International Work Question

[Inspector JacquesClouseau]

I'm currently doing international work and I noticed some people are afraid of mentioning activities in case the adcom would view it as unethical/inappropriate. I've been involved in the wards of the hospital I have been working at, with direct patient contact, including pricking fingers for rapid malaria tests. Would this be considered appropriate?

Also, where is the line between appropriate/inappropriate? I am being aided by qualified professionals while doing these activities, but I've been given more freedom than a U.S. institution would probably give me. This experience has been very important for the development of my views of medicine and public health, which I am particularly interested in.

TIA for your responses.

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[TMC07]

I think the issue with this type of thing is being allowed to do stuff you are not qualified to do, simply because you are working with a population that is very in-need. For example, I had a friend go to Guatamala with a dental mission trip and the dentists let her pull teeth... She's a sophomore in college. Just because a person is desperate for help doesn't mean that it is okay to provide them with mediocre and possibly dangerous services. Mentioning something like this is detrimental to your application because it calls your ethics into question. Saying, "But they told me I could!" is not an excuse. (If some cop told you it was okay to kill someone, does that mean that you couldn't be arrested for it? No. You are expected to be able to judge right from wrong.) So, if you aren't doing anything that you couldn't walk into a hospital in the US and legally be allowed to do, you're fine.

It is also important to demonstrate dedication. Going somewhere for a week or two and poking a few fingers isn't making a difference. Sorry, but that's the reality. However, if you've been there for an extended period of time and formed relationships with the locals, then it would be looked upon more favorably.

 

[gyngyn]

If you were providing free care, and you were displacing a local who was or could have been trained to do the job you were doing, it was not ultimately in the best interest of that community. With a broad view of international "missions," you can see how we have become neutral, at best, regarding untrained participation.

 

[Inspector JacquesClouseau]

I don't want to divulge too much for anonymity. I've been here aiding staff at a research center with clinical research studies. Since we work at the pediatric clinic, if the nurses are busy and the doctor would like a quick malaria test, they let the clinical research staff do it if they're not busy. I won't mention it if it seems unethical. I am working at a teaching hospital, and I am not displacing any local, it is just something the clinical research staff to help the hospital (it is an esteemed hospital but overburdened). I will be here for a couple of months. This is not a mission, this is actually an independent project I created in conjunction with a scientist in the States and his contacts in the country I am in.

 

[Inspector JacquesClouseau]

Does this change anything? Or would it be viewed as a neutral or a negative experience? TIA

 

[gyngyn]

Does this change anything? Or would it be viewed as a neutral or a negative experience? TIA

Research on vulnerable populations adds another layer of complexity.

 

[Inspector JacquesClouseau]

Research on vulnerable populations adds another layer of complexity.

All studies are in conjunction with institutions such as the Yale School of Medicine and Pitt. They were all reviewed by IRBs in the U.S. and the country I am in. Every patient is read through a consent in English and the local language, with care to ensure they understand the study and can leave at any point without effect on their care, etc.

I do this work in the States and would never engage in unethical research. I was just worried that pricking a finger would be considered crossing the line. I am an EMT if that makes any difference. It would be disappointing if a project a year and a half in the making could turn out to be a red flag. I think this has broadened my perspective and solidified my interest in medicine.

That being said, it's already in my work and activities section so I will have to face the music.

 

[LizzyM]

All studies are in conjunction with institutions such as the Yale School of Medicine and Pitt. They were all reviewed by IRBs in the U.S. and the country I am in. Every patient is read through a consent in English and the local language, with care to ensure they understand the study and can leave at any point without effect on their care, etc.

I do this work in the States and would never engage in unethical research. I was just worried that pricking a finger would be considered crossing the line. I am an EMT if that makes any difference. It would be disappointing if a project a year and a half in the making could turn out to be a red flag. I think this has broadened my perspective and solidified my interest in medicine.

That being said, it's already in my work and activities section so I will have to face the music.

This is a horse of a different color in my book compared with a 10 day medical mission trip. One presumes that you have been taught universal precautions so that the testing is done safely for you and those with whom you interact. I would also hope that you have been instructed how to do the test so that the results are accurate. Given that lay people are trained to do finger sticks on young family members with diabetes and so forth, it is a procedure that can be done safely by a well trained non-professional. Furthermore, if you are an EMT, I would presume that you have been instructed on how to do this procedure safely but I really don't know what EMTs are trained to do.

Research meant to add to new knowledge about the population being studied and ultimately meant to benefit that population is ethical under the Belmont Report. It would be unethical if it were performing risky procedures on that population with the goal of producing treatments that would be too costly there but that would be useful in the US.

 

[Inspector JacquesClouseau]

This is a horse of a different color in my book compared with a 10 day medical mission trip. One presumes that you have been taught universal precautions so that the testing is done safely for you and those with whom you interact. I would also hope that you have been instructed how to do the test so that the results are accurate. Given that lay people are trained to do finger sticks on young family members with diabetes and so forth, it is a procedure that can be done safely by a well trained non-professional. Furthermore, if you are an EMT, I would presume that you have been instructed on how to do this procedure safely but I really don't know what EMTs are trained to do.

Research meant to add to new knowledge about the population being studied and ultimately meant to benefit that population is ethical under the Belmont Report. It would be unethical if it were performing risky procedures on that population with the goal of producing treatments that would be too costly there but that would be useful in the US.

Ok this makes me feel much better. Yes, I was trained briefly on how to obtain accurate results, and its almost an identical procedure to a finger stick. The research is mainly observational: its examining changes in biomarkers for those suffering from a lifelong disease. It is to benefit the population here which is disproportionally affected by this disease. One study is interventional, but it is counseling for those caring for children suffering from a condition that carries heavy social stigma.

Thank you for your responses! I'm new to SDN but I'm starting to see how helpful it can be. I hope I can be in a position to contribute some wisdom of my own someday.