Between thoughts and words

We were conducting a workshop on ethics and professionalism among community health workers. There was a case study which we discussed in the workshop. A community health worker (CHW) is posted in a village which has many members belonging to a nomadic tribal community. The CHW provided care for a woman who had just delivered her fourth child, a healthy boy. She instilled an intrauterine contraceptive device in this woman without informing her, immediately after the delivery, even when she was still drowsy from the labour. We were discussing the ethics of instilling an intrauterine device in the tribal woman without informing or obtaining consent from her.  "People belonging to that tribal community never practice contraception. They have many children. They have frequent childbirths without any spacing. It is impossible to convince them to have an intrauterine device. If we do not instill the device now, we will miss the opportunity and she will get pregnant soon. It will be harmf...

Someone I know was going through a tough time. They were venting to me about their situation. Their supervisor at their work was giving them a hard time. "They treat me like a child. They speak down to me and give me instructions and lessons for everything", this person was complaining about their supervisor. When we were discussing this, one thing that came up was how my friend felt a sense of obligation towards this supervisor because this supervisor was the one who got them the job. This led to several important questions -  1. Is the help we do transactional?  2. What is gratitude?  3. Is gratitude accompanied by indebtedness? I am writing my thoughts on these questions in this blog with an intention to share with my friend as a follow up to our conversation that day.  Is help transactional? The word 'help' means doing something for others to make something easier for them or to be useful to them. Therefore there is a difference between doing a work for someone a...

Last week we conducted a training for community health workers on ethics and professionalism. We were discussing the principle of autonomy and the right of every individual to decide what treatments they will take and refuse. We used a case vignette which describes a community health worker inserting an intrauterine device to prevent pregnancy in a young woman belonging to a marginalised tribal community without informing her, immediately after delivery even before she could recover from the dizziness and fatigue of the labour pains. It was no surprise to us that most of the participants argued that what she did was right. They had the following arguments: 1. The young girl is from a poor, marginalised tribal community. She is uneducated. She will not understand what is birth spacing, contraception or intrauterine devices. It is difficult to explain to her.  2. Even if we explain, it will only make her afraid and she will refuse.  3. If she refuses now, we will not be able to ...