Call for Responses

The case outlined below will be the basis for the “In That Case” section in the 12(1) issue of the Journal of Bioethical Inquiry (JBI). We invite interested readers to provide responses to the case for possible publication. Responses should be 500–700 words, although longer manuscripts will be considered for publication. Responses should be submitted as soon as possible after publication of this issue. The editors will select the responses to be published in the 12(1) issue of the JBI and reserve the right to edit contributions to avoid repetition. Editorial changes will be cleared with authors before going to press. Responses should be submitted via Editorial Manager (http://www.edmgr.com/jbin/).

The Case

Priya recently finished a master’s degree in business administration after earning an undergraduate degree in international development studies. She is interested in essential medications and the strategic planning and policy infrastructure countries use to provide them to their citizens. She accepts an internship through a Canadian nongovernmental organization (NGO) in the Democratic Republic of the Congo (DRC) in order to build her practical experience. This organization is involved in medication distribution to people living with HIV and AIDS.

Priya likes that her job description is quite specific, asking her to develop a funding proposal that would allow for an increased number of trained community health workers distributing antiretroviral medications. With some concern about being an outsider in a new organization and how helpful she could be given cultural and language differences, she feels reassured by her extensive experience in grant writing that she obtained through internships as part of her graduate education. Priya imagines that this is a relatively straightforward skill she could contribute.

Her family expresses how nervous they are at her departure, traveling somewhere relatively unknown to them. They express concerns about the potential for political and personal violence. Ultimately she garners their support by ensuring them that she will be living in a protected compound as an expatriate. In addition, they have always been proud of her dedication to “helping those less fortunate” and secretly boast about her to other members of their social circle.

Upon her arrival in the DRC, although she is conversational in French, she realizes communication will be a significant obstacle as many staff communicate mainly in their local dialect during meetings. Other than the director of the DRC office, her local colleagues are unaware of the grant proposal with which she has been tasked by the Canadian office. Priya becomes more and more uncertain of where to gather information about what is needed to support the grant she is supposed to write. She systematically interviews each person at the local office, trying to get a clearer sense of what is needed and where this grant might play a role. It is unclear to her which regions actually need more community health workers and also unclear if there are sufficient medications available to expand the organization’s regional scope. She takes some day trips into communities serviced by existing community health workers, but finds it hard to get much detail about their work and needs in just a few hours. She senses people are nervous to talk with her but seem eager to please her. Priya wonders if she is missing some cultural cues or if she is behaving appropriately in the eyes of her colleagues. She spends most of her free time with other expatriates, trying to ascertain if they have similar challenges at their workplaces.

After several months and in discussion with the Canadian office, Priya decides to craft a proposal for expansion of community health workers into some areas that seem to need more support. Her proposal, written in English, is sent to an American funding agency and is successful shortly before her departure from the DRC. Despite her drafted project implementation plans and timelines, as well as ample funds, it remains unclear who will take the reigns on this project when she leaves. No one has prioritized her work in the way she expected, and she wonders if this entire grant process was actually what was most needed. It was rarely discussed at meetings or among her colleagues. On her return home, her family is relieved to see her and congratulates her on her accomplishments overseas in such a short period. Priya is offered a second contract through the same NGO, offering her a departure to work in Malawi on a similar project in one month.