Health systems in developing countries are under extreme pressure. Here we give a few brief hints, taken from our more detailed electives toolkit, of the kinds of ethical issues you need to bear in mind when considering your elective.
Issues you might encounter on an elective
The medical elective can be one of the most rewarding parts of undergraduate medical education. It is certainly one of the most eagerly anticipated.
Resource-poor settings can, however, present you with searching ethical and clinical dilemmas.
You may feel under pressure to exceed your competence, there may be problems understanding local languages and dialects, and different cultures can have different approaches to fundamental issues such as consent and confidentiality.
Staying within your competence
In developing countries, shortages of qualified health care staff combined with extremes of health need can mean that you may find yourself called upon to undertake procedures that you would not be in a position to do at home. If you are on an elective, you must remember that you are under an obligation to maintain the standards set by the GMC (General Medical Council).
If asked to undertake procedures that you would not be asked to undertake at home, it is important to ask the following questions:
- Why am I not allowed to do this procedure at home?
- Am I capable of performing it without suitable supervision?
- Am I putting my patient or myself at risk?
- Would it be possible or practicable to ask for supervision without imposing excessive burdens on other key health personnel?
If you are being asked to act beyond your clinical competence you should politely but firmly decline.
Emergency situations
Responding to emergencies can present students, and qualified health staff, with challenging ethical dilemmas. In resource-poor settings situations may routinely occur that would be regarded as emergencies in more developed countries.
It is important to emphasise that you must avoid getting involved in providing routine care that is outside your level of competence. Where a patient is at immediate risk of death or serious harm and no other qualified health professional is available, you can assist, provided you have a reasonable belief that you can improve outcomes.
Maintaining ethical standards
You must maintain the same high standards of professional ethics during your elective as you would during clinical rotations at home. These include:
- acting with honesty and integrity
- treating all patients with dignity and respect
- avoiding discrimination
- prioritising the needs of patients
- respecting the requirement to seek consent and to respect confidentiality.
Minimising burdens on the host country
Providing elective opportunities for medical students can impose a significant administrative burden on host countries. Given that resources may already be extremely limited you should make every effort to avoid imposing unnecessary burdens on your hosts.
If you do not speak the local language or dialect, you should consider whether you have the time to develop an understanding before you visit the country. If not, you should ask yourself whether or not the language barrier will serve as a significant impediment to a successful elective.
You should also think carefully about the levels of supervision that can realistically be provided by senior colleagues in resource-poor settings. It is important to recognise that the primary obligation of health professionals is to their patients. In terms of educational resources, the priority will also be the training and development of professionals who are working within the country.