1. Freshman Seminar University of Massachusetts- Boston
March 9, 2017

2. 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

3. Tufts Around The Globe

4. 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

5. 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

6. Special Focus: Resource-limited Settings
What Types of Ethical and Cross-cultural Issues Arise When Working in International Settings?
Special Focus:
Resource-limited Settings

7. Ethical Considerations
Patients
Host institution
Sending institution- Tufts
Personal safety

8. 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

9. Host Community Community-centric Cultural humility
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

10. Patients Right to appropriate care Privacy Informed consent
Confidentiality
Cultural sensitivity
Communication skills

11. 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.

12. Core Guiding Principle
Primum non nocere-
First, do no harm

13. 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.

14. Framework for Resolving Ethical Dilemmas
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

15. 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.

16. A ten year old boy presents hours after an unprovoked dog bite
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)

17. Summary 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

18. Social justice and Advocacy
Your final ethical responsibility is to share what you have learned. Bear witness!