Setting: A small rural hospital in a country in sub-Saharan Africa with a recent history of civil conflict

Scenario: An expatriate nurse is working for an international medical NGO in a small rural hospital in sub-Saharan Africa when a cholera outbreak occurs in the local community. A significant number of patients present to the hospital with severe diarrhea and signs of life-threatening dehydration. Patients with suspected cholera are quarantined and given intravenous fluids and oral rehydration therapy. However, the influx of patients quickly exceeds the capacity of the hospital’s limited resources and small staff of two physicians and five nurses. It could take several days for the NGO to send additional healthcare workers to this remote region.

The expatriate nurse has a background in public health as well as clinical experience dealing with cholera outbreaks from previous humanitarian missions. Her remit is as an in-patient department nurse. She soon realizes that the spread of cholera could threaten the entire community and overwhelm the hospital unless the source of the outbreak is quickly identified. However, it will likely require several days of work to survey the local population and test water sources for contamination. The nurse is the only member of the small healthcare team qualified to conduct this epidemiological survey. At the same time, her previous experience in treating cholera makes her essential to the acute care of patients in the isolation tent.  The nurse feels conflicting priorities about her role and must quickly decide what to do.

Analysis: Apply this case to the Humanitarian Healthcare Ethics Analysis Tool (HHEAT). The HHEAT  is intended to facilitate discussion and deliberation for those involved in ethically challenging situations and will assist humanitarian healthcare workers in implementing well-considered decisions.  The six steps are designed to help you or your team structure reflection and deliberation on the ethical dilemma presented in the case study. You may skip questions that appear less relevant to the issue or explore dimensions pertinent to the context but not listed in the tool.

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Disclaimer: Case studies in the ENHA (Ethics Narratives in Humanitarian Aid) series are based on the reflections of humanitarian healthcare workers on ethical challenges experienced in the field. While the stories presented in the cases draw on real events and the accounts of real persons, many stories are composites in which similar experiences are woven together. In all of the stories, details such as names, dates, locations, career and life stage, gender, and profession have been changed, obscured, or omitted. Any resemblance the stories may bear to actual persons, places, and events is co-incidental.

While the stories often aim to show what the protagonist is thinking or feeling, the Humanitarian Healthcare Ethics Research Group’s intent as the stories’ author is not to suggest that the values and assumptions held by a story’s protagonist are those of all or many humanitarian healthcare workers. Similarly, the values, opinions and actions of a protagonist or other actors in a story should not be understood to reflect those of, or be endorsed by, the Humanitarian Healthcare Ethics Research Group.

How to cite: Humanitarian Healthcare Ethics. 2014. ENHA Case Study Series: Conflicting Priorities during a Public Health Emergency. www.humanitarianhealthethics.net.

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