Rethinking global health practices in light of South Sudan catastrophe

Fifteen children died in the village of Nachodokopele in South Sudan. They died in pain, while struggling for air. Each death could have been easily avoided. The cause of their deaths was a contaminated measles vaccine that caused infection and septic shock.

How could this happen? What we know right now is that over a four-day campaign, about 300 children received the vaccine from a single syringe, drawn from vials that had been sitting at room temperature.

Basic safety precautions tell us that the syringe should have been thrown out after its first use and a new one used for each injection. The vaccine should have been refrigerated. Although no one is certain, the vials probably acted like “incubators” where germs quickly multiplied. Thirty-two other children got sick, but didn’t die.

To respond to these deaths, local officials and global health workers have issued calls for more education and safety training for global health workers in the war-torn region. This is the quickest way to ensure that a catastrophe like this doesn’t happen again. But it isn’t enough.

As a medical ethicist, I wonder if these calls are missing a key cause of the problem: Global health professionals are not beholden to the communities they serve. By this, I mean that health professionals should be invested in – and, when possible, a part of – the communities where they serve.

While I acknowledge the real and significant limitations to providing care in places like South Sudan, I also hope we can find long-term solutions to problems like the one that caused these needless deaths. Nachodokopele needs doctors, not just vaccines. Nachodokopele needs nurses, not just gifts of good will and medical supplies. Sepsis might have been the direct cause of death, but the structural shortcomings of our current model of global health aid contributed.

From an ethical perspective, good medicine requires investment in the lives of those served. It is difficult to be invested when providers are limited by resources and lack continuous patient interaction. While aid, no matter how small, can do some good, properly responding to those in Nachodokopele means creating relationships that span more than one visit. It means becoming responsible to a community.

Vaccine campaigns have saved countless lives. In fact, some might say that the gifts communities receive from professionals with no long-term investment are “good enough.” But these deaths should make us rethink the way we understand global health medicine as a gift-giving venture. We may find medicine that is “good enough” is no longer good enough.

– By Trevor Bibler, Ph.D., M.T.S., assistant professor of medical ethics at Baylor College of Medicine’s Center for Medical Ethics and Health Policy

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