Global health really is an exciting field to be involved in and brings with it many privileges as we work and study alongside diverse people from communities around the globe.  Cultivating an ‘ethical sensibility’ is not about taking the fun out of what we do, but about ensuring that above all we do no harm – to ourselves, to other individuals and to the communities within which we work.  Embrace these principles and use them to take your experiences in global health to a whole new level!

1. Recognise that patients’ rights are universal.
Patients’ rights are based on the concept of fundamental human rights - as articulated in the 1948 Declaration of Human Rights and enshrined in international law. The World Health Organization (WHO) has achieved international consensus on a minimum standard: “that all patients have a right to privacy, to the confidentiality of their medical information, to consent to or to refuse treatment, and to be informed about relevant risk to them of medical procedures”.

2. Put your host community’s interests first.  
Ultimately it is your hosts that invite you to practise in their community. It is they who should define your role, and it is essential that you ask a few key questions before you undertake professional activity: What are the community’s needs? Is there a gap that needs filling?  Practising in this way will make your work abroad meaningful for both you and your hosts.

3. Give local trainees, practitioners and researchers priority.  
Health workers have a huge opportunity to use and develop their skills in a global health context, however this should never be at the expense of local trainees.  For researchers, involve local staff in as much of the research as possible, giving them ownership over the process from planning to publication (and always cite their contributions appropriately).  

4. Emphasise education.
Frequently the biggest contribution that can be made by health workers is in leaving their skills behind.  Make an effort to work with local staff to identify, and then fill, skills and information gaps. There should be an educational and capacity-building element to all of your professional activities.

5. Think long-term sustainability.
Just as you will take new knowledge and skills home, there will be opportunities for you to have an impact on your host community beyond your departure. Think about ‘big picture’ issues (eg, prescribing choices, clinical decision-making, resource management, staff recruitment and training and data collection) and how, based on your Australian experience, you can empower local staff to create enduring structural change. Whatever your role, consider how you can promote local ownership and self-reliance.

6.  Do not use the ‘developing world’ for practicing.
The ‘developing world’ provides health workers with a unique opportunity to learn new and innovative ways of understanding health and illness and using their clinical skills.  But this does not mean you should use your host community as ‘guinea pigs’ on which to hone your skills.  If you wouldn’t do it back home, don’t do it in other communities.

7. Practise quality global health.
Working in an under-resourced setting invariably means that you will have to work differently.  For clinicians, the aim should always be to provide the highest standard of care to the greatest number of patients with the human, pharmaceutical and equipment resources available. For researchers, don't compromise ethical standards and always be sure to cite the contribution of local researchers appropriately.  Be creative in how you approach problems and use local colleagues to guide you towards the best decisions.  

8. Know your limits.
You should never expect to have all the answers and, for the safety of you, your local colleagues and the community, you need to know when you are reaching your limits – both personally and professionally.  

9. Have a focus.
The clearer your role is, the better you will be able to fulfil the needs and expectations of your host community.  Define a job description before starting, and review and refine your responsibilities as your placement continues.  It is easy to fall into the trap of doing ‘a little bit of everything’, but it is to everyone’s advantage that you focus on your strengths, and where the community need is greatest.

10. Consider the broader implications of your presence.
The presence of a foreign health worker in a foreign community has implications – perhaps far beyond what you might expect.  Cultural, social and educational differences all result in power imbalances and a degree of social disruption.  Acknowledging this reality is the first step to pre-empting and identifying relevant issues.  Remember: first do no harm.

References

• Crump J, Sugarman J and the Working Group on Ethics Guidelines for Global Health Training (WEIGHT). Ethics and best practice guidelines for training experiences in global health. Am J Trop Med Hyg. 2010; 83:1178–1182. 
• United Nations. The Universal Declaration on Human Rights - http://www.un.org/en/documents/udhr/index.shtml. 
• World Health Organization.  Patient Rights. http://www.who.int/genomics/public/patientrights/en/.
• World Medical Association. Declaration on the Rights of the Patient. http://www.wma.net/en/30publications/10policies/l4/index.html. 
• World Medical Association. International Code of Medical Ethics. http://www.wma.net/en/30publications/10policies/c8/index.html.
• Image by Johnny Grim (Flickr)

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