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Volume 5 Edition 1                                                                                    Winter 2017

Dear Readers,

Two and a half years ago, when the Humanitarian Health Ethics Group started exploring the concept and absence of palliative care in humanitarian healthcare, the topic was far off the public radar. Today, the question of where and how palliative care fits with humanitarian action is far less marginal. In November 2016, a small group including representatives from NGOs, academia, and inter-governmental organizations met in Geneva to share research and reflections on pediatric palliative care and emergency medicine. Joan Marston’s article in this issue of Reflections outlines many other promising signs. As Marston summarizes, there is a long road ahead in terms of figuring out what current levels of need for palliative care exist across diverse contexts, and how best to address these. What is also certain is that this road also involves cultural shifts: creating more room and acceptance of non-curative efforts in humanitarian healthcare as morally but also clinically important labor. This issue of Reflections thus focuses on palliative care, reflecting a sense in the Humanitarian Health Ethics community that it is an area meriting more attention. 

As others have noted, the persistent lack of attention to palliative care in humanitarian action cannot be traced to singular factors. Cultural and existential fears and discomfort with the topic and reality of death are constantly at play. Our publics, the donors, generally equate helping with helping to live, not helping to improve end-of-lives. There are well-documented Western medical professional equations of death with failure. Such equations intertwined with  forms of medical and/or humanitarian machismo, make discussion of those we cannot save (our “failures”) particularly challenging. Palliative care may also be a collateral casualty of a politics of refusal. Alleviating suffering is not sufficient for many in the field of humanitarian healthcare today. Ethical action includes and even requires addressing social determinants of health and pushing for the strengthening of health systems, often towards a goal of global health equity. The thing is, however much we reduce disease and mortality rates, humanitarian healthcare will always also be about caring for patients who are sick. Even if we manage to dramatically reduce health inequalities and resource limitations within specific contexts, humanitarian healthcare will always involve some individuals who cannot be cured, and therefore will always involve individual healthcare providers who face these patients and feel a responsibility to provide them care.

The political limitations of humanitarian healthcare are widely acknowledged at this historical juncture. Maybe growing recognition of palliative care within humanitarian healthcare marks a new era: one in which alongside the political limitations of humanitarian healthcare, we can acknowledge the limitations of modern medicine. This does not mean stopping work to challenge and change unequal geographies of disease and death in which we operate. It is about acknowledging that even while keeping this goal foremost in mind, the care and options available to patients with palliative needs might be improved. 

We hope you enjoy this edition of Reflections, and welcome your comments, questions, or concerns as always. 

Sincerely,

Elysée Nouvet, PhD
Co-Lead of HumEthNet

IN FOCUS - IBRAHIMA BARRY
Ibrahima Barry is born in Kindia, Guinea, in 1992. Currently pursuing a Masters in Social Actors and Local Development through Guinea’s new Socio-Anthropological Analysis Laboratory and under the supervision of Moustapha Keïta Diop, he holds a Bachelors of Sociology from the Institut Universitaire des hautes études de Guinée(IUHEG). His father was one of eight members of a public health team assassinated in the Forest Region on Guinea in September 2014, within an atmosphere of public distrust of humanitarian healthcare actors during that outbreak. Ibrahima has published his recollection of this brutal event in a book on Ebola (Ebola, Editions L’Harmattan, 2016 in French) and, in 2017, on the HumEthNet blog.
 
Ibrahima finished his BA at the top of his class in 2016, and joined the Humanitarian Health Ethics Research Group as a trainee on its R2HC-funded “Perceptions of research conducted during the 2014-5 Ebola outbreak” study. Ibrahima is interested in anthropology, to understand cultural diversity and to study what it means to be human in all its forms. Aiming to complete a PhD in this subject and become a professor, he also hopes to collaborate in the medical field, following in the footsteps of his late father: “I am thrilled to be collaborating as a research assistant to the Humanitarian Health Ethics Research Group this year.”
Authors Stefan Dercon and Daniel J Clarke have come together to produce an insightful & introductory guide to how countries can effectively make disasters "dull". Drawing upon lessons from finance, political science, economics, psychology, and the natural sciences, the book draws upon various preparatory measures that have been successfully implemented around the world. Dull Disasters presents a set of lessons and principles to guide future thinking, research, and practice in this area. The World Bank Group has provided Dull Disasters as an Open Access PDF, which can downloaded by clicking the button below (Also available in print).
Get the PDF

Palliative Care in Humanitarian Situations – is it achievable?

Excerpt from the Commentary by Joan Marston: "While we have estimates of the need for palliative care in relatively stable populations, we have no similar assessments in humanitarian situations. We can assume that where populations experiencing humanitarian emergencies remain in their home country, any pre-existing level of need for palliative care would persist or even increase under the additional strains of the emergency (depending on the humanitarian situation). There is a growing realization that it is precisely in these situations where there is a high level of physical and emotional trauma and death that palliative care is needed (6). Whether a humanitarian situation is caused by natural disaster, disease or conflict, those caught up in the disasters may have pre-existing conditions requiring palliative care such as cancer, HIV, cardiac failure or may develop conditions that would benefit from palliative care (i.e. Ebola and traumatic disabilities)"
Read the Full Commentary
Events & Opportunities
UNITE FOR SIGHT GLOBAL HEALTH & INNOVATION CONFERENCE (April 22-23) Registration

WORLD HEALTH SUMMIT (M8 ALLIANCE) (May 8-9) Registration | Program

3rd CONFERENCE OF THE CENTRE FOR GLOBAL BIOETHICS (June 1-2)  Registration | Event Page

ETHICS OF HEALTH SYMPOSIUM (June 8 & 9) Call for Abstracts | Registration | Event Page

NORTH AMERICAN REFUGEE HEALTH CONFERENCE (June 16-18) Registration | Event Page

International Health Conference (June 28 - July 1) Registration | Abstract Submission

CANADIAN CONFERENCE ON GLOBAL HEALTH (Oct 29-31) Event Page

22nd International Congress on Palliative Care (Oct 2-5 2018) Save the Date
Featured Publications
 

Chopper D., Ravinetto R., Schwartz L., Kamaara E., Sheel S., Segelid M. J., Ahmad A., Dawson A., Singh J., Jesani A., Upshur R. (2016) Research Ethics Governance in Times of Ebola. Public Health Ethics, phw03.


Nouvet, Elysée, Elizabeth Chan, and Lisa J. Schwartz. "Looking good but doing harm? Perceptions of short-term medical missions in Nicaragua.Global Public Health (2016): 1-17.

Sheather, J., Jobanputra, K., Schopper, D., Pringle, J., Venis, S., Wong, S., & Vincent-Smith, R. (2016). A Médecins Sans Frontières ethics framework for humanitarian innovation. PLoS Med,13(9), e1002111.
Learn more about  HumEthNet & the Humanitarian Health Ethics Research Group.
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Copyright © 2016, HumEthNet, Humanitarian Health Ethics Research Group. All rights reserved.
Commentary photo credit: CDC/ Amanda Mills

Reflections editors:
Gautham Krishnaraj & Elysée Nouvet

Our email address is:
humethnet@gmail.com

Our mailing address is:
Humanitarian Health Ethics Research Group
McMaster University, 1280 Main St. W., CRL-202
Hamilton, On, Canada L8S 4K1

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