Setting: A small rural hospital in East Africa

Scenario: An expatriate laboratory technologist has recently begun a two-year mission in a small rural hospital in East Africa. Her responsibilities include managing the hospital’s medical laboratory and training local staff about technical laboratory skills and protocol. However, it quickly becomes apparent that the national physicians working at the hospital expect the laboratory technologist to provide services beyond her training or prior experience. In one situation, she was asked to prepare a complicated blood transfusion for an infant with severe malaria and a rare blood type, despite having never done the procedure before.

One day, the hospital’s chief physician asks the laboratory technologist to examine a peripheral blood smear from a patient with suspected leukemia. The physician insists that she make a diagnosis and recommend the appropriate course of chemotherapy. Although the laboratory technologist has some training in hematological oncology, she does not feel comfortable making the diagnosis alone. In her home country, she typically performs this type of lab work in consultation with an oncologist who has the necessary clinical expertise. However, there are no other qualified personnel at the remote hospital who could assist in the interpretation of the blood smear.  The laboratory technologist is unsure how she ought to respond.

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: Responding to Needs Beyond One’s Experience or Training. www.humanitarianhealthethics.net.

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