Everyday ethics on the frontlines of global health
Everyday ethics refers to the ethical dilemmas and the day-to-day struggles experienced by front line global health actors while undertaking their tasks. These can include the challenges involved in the conduct of research (in clinical settings or in the field) and interventions (such as vaccination campaigns or responding to infectious disease outbreaks).
The key feature of everyday ethics for frontline healthcare workers is the difference between formal bioethical guidelines and the realities of global health in practice. For over 15 years my work has focused on exploring the everyday ethical dilemmas of a range of frontline healthcare workers including:
Fieldworkers (or data collectors)
“You know you can’t find someone [a research participant] with a problem and then the research [ethics] says it should be like this, and then you leave him with his problem. Secondly, as human beings what is your conscience saying? So, we [act out of] our conscience, for those people [community members]....
Figure 1: The research encounter: what is the right thing to do? (copyright: Patricia Kingori)
Data collectors and other field-level workers are the invisible army involved in producing scientific knowledge in global health. Yet their everyday ethical experiences are often overlooked. My research has focused on highlighting field-level workers’ unique ethical position at the frontline of face-to-face interactions with medical research participants and community members and the everyday ethical dilemmas of data collection in resource-constrained contexts.
This work has taken place in East and West Africa and South-east Asia where I have conducted in-depth ethnographic research over several months and years. A unique feature of this work has been the use of graphic elucidation methodologies which involves a iterative process of co-producing illustrations to bring the accounts of field-level workers into view.
Wellcome Trust Society and Ethics Postdoctoral award (grant number WT080546MF)
Wellcome Trust Strategic Award (096527)
Wellcome Trust Investigator Award (grant number 209830/Z/17/Z)
Figure 2: Data from under a tree
Frontline healthcare workers face a myriad of different everyday ethical dilemmas including reconciling professional ethical codes at times of austerity, making decisions framed by resource scarcity, institutional pressures to meet targets and personal and moral ethical codes. These challenges are experienced by frontline healthcare workers in a variety of contexts; my work includes examining experiences of everyday ethics in the UK and Europe.
Wellcome Trust (104107/Z/14/Z)
Wellcome Trust (code 203132) (grant numbers 221719 and 216355)
The urgency and emergency of infectious disease outbreaks creates particular ethical dilemmas for humanitarian healthcare workers and first responders. My work focuses on exploring the ethical issues are experienced by frontline humanitarian staff and the solutions they have devised to manage their everyday working lives. This includes projects examining the ethical preparedness of frontline workers in humanitarian crises (RECAP).
Wellcome Trust (Grant number 108769/Z/15/)
RECAP is funded by the Global Challenges Research Fund (ES/P010873/1)
Figure 4: Frontline healthcare workers during the COVID-19 pandemic