hamilton Health Sciences, Hamilton, Canada 

Corinne Schuster-Wallace, PhD – Associate Professor, Faculty of Geography & Planning, University of Saskatchewan, Saskatoon, SK

Lynda Redwood-Campbell, MD, FCFP, DTM&H, MPH, Canadian Red Cross International Emergency Response Unit, Professor of Family Medicine, McMaster University, Hamilton, Canada

 

Outputs 

Conference Oral Presentations: 

  • Schwartz L, de Laat S, Yantzi R, Nouvet E, Bezanson K, Amir T, et al. Refugee experiences of palliative care in humanitarian settings: Views from conflict and disaster. 30th Annual Canadian Bioethics Society Conference; 2019 May 22-24; Banff, Canada.  
  • Yantzi R. Dying in the margins: Palliative care, humanitarian crises and the intersection of global and local health systems. Presented at: 16th Annual HEI Research Day, McMaster University; 2019 Mar 14; Hamilton, ON.  

Conference Poster Presentations: 

References 

  1. Assar, M. Guide to sanitation in natural disasters. World Health Organization. 1971. Available from: https://apps.who.int/iris/bitstream/handle/10665/41031/10678_eng.pdf;jsessionid =890EB054FAB45D038B5BC2F479F6E813?sequence=1 
  2. World Health Organization. Definitions: emergencies. 2020. Available from: https://www.who.int/hac/about/definitions/en/ 
  3. World Health Organization. Environmental health in emergencies. 2020. Available from: https://www.who.int/environmental_health_emergencies/natural_events/en/ 
  4. International Federation of Red Cross and Red Crescent Societies. (2018). World disaster report: Leaving no one behind. Available from: https://media.ifrc.org/ifrc/world-disaster-report-2018/ 

New Report: “Dying alone is hard anywhere in the world” – palliative care in natural disaster response

READ THE FULL REPORT: Natural Disasters – Report and Recommendations

In response to the emerging recognition of the need for palliative care, the Humanitarian Health Ethics Research Group undertook a program of research in order to understand the ethical dimensions of palliative care during humanitarian action. Here, we present key findings of the sub-study focused on natural disaster settings that was part of this larger program of research. Through this series of reports, we hope to present the perspectives of those engaged in humanitarian healthcare firsthand – as patients, host community members, policymakers, and local and international healthcare providers – in order to clarify how humanitarian organizations and humanitarian healthcare providers might best support ethically and contextually-appropriate palliative care in a range of humanitarian crises.

KEY FINDINGS:

  1. Participants described palliative care as a key component of comprehensive humanitarian healthcare involving companionship and psychosocial support for patients and their families, dignity in death and dying, and the management of pain and other distressing symptoms.
  2. Barriers to the provision of palliative care in natural disaster settings included damage to health structures; inadequate resources; disrupted supply chains; the invisibility of patients with palliative needs; differences in local cultural norms; the prioritization of acute needs; and challenges of mobility and access to care.
  3. Despite existing limitations, respondents agreed that humanitarian aid organizations have an ethical obligation to provide palliative care.
  4. Integration of palliative care may play a role in alleviating distress among disaster responders, particularly those from affected communities.
  5. Participants emphasized that palliative care must be integrated into disaster planning from the beginning; otherwise, it is likely to be neglected during a crisis.
  6. There was a clear consensus concerning the need for palliative care training and protocols to guide practice in natural disaster settings.

Suggested citation: Amir, T., Yantzi, R., de Laat, S., Bernard, C., Elit, L., Schuster-Wallace, C., Redwood Campbell, L., Hunt, M. & Schwartz, L. (2020). “Dying alone is hard anywhere in the world”: Palliative care in natural disaster response. Isis A. Harvey designer. Available online at http://www.humanitairanhealthethics.net.

Triage and COVID-19: global preparedness, socio-cultural considerations, and communication

Principal Investigators: Elysee Nouvet PhD, Lisa Schwartz PhD

Report (EN): Triaging Critical Care During COVID-19- Global preparedness, socio-cultural considerations, and communication

Report (FR): TRIAGE AU NIVEAU DES SOINS AUX PATIENTS GRAVEMENT MALADES LORS DE LA PANDÉMIE DE COVID-19: PRÉPARATION MONDIALE, CONSIDÉRATIONS SOCIOCULTURELLES , ET COMMUNICATION  

Link to Survey: https://uwo.eu.qualtrics.com/jfe/form/SV_e2QyBOV2dBa9ECp

Triage – The process of deciding the order of treatment of a large number of patients based on the severity of each case. In severe cases can result in treatment of only the sickest due to scarcity of resources.

This study aims to understand (1) what health care workers consider crucial to the
treatment of patients that will not be prioritized for care during the COVID-19 pandemic, (2) if and how such triage plans will be shared with the affected populations, as well as (3) what social and cultural considerations are important during such communication. We will be conducting virtual interviews with 50 healthcare workers around the world that are involved in triage guideline implementation during the current COVID-19 pandemic. Alternatively, participants can submit written reflections to key questions via LimeSurvey. Descriptive analysis will be employed to identify patterns and differences in the data collected. An open-access report will be published with the results and a webinar produced in partnership with the World Health Organization (WHO) Global Outbreak Alert and Response Network (GOARN) Research working group. These findings will help healthcare organizations and governments across the world develop and implement triage guidelines and relevant communication strategies that take into account contextual differences. This study is a collaboration between Western
University, Humanitarian Healthcare Ethics Research Group, and the WHO COVID-19 social sciences research committee.

From Tokenism to Meaningful Partnerships

North-South research partnerships are a critical means of advancing global health research. However, research partners from the Global South have described feeling they were included to full funding requirements, and offered only token roles, saying “we were there to colour the soup.” Despite good intentions, researchers from the Global North often fall into patterns of tokenism. This 2-page report captures key lessons learned from our experiences of and data collected from two elrha-r2hc funded studies: (1) Aid when there is ‘nothing left to offer’: A study of ethics & palliative care during international humanitarian action, and (2) Isolation, quarantine, and research in Ebola management: A comparative study of stakeholder perceptions and experiences. These reflections point to possible strategies to move toward the goal of authentic partnerships during humanitarian health research. It reflects the reality that the overwhelming majority of transnational partnerships are collaborations in which researchers from Global North countries partner with researchers from what are essentially “research site” countries in the Global South.

PDF: FROM TOKENISM TO MEANINGFUL PARTNERSHIPS – FINAL [EN]

PDF: FROM TOKENISM TO MEANINGFUL PARTNERSHIPS – FINAL [FR]

 

Suggested Citation(s):

Humanitarian Health Ethics Research Group. (2019). From Tokenism to Meaningful Partnerships. Isis A. Harvey designer. Available Online on the Humanitarian Health Ethics Website.

Humanitarian Health Ethics Research Group. (2019). Du symbolism aux partenariats authentiques. Traduction [de l’anglais]: Aziza Mohamadhossen. Isis A. Harvey conception graphique. Disponible sur le site web de Humanitarian Health Ethics.