Case Study 8.4 Deciding priorities
Imagine that you are a Health Extension Practitioner in a rural area and you are planning to conduct a vaccination campaign and also a malaria control campaign. Both are necessary to improve the health of your local community, but there are only limited human resources available and it is not possible to do both of these campaigns immediately.
In this situation you need to decide: should you continue with the malaria campaign or the vaccination campaign, or share your resources in some way between both campaigns? There may be ethical principles that you can use to help you make your decision. Both campaigns may be beneficial for members of the community (beneficence), and none of the decisions seem to involve potential breaches of confidentiality. You may need to gather more information about the situation in order to be helped to make the correct decision.
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- Box 8.2 sets out the steps that can be used in decision making over ethical issues. How might following these steps help you to make the best decision about how to proceed in Case Study 8.4?
- Following these steps might give you additional information that will help you take the decision. For example, you might find out that doing both campaigns using reduced resources would make both campaigns ineffective. When you consult both the community and the expert it might become apparent that you should give priority to the malaria control campaign, because this disease cannot wait. If it is not controlled speedily it may kill, or make many people in the community ill within a short period of time. Vaccination of children, on the other hand, can be postponed for another time because if the children are not vaccinated right away this will not necessarily bring about a disastrous health outcome. Remember that there will always be other people who can help you make important decisions, including ethical problems. Often it will help you if you ask your community what they prefer when there are options.
8.6 Stigma and illness
As a Health Extension Practitioner, you will be working in the rural areas where 80–85% of the population of Ethiopia lives. The healthcare practice in rural areas is different from that of urban centres. The closeness you create with individuals, families and the community may make it difficult to decide about any ethical conflicts (dilemmas) that may occur in your day-to-day practice.
One of the serious ethical issues that you may encounter is stigma. Stigma is defined as a negative perception that is assigned to an individual because of any feature that, in the view of others, discredits and diminishes them from other people. The stigmatised person becomes a person who is discounted. In rural healthcare settings, stigma takes on special importance because of the close relationships that exist in small communities. To be viewed negatively by others, to be avoided, and to be seen as less than a full member of the community is a major burden for a person in a rural community.
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