Freshman Seminar
University of Massachusetts- Boston
March 9, 2017
Ethical & Cross-Cultural
Considerations in
Global Health Education
Joyce A. Sackey, M.D., FACP
Dean for Multicultural Affairs and Global Health
Associate Professor, Departments of Medicine &
Public Health and Community Medicine
Tufts University School of Medicine
Tufts Around The Globe
Educational Benefits of Participating in
a Global Health Experience
• Service opportunity
– Become part of the solution to inequities in
global health
– Personal growth
• Learning opportunity
– Health systems other than US
– Cultural competency through immersion
– Spectrum of diseases otherwise not
encountered during medical school
Global Engagement:
TUSM’s Approach
• Hallmarks– A passion for excellence, active citizenship,
and a deep commitment to addressing global
health disparities.
– Time-tested, community-centered approach
to problem solving and finding locally- driven
solutions
– Empowering global partners to work directly
with their communities to find innovative,
transformative and sustainable solutions
What Types of Ethical and Cross-cultural
Issues Arise When Working in
International Settings?
Special Focus:
Resource-limited Settings
Ethical Considerations
• Patients
• Host institution
• Sending
institution- Tufts
• Personal safety
Sending Institution
• Primary purpose of experience is global
health learning (service to a lesser extent).
• Tufts ambassador
• Tufts professionalism standards
• Communication with Tufts mentor and
other administrators
Host Community
• Community-centric
– Consider local needs and priorities
• Cultural humility
– Be open to listen and learn from all sources
• Be mindful of burden on host
– Unintended consequences
• Solidarity
– Importance of establishing relationships
Patients
• Right to
appropriate care
• Privacy
• Informed consent
• Confidentiality
• Cultural sensitivity
• Communication
skills
Common Themes
• Allocation of scarce resources.
• Reconciling the provision of care within a
particular cultural context and our notion of
“standard of care.”
• Balancing educational and training needs
and patient care.
Core Guiding Principle
• Primum non nocere– First, do no harm
Case Discussion
• A rural hospital in a resource-limited setting
with a new “neonatal intensive care unit.”
• A mixed health care team, consisting of local
professionals (permanent) and volunteers
(short-term), including students.
• The patient- a baby born prematurely and
requiring “intensive” care in the new NICU.
• Resource in question: Oxygen.
Framework for Resolving Ethical Dilemmas
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What is the problem or dilemma?
What are the facts and issues?
What are the values at stake?
Are the values and preferences of different
stakeholders (e.g. patient vs. health care
provider) at variance or in conflict?
• What ethical principles are at stake?
• What practical issues need to be addressed?
• Principles of Biomedical Ethics, Beauchamp, Childress, 6th Ed
Four Key Principles of Health Care Ethics
• Beneficence
– Doing good for a patient
• Respect for autonomy
– The patient’s right to decision-making regarding
his/her body
• Non-maleficence
– “Primum non nocere”- First do no harm
• Justice
– Protecting one’s patient from exploitation and
discrimination
– Principles of Biomedical Ethics. Beauchamp, Childress, 6th Ed.
Case Discussion 2
• A ten year old boy presents hours after an
unprovoked dog bite
• Health care team is concerned about a possible
risk of exposure to rabies, a condition that
carries with it a high mortality rate
• The boy does not have access to anti-rabies
immunoglobulin at the location, and the visiting
team contemplates obtaining an emergency
supply from the US (at a considerable cost)
Summary
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Primum non nocere- First, do no harm
Adopt an attitude of cultural humility
Learn first, do later
Be community-centric in your approach
Strive to understand the values at stake
(or at odds) when facing an ethical tension
• Use a win-win strategy to resolve conflicts
Social justice and Advocacy
Your final ethical responsibility is to share
what you have learned. Bear witness!