Case Study 3: Ethical Decision Making and Grassroots Diplomacy

Part 1: Ethical Decision Making

In a certain region in East Africa there is a high HIV/AIDS rate and 35% of children are stunted. Mothers who are HIV positive risk transmitting the virus to their child if they breastfeed and few women are actually tested for the virus.  When weaning children off of breastmilk, mothers use a porridge that is not nutritious and is missing key nutrients. However, the cash crops that could be used to make the mix more nutritious are grown using pesticides. There is a grant to establish a women’s cooperative to create a nutritious mix for infants while improving the womens’ livelihoods.

The ethical issue surrounds the question of how the women’s cooperative can the prevent transmission of HIV from mother to child AND prevent children from eating pesticides and whether or not it is worse to get HIV or ingest pesticides.

This ethical issue has several main stakeholders:

STAKEHOLDERS AND MOTIVATIONS

  • Mothers 
    • Want children to be healthy
    • Don’t want to pass HIV to children
    • Don’t want children to have adverse effects from pesticides
    • Want children to be properly nourished
  • Children
    • They are directly impacted by the breastfeeding/pesticides
    • They need to obtain all required nutrients 
  • The donor
    • Wants its money to be spent properly
    • Wants a good reputation
  • Us
    • Provide nutritious porridge for the children
    • Ensure the cooperation is built right and is sustainable/scalable
    • Invested in seeing the impact through 
  • Women’s Cooperative
    • Wants to provide children with a nutritious porridge to wean children off of breast milk
    • Are skeptical of the impacts of pesticides and of HIV transmission 
    • Wants to attract investors to the cooperative
    • Want to bring in a stable income to support their families
    • Wants good reputation
  • Local cash crop farmers
    • They grow the crops that are being bought for the porridge
    • Financially invested

There are 3 solutions that could be put into action to ensure children are receiving proper nutrients and also empowering women in the cooperative.

POTENTIAL SOLUTIONS

Solution 1: Have the cooperative grow their own produce (pesticide-free) and employ more local women 

Ethical Principle: Duty-Based

  • “Do only that which you would want everyone to do”
  • We would not want our children and communities eating crops sprayed with chemicals

Pros: 

  • Creates jobs for women
  • Not only the cooperative but the community as well can have access to clean and healthy crops
  • Can be fully in control of the crops 
  • Children will get the nutrition that they need

Cons:

  • It may cost more setting up another piece of land
  • Have to educate the women on farming practices
  • Will put some farmers out of business 

Solution 2: Wash the produce when it gets to the cooperative
Ethical Principle: Virtue-based thinking

  • “What is ‘honest’ depends on social traditions, history, etc. the gruel the children receive already has pesticides (the maize and bananas currently used currently in gruel also have pesticides) and the solution would reduce HIV transmission while possibly decreasing pesticides in gruel. 
  • Ethics often times can rely on judgement

Pros:

  • There would be no more/significantly less pesticides in the food
  • They get the nutrients they need
  • Don’t need to breastfeed so avoid HIV transmission 
  • Cheap way to avoid pesticides

Cons: 

  • The water may not be clean
  • Hard to measure if washing it is effective
  • We’d need a water filtration system
  • If the pesticides were treated with wax then they could be trapped beneath the waxy surface

 

Solution 3: Develop a vitamin supplement to add to the gruel so that children can continue eating gruel but also be nourished
Ethical Principle: Consequence-based thinking

  • Although the children would still be eating pesticide-contaminated gruel, they would definitely be getting the nutrients they need through the supplement
  • The benefits outweigh the negatives

Pros:

  • They get the key nutrients that they need
  • Don’t need to breastfeed
  • Better than HIV
  • Using the base recipe – may be cheaper

Cons

  • Probably have to import the supplement which might be expensive
  • Still getting pesticides 
  • Could possibly alter the taste
  • Supplements may not be as nutritious as incorporating healthy foods 
  • The mission is to create opportunities for women and this does not follow that

The malnutrition team in Sierra Leone had experience creating a product for children and have learned the importance of incorporating whole, nutritious foods into childrens’ diet, but have also learned about supplements that can be effective too if they need to be used.


The best solution is to wash the produce with filtered water while creating a porridge that is more nutritious. This will easily get rid of the pesticides in the food and children will be able to eat clean and nutritious food. Although it might be expensive to get a water filter, this will be a one-time upfront cost. There might be slight maintenance costs in the future that the cooperative will have to cover (because the donor money will eventually run out) but this will be much cheaper than starting up a new farm, so it is better than Solution 1. Additionally, it is better than Solution 3 because eating whole foods is much better than using supplements and Solution 3 still gives children pesticides. 

IMPLICATIONS OF THE SOLUTION

  • There would be an added step in the preparation of the porridge
  • We have to educate the women to make sure they properly wash all the fruits and vegetables
  • We have to know how to install a filtration system properly so that the water is clean 
  • They will have to upkeep the costs of maintaining the filtration system, even when the money from the donor runs out
  • Children will not be getting as many pesticides and will be properly nourished 
  • Using locally grown cash crops will also stimulate the local economy and create more revenue streams for farmers.

 

Part 2: Grassroots Diplomacy

 

FACTS OF THE CASE

The cooperative is doing well and there are multiple income earning opportunities for women as they can sell produce from their own small farms for cash. However, the womens’ hard-earned money is taken by their husbands to be gambled. The cooperative is not achieving its dual outcomes of both improving nutritional status AND improving livelihoods. I do not have a direct say in how the cooperative functions and I have 6 months left to make a change before I have to leave. The women are upset that the money that they are earning is not being used to feed children, but also don’t mind that they are not in control of the money because it is culturally normal. However, the children of the women in the cooperative are not getting the nutrition that they need.

 

Ethical issue: How can we achieve the twin social outcomes without disturbing the culture?

 

STAKEHOLDERS AND MOTIVATIONS

  • Us
    • Personal and Professional
      • We want to achieve twin social outcomes
      • We want to financially empower women
      • We want the children of the women in the cooperative to be fed nutritious foods
      • We want cooperative to be successful
  • Women in the cooperative: 
    • Personal
      • Want to use the money they earn to support their families
      • Want their children to be healthy and fed
      • Want to have a good relationship with their husbands
    • Professional
      • Want to make money from the cooperative and their farms
      • Want the cooperative to be successful
  • Children
    • Personal
      • Need the money that their mothers are earning to be used to support them
  • Men
    • Personal
      • Want to be in charge of the money
      • Want to buy alcohol and frivolous things 

POTENTIAL SOLUTIONS

Solution 1: Compensate the women in goods (i.e. food, personal care products) instead of money

  • Pros:
    • Women are able to support their families with goods and foods
    • The products and nutrients are going directly to the children in town rather than just to the cities
    • The children will have more resources
  • Cons:
    • The husbands could be upset that the women aren’t bringing money back with them
    • Hard to always predict exactly what women need
    • The women may be less willing to work such long hours without monetary compensation
    • Might be hard logistically
  • Saves face for 
    • the women because they do not have to directly face their husbands, but are getting the desired outcome of putting the money towards the family
    • the cooperative because they would achieve their joint goals and run a more ethical venture
  • Implications on relationships 
    • Short term
      • Men may be angry at the women for not bringing home money
      • Immediate unhappiness within family units
    • Long term
      • Family will be better off so it may eventually build relationships in the family
  • Implications on venture
    • Short term
      • The children will receive the necessary nutrition 
    • Long term
      • The venture will achieve both of its goals
      • The children will have more resources and become more nourished

 

Solution 2: In addition to still paying the women regular wages, compensate for some of their wages in goods (i.e. food, personal care products) 

 -The goods would be in exchange for the money they would get for selling their produce

  • Pros:
    • Easier to integrate with the families because they are getting both money and resources 
    • The products and nutrients are going directly to the children in town rather than just to the cities
  • Cons:
    • Men can still waste money 
    • Women may want to choose exactly what all their money goes to go
  • Saves Face
    • Saves face for the women because they are still bringing in money and it will keep the peace between them and their husbands
    • Saves face for the cooperative because they are able to accomplish their goals and provide nutrients through the goods 
  • Implications of the relationships
    • Short term
      • Men in the family may be angry 
      • Unrest within the family units
    • Long term
      • Hopefully the families get used to this way of compensation and relationships strengthen
  • Implications of the venture
    • Short term: 
      • The children receive more nutrients and are healthier
    • Long term
      • The venture will be achieving its duel goals
      • The children will get more resources and access to nutritional foods (the porridge)

 

Solution 3: Doing nothing 

  • Pros:
    • Not interfering in culture 
    • Women are not necessarily opposed to men taking money anyway 
    • Not putting women at risk since not taking money away from men 
  • Cons:
    • Men can still waste money 
    • Children do not receive as much food
  • Saves Face for the women and their husbands
    • The women do not have to disturb the family dynamic
    • The husbands are not exposed for their irresponsible behaviors
  • Implications of the relationships
    • Short term
      • There is no tension in relationships between men and women because the status quo is maintained
    • Long term
      • The issue could cause problems down the line as the children aren’t getting important resources like food and clothing.
  • Implications of the venture
    • Short term
      • Venture still not achieving dual goals 
    • Long term
      • The power dynamic within the family still probably would not be fixed and tensions could run high

 

Other solutions could also include vouchers for food instead of money, setting up a daycare at the cooperative to ensure that children are receiving food, resources, , get shares (build up equity which you can liquidate for a lump sum).

The best solution is to compensate the women with a monetary salary but also include goods as some of their wages. This would ensure that the women’s earnings are being put, at least in part, towards their children and household.  This is a good middle ground between only compensating the women in only goods, which may impact the relationships between them, and paying them a normal salary which leads to the men spending all of their money, impacting the lives of the children. In addition, paying the women with only goods could cause their husbands to pressure them to get different jobs with normal compensation. 

IMPLICATIONS OF THE SOLUTION

  • Women will be able to provide food and clothing for their children 
  • The women “save face” by appeasing the men by allowing some of their income to go toward their habits 
  • This could be the start of a gradual push towards the women taking greater ownership in their fiances
  • Providing goods to the women as well will stimulate the local food and clothing markets

Week 2: Case Study CINQ

In this week’s case study, Jack is an American working at a youth center in Kenya for 5 months. During a gift-giving ceremony, the center had 4 fewer gifts than children so they gave the left out kids black hats in a non-ceremonious manner. Jack noticed that the children were upset, so he brought it up to the staff at the center. He didn’t want the kids to blame the mishap on him since he was the one giving the gifts, straining his relationship with key players during his stay at the center, the children. The staff told Jack that if he had a problem, he should deal with it himself and they don’t want him becoming a “children’s rights activist”. The issue here arises because Jack wants to “save face” with the kids, but also his coworkers, with whom he wants to maintain a strong professional relationship. Jack needs to find a solution in which he can make the four kids happy again without offending or undermining the staff of the youth center by seeming as though he is stirring trouble.

The three main stakeholders in this situation are Jack, the youth center staff, and the children. Jack is a stakeholder because his reputation is on the line with both the children and the center. Personally, he wants to fulfill a moral obligation to treat all of the kids fairly and make them feel like equals. The inequality in gift receiving could also cause problems between kids which he could feel responsible for. Professionally, he wants to accomplish his goals of the trip during his 5 months there, which may not be possible without a good relationship with both the children and staff. The youth center is a stakeholder because they are the primary ones responsible for the wellbeing of the children. Personally, the staff likely have the best interests of them at heart and want them to be happy. Professionally, however, they have a job to get done with limited resources and likely wanted to give the children gifts and move on. Jack’s questioning of the gift giving likely questioned their process and they may want to ensure that Jack does not cause a stir over what they may deem to be a small issue again, causing them more work and trouble. The kids who did not receive normal gifts are stakeholders as well because they may have felt left out by receiving a black hat instead of a nicer gift. They have personal motivation because socially they could have been teased or excluded for their gifts or generally made to feel inferior because of the lack of ceremony in their gift as well. The kids also blamed Jack for this because he handed out the gives so they may feel some resentment towards him as well.

  1. Administer the same gifts to the 4 children who did not get them originally

    1. Make sure this is in a public place to ensure that they feel respected and the “ceremony” aspect is achieved
    2. Pros
      1. Equality is achieved
      2. No difference in what the kids are getting or how they are getting it
    3. Cons
      1. The other kids might get mad that these 4 kids get the same gifts they got + a hat and another ceremony
      2. The youth center workers might get mad for working without them ruining necessary relations
    4. Saves face for the children, Jack and the youth center
    5. Implications on relationships
      1. The relationships between the kids would be salvaged because they would see each other as equals (short term and long term)
      2. The relationship between the kids and Jack would be fixed because the kids would believe Jack cares about them all (short term and long term)
      3. The relationship between the youth center and Jack could be fixed too because Jack would have taken the advice the youth center said and fixed the issue on his own (short term and long term)
    6. Implications on the venture
      1. Long term – Jack could show the initially hurt kids that he went out of his way to make an effort which, in the short term, would get him in better standing with those specific kids and also, long term, strengthen his relationship with all of them, allowing him to be more effective in his work
      2. Short term, his colleagues may be surprised that he took charge which they could potentially view poorly. However, it could show that Jack takes initiative and could be positive for his relationships with his colleagues in the long term.
  2. Give the kids some type of a leadership role in some event in order to make them feel as though they are on the same social level.
    1. Pros
      1. The kids feel equal
      2. Might seem to the staff as though Jack did not see a problem with their opinion and preserve the relationship
    2. Cons
      1. The other kids may feel slighted for not receiving a leadership role
      2. Maybe the kids actually just care about the gifts and will still be upset
    3. Saves face for the kids, Jack, and the youth center
    4. Implications on relationships
      1. Hopefully the relationship between Jack and the children would be fixed because they would know Jack cares about them. However, the children who do not get a leadership role may feel to be second tier.
      2. The relationship between the youth center and Jack may be fixed because Jack solved the solution but it also may be worsened if they feel Jack went behind their backs.
    5. Implications on the venture
      1. Long term– May be extremely helpful to figure out this situation in the beginning so that it does not spiral into something bigger affecting the actual venturelater on 
      2. Short term- There may be some upset between the youth center and Jack because the youth center did not think that this was an issue to begin with.
  3. Work in collaboration with the youth center workers to educate them about the problem in the situation and then plan something nice (but can be small) for the 4 children.
    1. Pros
      1. Not backdooring the youth workers, they will appreciate Jack prioritizing working with them
      2. Teaches the youth workers to better understand and deal with situations like these in the future
      3. The 4 children are receiving something special, and could improve their relationships with both Jack and the workers
    2. Cons
      1. Other kids may be mad bc the 4 kids are getting extra events for them
      2. The youth center staff may tell Jack to “fuck off”
    3. Saves face for Jack, the youth center workers (even though they might not care about that) as well as kind of patching up the relationship with the children
    4. Implications
      1. Short Term
        1. Makes 4 kids feel important/at the same level as the other children, could help them integrate themselves back into the rest of the group
        2. Kids will appreciate Jack doing something for them
        3. Rest of the kids may be mad the 4 kids are getting another event
      2. Long Term
        1. All kids may respect Jack & workers, make the 5 months easier
        2. Workers may appreciate you trying to work with them on that situation, helps your time with them
        3. The health workers may treat the kids better and have better relationships

The best solution to the issue is for Jack to wear a black hat every day for a few weeks or months after the ceremony. This would show the kids that the gift they received is special and “cool” because Jack is wearing it too, saving face to the kids. In the short term, it will likely mend Jack’s relationship with the left out kids because they won’t feel inferior. In the long term though, Jack will need to continue to work to maintain his relationship with them as similar situations with staff members could arise in the future since Jack didn’t really push for any change or inclusion of the kids after being brushed off by the staff. In the short term, his relationship with the staff could be a little strained because it might be bold of him to start wearing the hat and they may view it in a negative way. He did avoid confrontation though, maintaining a professional relationship with the staff and saving face. In the long term, after a few weeks, it probably will have little to no impact on their relationship and the staff may approve of his diplomatic way of solving the problem.

An advantage solution is that it is subtle, and non-confrontational. Jack caused a little stir by bringing up his concerns to the staff before, so this solution shows that Jack can take matters into his own hands and solve the problem. It also seemed that culturally, they may have not liked Jack coming in as a foreigner trying to create new problems so this would respectfully and subtly push for change without stepping on any toes. It would also likely improve his relationship with the kids because it would demonstrate his effort to make them feel included and make them happier with their gifts in general. A disadvantage to this, however, is that this relies on the kids seeing Jack in a way that him wearing the hat would make them want to as well. From our experiences in Sierra Leone though, we found that kids were eager to follow and look up to us which would probably work in Jack’s favor. In addition, this method, although non-confrontational, could be viewed as a little passive aggressive by staff members as Jack would be making a statement by wearing the hat. However, Jack would be taking matters into his own hands which the staff suggested and he wouldn’t cause any more work for them either.

Jack should start wearing the hat the next day after the ceremony, and should wear it every day after that. By wearing it all the time, he makes a stronger statement and it is more noticeable to the kids. If questioned about why he wears it by staff he should explain that he likes the hat but also wanted to set an example for the left out kids. This could also show the staff that there are small solutions to make everyone feel included and keep the peace in relationships.

Case Study One: Ethics

The case study today surrounded the theme of ethics when conducting research, especially in an international setting. A team of 10 researchers travel to test the water in Lesotho, a community in South Africa for a pathogen that could harm the people there. However, in order to successfully survey, the team will need significant on the ground support from community members, who they assume will help them with the project out of generosity.

The ethical dilemma in this situation is whether or not it is ethically correct to enter into a village planning to not need to pay for the time and knowledge of the community members. Without absolute guarantee that people will be willing to help readily, it is unreasonable to travel so far without another plan since the two weeks of surveying time is on the shorter side as well.

In class we talked about the terms respect, beneficence, and fairness surrounding research. It is important to consider what others can contribute to a project and to ensure that everyone’s efforts are compensated for justly. It is unrealistic to not pay for costs such as transportation and guidance when traveling to sampling sites.

The stakeholders in the project include the organization that supports the researchers such as a university or funders who seek to gain a better reputation for themselves in research, to advance science for the better of society, and to gain a return on their investment. The research team also holds a stake in the project as they want to spread awareness of the issue they are working to solve and they likely want to publish their work in journals and papers. Community members want cleaner water for better health in general, for a stronger community, and for a sense of security and safety. Another stakeholder is the large scale government which has political, capital, and economic opportunities from this international research and has the well-being of its constituents in mind as well.

The ethical question in this scenario is whether it is just to not compensate community members for their guidance on where to survey. The research team made the assumption that people would want to get involved because their work could better lives. However, there are other alternatives that could be more reliable for conducting the study as well as more fair to all parties involved.

An alternative is to partner with a NGO or established organization in Lesotho instead of arriving to the area without support. An advantage of establishing these connections would be that the NGO could decide, using their experience, who the team should work with and how they could collect samples most effectively. In addition, the organization makes the work of the team more credible to people on the ground, similarly to how GSIF worked with World Hope International in order to arrange transportation and meetings in Sierra Leone. This would be a better solution than, for example, hiring specific community members to help with sampling locations or educating community members and hoping they will let researchers sample their water because the infrastructure behind the NGO would likely help the researchers collect more accurate and precise data because of their credibility and pool of resources. If they used specific community members, there could be mistranslation or interpretation when going out to collect data and a bigger organization could provide a connection to a reliable translator.

Some potential issues with an NGO are that they can be bureaucratic and hard to work with at times. A solution to some of the difficulties that may come with working with an organization would be to be very specific and clear with the colleagues at the organization about the team’s objectives before arriving to Lesotho and what non-negotiably needs to get done on the ground. From my team’s experience with our translators and working in a country where things can often be slow to get done, we found that letting our translators and partners know that we absolutely needed to achieve a minimum number of surveys each day created some accountability and ensured that everyone knew our expectations. Being direct, clear, and helped to resolve almost all of the issues that we personally faced while working with an NGO in Salone. Since the researches are collecting samples, they also will have a “quota”, which will give them enough information to process the data properly, and will need to be upfront and hold the organization accountable in order to get work done, however, the benefits and resources of a partnership outweigh the challenges.

Partnering with an NGO or other organization has the most benefits and is likely to result in the best outcome of the study. It will provide added credibility and safety while on the ground while also giving them team resources and invaluable knowledge. The NGO may be paid for the partnership or have an another agreement with the team in exchange for their help, stimulating the local economy by paying for accommodation, transportation, food, etc. in country. This decision is also the most ethical because it involves community members and gives them a fair exchange for their time and efforts. The solution would also likely ease stress and tension within the group because the small details pertaining to things like transportation and translation would be handled by those who better understand the culture and environment and the team can focus on collecting the best data. In addition, socially, the partnership would help to avoid the perception of white saviorism by working in collaboration with the community.

Fall Week 1: Assessing the Socioeconomic Factors Underlying Ebola Infection

Lessons Learned:

  1. The first lesson I learned was about acceptance and understanding. There were many times that I felt out of place while in Sierra Leone, however, I felt surprisingly welcomed by almost all of our respondents. It seemed like community members generally understood that we came to Salone with positive intentions and through our connection with World Hope, trusted our credibility. They always made an effort to pull up a chair for us during an interview or told us that they were thankful for our efforts. This made me want to approach all new situations and people with an open mind and a good attitude.
  2.  I learned another important lesson about differences in lifestyle. I realized quickly during our trip that things work differently in Sierra Leone, and that their concept of time, work, family, and relaxation all differed greatly from mine. It was a little bit of a culture shock at first to experience so many new people with different boundaries that tested my comfort zone and adaptability in a unique setting.
  3. The third most important lesson that I learned was that people really tend to get used to and accept their version of “normal”, whatever that may be. I realized that a lot of the material things I missed while in Sierra Leone and “couldn’t really imagine living without”, most people there had never experienced. It made me realize that we really are products of our environment and can learn to adapt and live contently for the most part wherever we are placed.

Professional Development

  1. On the ground, I really learned how to step up and be vocal in my group in a new setting. I got more comfortable with my teammates on the trip which I think helped me do this, but also I think will help me to take a stronger leadership role in new groups in future endeavors as well.
  2. Working in a smaller team with only three group members, I really learned how to better understand my teammates’ strengths and weaknesses. This helped to assign tasks and get work done most efficiently with our limited resources. It also helped to understand the different personalities and roles within the group in order to better manage and use them.
  3. Finally, professionally I gained a better of understanding of how to participate in a professional meeting to form potential partnerships. We met with Statistics Sierra Leone and the Ministry of Health and our professors gave our project “pitch”. It was great to gain firsthand experience that I can use later in my professional career.

Personal Growth

  1. On a personal level, I learned a lot about myself on this trip as well as well as about my project. I discovered that sometimes it can be hard for me to accept change but I really like routine and can fall into “homeostasis” wherever I am. At first, I was really overwhelmed and homesick in Sierra Leone, however after one of our first days surveying where we got used to the timing and went really fast, I realized I liked the work we were doing and started getting used to the new environment.
  2. I learned to be a lot more independent this summer as well. We got some freedom in SL and there were times I really missed my family and friends, but I got used to a routine on the ground and was accustomed to it by the end. I think it was a good life experience to be able to survive on my own and take care of myself to some extent.
  3. I also learned a lot about gratitude and appreciation. I realized that it’s really the people in life that make it worth living. I saw so many moments of genuine and strong happiness experienced by people who, by the standards of the developed world, have practically nothing. It really emphasized for me what I really find of value in my life.