ethics

Critical Thinking: Case Study – Cholera Outbreak (90 points)

In this assignment you will examine the international legal entities dealing with global health law incidents. Read “Cholera Outbreak in Zimbabwe” (5.2) on pages 68-69 in An Introduction to Global Health Ethics. In this case study you explore options available for dealing with this health crisis. Write a four- to five-page paper evaluating the steps Zimbabwe should take in dealing with this situation and provide your recommendation on how to remedy a future situation.

Your report should address the following substantive requirements:

• Examine the purpose of laws.

• Describe and assess each agency that would be involved in the situation. Include pros and cons for international involvement in state affairs.

• Develop a law that would prevent such a breakdown from occurring in the future and use reasoning to illustrate why such a law would not be considered intrusive.

Your well-written report should meet the following requirements:

• Be four to five pages in length, not including the cover or reference pages.

• Formatted according to Saudi Electronic University and APA writing guidelines.

• Provide support for your statements with in-text citations from a minimum of four scholarly articles. Two of these sources may be from the class readings, textbook, or lectures, but two must be external.  

• Utilize the following headings to organize the content in your work:

  • Introduction

  • Description and Assessment

  • Recommendation

  • Conclusion

Cholera Outbreak

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ID -----

HCM515 – Health Ethics and Law

Saudi Electronic University

Dr. ----

-------, 2017

Cholera Outbreak

Cholera is acute infectious disease caused by ingesting of contaminated food or water (World Health Organization, 2017). It causes severe dehydration and leads to death. Primary causes are insufficient safe water and lack of appropriate sanitation. It occurs in areas where the environmental infrastructure is destroyed and damaged such as in Zimbabwe. Many cholera outbreaks were reported in Zimbabwe in past years from 1992 till 2008 (Mason, 2009). The most tragic one was in 2008 where more than 600 cases were reported and death rates were 104 in one city (Mason, 2009). In few months, cholera cases dramatically increased in all provinces of Zimbabwe (Mason, 2009). By the first week of December 2008, cholera was reported endemic as it reached other neighboring counties and emergency was declared (Fisher, 2009).

Healthcare system breakdown in Zimbabwe was due to the economic crisis. Financing problems and infrastructure failure were not solved earlier. In addition to, shortage of medical equipment, lack of health workforce, many hospitals are closed and limited health services have contributed in this tragedy (Mason, 2009). The deteriorated civil and political rights have failed to protect the people (Howard-Hassmann, 2010). Human rights were violated in which there was a severe food crisis from 2000 to 2009 that led to many deaths (Howard-Hassmann, 2010). Clearly, there are many aspects to consider in this matter which include governmental, political, financial and public health aspects. This script will provide comprehensive analysis of decision making in Zimbabwe politically as well as clinically and its influence on ethical practices among public health demonstrators.

Political and Social Aspects in Zimbabwe

Democracy in Zimbabwe was known to be role of whites. White contribution in politics was honored and respected while black contribution was criminalized (Jonga, 2012). After Independence Day in 18th April 1980, Zimbabwe became more like a dictatorship government (Jonga, 2012). Mugabe was playing a monopolizing power in Zimbabwe (Compagnon, 2011). When there was a threat to his power or opposing opinions to his politics, violence was the solution. The irresponsible politics have led Zimbabwe to crisis (Compagnon, 2011). Mugabe’s work was to rule with power and to accumulate all the wealth to his personal interest at expense of the population (Compagnon, 2011). His mind was not into the social and economic states of Zimbabwe, but only into ruling Zimbabwe with and merciless power (Compagnon, 2011).

Multi ethnic states of Zimbabwe made the political management complicated. Financial failure and organizational ineffectiveness were common because of central government’s interference. In August 1980, Mugabe gave a speech at the United Nation (UN) emphasizing on five values of Zimbabwe’s foreign policy, which are: equity, democracy, non-racialism, right of independence and peace (Patel, 1987). These values were only spoken words. Racism was common in which there were multi ethnic groups in Zimbabwe favoring black Africans and colonizing white Africans (Chan & Primorac, 2013). There was no democracy but only tragic and horrible bureaucracy (Chan & Primorac, 2013). The power of colonizing whites was dominant until he was called “the black Hitler” (Harris, 2015).

Political crimes were allowed and practiced until the year 2000 (Jonga, 2012). Zimbabweans became the victims of these political crimes. Corruption and fraud were common in which the police can change reports and destroy evidences (Compagnon, 2011). Politicians who are committing violence and crimes seem to be protected and above the law (Jonga, 2012). Corruption, fraud, crimes and threats in Zimbabwe have made the population live in fear. The political power was just to control the wealth regardless of populations’ needs and to rule with power and threats. Politics in Zimbabwe government were unstable and politicians are above the law. Human rights were violated frequently (Howard-Hassmann, 2010). Social life in Zimbabwe is tough since there is no law to protect the people and their rights.

The response to cholera outbreaks was the responsibility to be taken by Zimbabwean healthcare system and government. It is well known that the government is responsible to deal with these situations internally and try their best to control it. Cholera outbreaks rapidly spread to neighboring countries for example Mozambique, South Africa and Botswana (Said et al,2011). Cholera spread also to Angola, Malawi, Namibia, Swaziland and Zambia (Said et al, 2011). The government and national health departments didn’t take any actions to control this rapid spread of cholera. Cholera crisis in Zimbabwe was out of control that led WHO and related international agencies to help and provide support.

Description of Health and Financial Aspects in Zimbabwe

Government’s role in the health sector of Zimbabwe is to promote health, provide access to healthcare services, provide maintainable funding for health settings, prevent and control the spread of infectious diseases (Tizora, 2009). All these objectives were not met and Zimbabwean government has failed to achieve them. There was insufficient and unequal access to healthcare services, poor quality of healthcare services, no funding to healthcare sectors and the wide spread of cholera (Tizora, 2009). In 2008, cholera has killed 2024 people and infection rates were at least 40,0005 (Tizora, 2009). The lack of safe water and sanitation have led to the spread of cholera in all provinces of Zimbabwe (Tizora, 2009). Major hospitals were closed and other hospitals had been functioning without running water, no functioning toilets, no soap, no medications and no enough food for patients or healthcare workers (Tizora, 2009). Also, medical and nursing schools were closed. Exams in medical schools were cancelled because of lack of papers and ink to print the exam papers (Tizora, 2009). There was no fund to help heath sectors to function well. There was no electricity in main mortuary in which deceased are rotting (Tizora, 2009).

There were some free medications that patient but they were sold to them with unexcepted high prices. Therefore, most of Zimbabweans were not getting proper treatment and medications that they can afford to pay (Tizora, 2009). The healthcare system in Zimbabwe have failed to meet the needs of population due to the economic crisis. In addition to, shortage of medications, medical equipment and health workforce that led to the bad health status in the country (Mason, 2009). Severe dehydration caused by cholera can often be prevented using oral rehydration salts (ORS) which was not available in Zimbabwe (Mason, 2009). Many physicians left their job because of the low salaries, lack of medical tools and medications (Mason, 2009). There was no clear and complete assessment on the progress of cholera in Zimbabwe due to staffing and economic limitations which resulted in the inability to have a countrywide health profile (WHO, 2008).

The terrible levels of healthcare services in Zimbabwe could be controlled if there was a strong healthcare system that applies heath laws and human rights effectively. In addition to, the presence of a strong government who attends to the populations’ needs and care about their rights. Unfortunately, the healthcare laws and ethics were absent in healthcare system of Zimbabwe. Besides, Mugabe was accumulating all the wealth to his personal interest at expense of the population who are suffering to receive their basic rights and meet their basic needs (Compagnon, 2011).

Agencies involved in Zimbabwe’s health situation. In December 2008, cholera was declared as it reached neighboring countries. Zimbabwe needed assistance and received help from external agencies such as World Health Organization (WHO), Medicines Sans Frontieres (MSF), The United Nations International Children's Fund (UNICEF), the Centers for Disease Control and Prevention (CDC), Oxfam, Plan International and the Red Cross (Fisher, 2009). The WHO, Global Outbreak and Alert Response Network (GOARN) and its allied organizations have developed medical and healthcare services that include infection control specialists, public health professionals, epidemiologists, communications and social transport experts (Fisher, 2009). Also, they procured emergency kits and medical aids across Zimbabwe.

WHO’s objective is to promote health and build a healthy future for people all over the world. WHO have created Cholera Response Operational Plan to control cholera outbreak in Zimbabwe (WHO, 2008). It is an emergency measure for deteriorating Zimbabwean healthcare system which is consisted of many services to support Ministry of Health (WHO, 2008). This plan aimed to reduce the spread of cholera by ensuring effective isolation, mobilization, safe water and sanitation. In addition to, reduce mortality rates by ensuring efficient access to care and early detection of disease. All of these services were provided in cooperation with ministry of health in Zimbabwe and other agencies.

MSF is an international medical organization that provide emergency relief to needy countries with weak healthcare system (MSF, 2008). It has opened many Cholera Treatment Centers throughout Zimbabwe. MSF treated more than 6,000 people and was providing healthcare services in places with no electricity (MSF,2008). These services have dropped mortality rates significantly and improve the health status in Zimbabwe. UNICEF is another agency that was involved to defend rights of children in Zimbabwe. Its goal to provide a better life to children and their families. UNICEF has contributed $17 million to health emergency programs in Zimbabwe. It sent airlift of emergency supplies which included drugs, health kits and intravenous fluids to Zimbabwe (UNICEF, 2008). Also, more than half a million of safe water was sent to Zimbabwe (UNICEF, 2008).

CDC is a healthcare agency that aims to prevent and control infectious diseases. CDC had a great role in controlling spread of cholera and strengthening Zimbabwean healthcare system. It has built safe water systems across Zimbabwe. Moreover, it provided public education and required information about mobilization. Oxfam is an international agency aims to a world with no poverty. It responded to cholera outbreak with effective healthcare strategies. It has contributed to treat cholera cases by early detection, immediate treatment and effective prevention of cholera. It provided sanitation, safe water and food to thousands of people in all provinces of Zimbabwe. In addition to, proper education about early signs and symptoms of cholera was given.

Another well recognized humanitarian organization that contributed to save the lives of Zimbabweans is Plan International. It protects children rights and advocates equity to girls. Many healthcare programs were established in Zimbabwe to control spread of cholera and educate the people about it. Plan International offered education, training, safe water and sanitation that helped Zimbabwe to recover from cholera crisis (Plan International, 2016). Another independent humanitarian agency that helped to treat cholera is Red Cross. It aims to prevent human suffering in emergencies. It has produced sanitation and safe water to Zimbabweans in all provinces starting from the main affected ones. Treatment facilities were established and health awareness programs were given (International Federation of Red Cross, 2009).

Advantages and disadvantages of international involvement in cholera outbreak. The main advantage of international involvement in Zimbabwe was control the spread of cholera. Cooperation of international agencies in Zimbabwe have helped healthcare system to overcome the tragic crisis of cholera gradually. When cholera became endemic, there was a need for immediate response by experts and health professionals to set proper plan of actions toward preventing and controlling spread of cholera. These experts and health professionals from all international agencies have made the change. Zimbabwean’s healthcare system was strengthening by the support of all international organizations. In addition to, cholera awareness and education that led the people to take actions and speak up. Another advantage was paying attention to human and children rights which include right to healthcare access, right to be safe, right of justice and peace.

Thinking about legal aspect of international agencies’ involvement to solve cholera crisis in Zimbabwe is complex (Said et al, 2011). The advantages overcame disadvantages of international involvement in Zimbabwe. In this matter the inability of population to trust their own healthcare system is the possible disadvantage. They waited long time to receive their basic needs, help and support from their country while international organizations were offering help. The image of Zimbabwean’s healthcare system is damaged. It can gain the public trust if they receive government’s support and encouragement.

Cholera Outbreak Law

Cholera outbreak law covers health, financial, governmental and social services. Health services must be supported by strong health policies that are approved by ministry of health and healthcare system. Healthcare policies should address control of disease, prevention, measurement and treatment. As well, standardized case reporting, guidance to treatment priorities and prevention awareness (WHO, 2008). Also, ensuring access to safe water and sanitation. In addition to, reduce mortality rates by standardized case management, treatment plans and prevention tools. More important is cholera prevention campaigns and proper mobilization (WHO, 2008). Availability of ORS treatment in each healthcare setting is needed. Besides, assigning emergency teams in healthcare settings can help to control the spread of cholera (Said et al, 2011). Implementation of international health regulation can create a consistent work flow that would assist the healthcare system in emergencies (Said et al, 2011). Strong healthcare system, professional healthcare workers, essential drugs and more clinics in urban and rural areas can help in cholera outbreak.

Financial support is needed to improve quality of healthcare services. Realistic pays and better work environment can retain healthcare workers (Mason, 2009). Government support of healthcare system financially is needed. Improvement of healthcare services depends on having enough healthcare funding. Providing basic public needs such as water and food is essential (Mason, 2009). Economic support of these basic needs is the government’s responsibility and obligation to do. Government should pay attention to the population’s needs. Safe water and sanitation are basic requirement that should be provided to prevent cholera. Government’s awareness of human rights and needs are highly important. Applying health ethics and law in healthcare sectors can improve the standards of healthcare delivery and strengthen the healthcare system.

Recommendations

A strong healthcare system should be ready to face the emergence of infectious diseases. Plan of prevention and disease control should be established. Clear polices and guidelines about treatment plans should be followed. Ongoing health education and awareness about infectious diseases are highly needed in outpatient and inpatient settings. Vaccination and proper documentation of disease progress is important to keep constant healthcare profiles. Health ethics and law are important to be practiced in each healthcare setting. Human rights should be protected. Zimbabwe and other countries should advocate for patients’ rights. Governmental support to healthcare system is necessary in order to provide healthcare services to the population. It is the time to take an action and recognize the need of disease prevention in its early stage (Mason, 2009). Cholera crisis is just one example of may infectious diseases that can emerge any time. Effective collaboration between Zimbabwe and international agencies is crucial for observation and action plans (Mason, 2009). Even though, there are some political and financial issues, improvements and better changes are approaching.

Conclusion

Many cholera outbreaks were reported in Zimbabwe in past years from 1992 till 2008 (Mason, 2009). Comprehensive analysis of decision making in Zimbabwe was described in details. The irresponsible politics have led Zimbabwe to crisis (Compagnon, 2011). Healthcare system breakdown in Zimbabwe was due to the economic crisis. Financing problems and infrastructure failure were not solved earlier. Mugabe was ruling with power and he was accumulating all the wealth to his personal interest at expense of the population who need safe water and food (Compagnon, 2011). There was insufficient and unequal access to healthcare services, poor quality of healthcare services, no funding to healthcare sectors (Tizora, 2009). In December 2008, cholera was declared as it reached neighboring countries. Zimbabwe needed assistance and received help from external agencies such as WHO. Effective collaboration of all international agencies with Zimbabwean ministry of health have improved healthcare status and prevented the spread of cholera. Advantages of international agencies’ involvement overcame the disadvantages. Main advantage was controlling spread of cholera and another important advantage was the big attention to human rights and ethics. The best method to control a disease is to prevent it from happening in the beginning. This is what it needs to be done by all healthcare systems all over the world.

References

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CHOLERA OUTBREAK

Running head: CHOLERA OUTBREAK