Using the case presented below, discuss and answer the questions at…Using the case presented below, discuss and answer the questions at the end of the case.Thank you. Implementation of Global Public Health Programs and Threats to Personal Safety BackgroundMany global public health agencies and organizations from high-income countries conduct programs in locations where the personal safety of workers and volunteers cannot be guaranteed. Staff and volunteers of nonprofit organizations and government aid agencies face a variety of threats. In 2012, aid workers were harmed in 100 discrete incidents involving 187 aid workers, 43 of whom were international aid workers (Humanitarian Outcomes 2013). These incidents included kidnappings, murder, and traumatic injury. The profile of deaths amongst aid workers and volunteers who serve in conflict zones significantly differs (Sheik et al. 2000). Contrary to popular belief, tropical infectious diseases rarely cause death in aid workers (Hargarten et al. 1991). A systematic review of unintentional injury in international travelers found that only 2 % of traveler deaths were secondary to infectious disease, whereas injury represented a major cause of death. Motor vehicle accidents were the leading cause of fatal injury to travelers (McInnes et al. 2002). According to the World Health Organization’s Global Status Report on Road Safety, more than 90 % of the world’s road fatalities occur in low and middle-income countries. The report further notes that the majority of road fatalities in these countries occur among vulnerable road userspedestrians, cyclists, and riders of motorized two-wheeled vehicles (World Health Organization 2009). Little research has been conducted on health and safety policies and procedures for international nongovernmental organizations (O’Sullivan 2010). One exception is the U.S. Peace Corps. A study done of fatalities in the Peace Corps between 1962 and 1983 revealed that unintentional injuries caused 70 % of deaths, with motor vehicle crashes the top cause of fatality, and motorcycle collisions responsible for 33 % of the deaths related to motor vehicles (Hargarten and Baker 1985). After release of the report, the Peace Corps banned motorcycle use in many countries in which their volunteers serve and mandated a motorcycle safety course and helmet usage in countries where the use of motorcycles was still permitted. A follow-up study of fatalities through 2003 concluded that injury prevention measures instituted as a result of the prior study had significantly decreased the risks faced by Peace Corps volunteers (PCVs), although, once again, motor vehicle collisions topped the list of causes of death. In the 20 years prior to institution of the helmet rules, 22 of 105,539 PCVs died in motorcycle collisions. In the following 20 years, another 71,198 PCVs participated in the program, but only 2 died in motorcycle collisions (Nurthen and Jung 2008). These studies provide evidence that preventive measures can save the lives of aid workers and volunteers even in low-income countries with poor transportation safety and infrastructure. Case DescriptionIn rural sub-Saharan Africa, you oversee the operations of a nonprofit organization that provides public health programs to remote communities. Needs assessments have shown that these areas have the greatest poverty, as well as lack of access to safe water sources and health care facilities. But the roads leading to the villages, which become little more than footpaths at some points, pose challenges to travelers that include erosion, flooding, and large potholes as well as the physical obstacles of livestock, children, other pedestrians, and bicyclists. The optimal strategy for reaching the villages is to use a motorcycle. While working on a grant proposal one afternoon at the office, you receive a cell phone call from Moses Izimba, a program manager for your nonprofit. Earlier in the day, several staff and volunteers had taken “boda-bodas” (motorcycle taxis) to a remote village to offer a sanitation outreach program. Despite passenger warnings to drive slowly due to the road conditions, the taxi drivers were speeding when a car that pulled suddenly into their path caused a collision. One victim is a staff member who had left without his motorcycle helmet as the group rushed to depart. With a quivering voice, Moses reports that this staff member did not survive the collision. Another victim is a volunteer who had purchased a helmet at a local shop, which likely was not safety certified by the Ministry of Transportation. This helmet now lies shattered near the accident scene, while the volunteer, still bleeding from a large scalp laceration, is alive but comatose. The only four-wheeled vehicle on hand for transportation is the car involved in the accident, which now has a broken windshield, but the driver has offered to transport the victims to a health care facility. You urge Moses to get the injured staff member to the district hospital quickly. As you end the phone call, shocked by the tragic news, several thoughts come immediately to mind. Could this accident have been prevented? How can the organization best deal with a serious trauma to one of its staff members during fieldwork? You convene a committee to discuss the ramifications of the accident. The committee’s pragmatic charge will be to examine staff insurance benefits, including evacuation coverage and repatriation of remains; organizational policy improvements to minimize the likelihood of riding without a helmet; appropriate standards for safety equipment; an alert system to warn of hazardous road or transportation conditions; and innovative strategies to optimize transportation safety under local conditions. But the committee has also been asked to consider three areas of ethical challenge the situation has presented. Discussion Questions1. Under what circumstances should you limit humanitarian aid based on the assessment of risk to workers or volunteers? What is an acceptable level of risk, and what harms to the organization, its staff, and the communities being servedcould potentially result from limiting or ending aid? 2. What are the obligations of nonprofits or humanitarian agencies to protect their workers from safety threats, given that they frequently operate in dangerous environments where infrastructure is lacking? Do the obligations of nonprofits differ from the private sector when it comes to protecting the health and safety of their staff, and if so, how? 3. How can a nonprofit or humanitarian agency best deal with a tragic accident resulting in the death or serious injury of a volunteer or worker? Consider the ethical pros and cons of the potential approaches that could be taken to prepare for risks to aid worker health and safety and address such a situation as it unfolds, including risk communication. Arts & HumanitiesCommunicationsPublic Relations ENS 106
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