Setting: Several rural health clinics in a country in sub-Saharan Africa

Scenario: An expatriate nurse has been given a mandate by an international medical NGO and the host country’s Ministry of Health to identify outbreaks of meningitis in rural areas. She visits numerous remote health clinics with a driver and translator in order to assess where the greatest needs are so as to optimize the allocation of scarce healthcare resources to address the outbreak.

In many locations, the clinics are understaffed and seem to be overwhelmed with many seriously ill patients and a crippling lack of medicines. However, the patient numbers at several of these sites do not meet the strict epidemiological criteria of a meningitis outbreak, as defined by the international NGO and Ministry of Health. As a result, these sites are unlikely to receive additional personnel or resources, despite the fact that the local clinic staff are barely able to cope with the present burden of disease. The overwhelmed clinic staff plead for more support and ask the expatriate nurse to stay and help treat patients. The nurse is deeply conflicted about 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: Coping with Outbreaks of Disease with Limited Resources. www.humanitarianhealthethics.net.

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