Conner Calzone, Tiffany Pang

9/24/20

Develop Top 20 FAQs for your project.

 

• Identify the most important questions, building on the referee Qs/

• Why? What? How? How well? How exactly? At steady-state?

• Provide concise and precise responses to each question

 

 

What is the specificity and sensitivity of your device?

1. 1. We have not yet determined the specificity and sensitivity of this device, but we are planning to test increasing the sample size of the test line antibody selection experiment and using purified HbA and HbS, in order to maximize the specificity and sensitivity. 
   2. (follow up answer) However, our test strip utilizes a direct binding lateral flow mechanism (sandwich structure) that is more analytically sensitive with a range of 98.2-99.5% compared to the competitive binding structure, with a sensitivity of 90%.

 

What approvals are needed to market this device and how long would they typically take?

1. 1. Sierra Leone Pharmacy Board: 5-6 months of consistent contact with them, and sending them our concept papers to read.

 

Why don’t you think that something like (our venture) has not been brought to the field before?

1. 1. Other ventures implemented in LMICs were too time consuming and expensive, our venture is a point-of-care and an affordable solution that can deliver results in 15 minutes because of the optimized use of reagents and materials, and the fact that we do not need a constant supply of electricity.

 

What are the core innovation of the device?

1. 1. So, our core innovation of our device is that it’s affordable, simple to use and eliminates a dilution step. It reduces the hook effect which will cause a false negative when the results should be positive due to an oversaturation of the hemoglobin bound to the test strip. 

 

(follow up question): How does the E-junction work? (refer back to slides and show the diagram)

1. 1. Arm 1 is where the blood is distributed, arm 2 and arm 3 is the wash buffer+blue latex beads. As can be seen, the second wash step eliminates the extra hemoglobin, allowing the two checkpoints (sandwich structure): the conjugated bead and spotted antibody with the HbA analyte to produce the diagnosis.

 

Once the device is distributed to the hospital, how will the device be implemented?

1. 1. We will sell a bulk amount of the test strips to clients (hospitals and clinics) and the staff will undergo the requisite training to use it. It will be implemented into the SOP’s of the hospital, where the diagnosing will be directly administered during the labor routine, right when the baby is born.

 

What do you plan to do with the money earned from sales? (giving back to SCD-related services; penicillin therapy)

1. 1. So, from these sales we plan to give them back to SCD-related services such as penicillin therapy. It is recommended for all children younger than 5 with SCD to take prophylactic antibiotics daily. The earliest treatments possible have been proven to show the best benefits to reduce child mortality rates.
2. Are there any SCD devices implemented in Sierra Leone right now?
   1. There have been a couple of tests such as the dried blood spot (DBS) programs, which involve collecting samples from newborns in high-risk areas and sending them to centralized laboratories for isoelectric analysis. These programs were initiated in Angola and Uganda, but were time-consuming and expensive with costs estimated to be around $9 to $15 per test.

 

Are there any SCD devices implemented in Sierra Leone right now?

1. 1. There have been a couple of tests such as the dried blood spot (DBS) programs, which involve collecting samples from newborns in high-risk areas and sending them to centralized laboratories for isoelectric analysis. These programs were initiated in Angola and Uganda, but were time-consuming and expensive with costs estimated to be around $9 to $15 per test.

 

What expenses must we consider to execute our plan?

1. As shown in our income statement, expenses to consider include networking, communications, transportation, advertising, start-up, raw materials, packaging and shipping.

 

What makes a hospital our target?

1. We will implement our product anywhere where they want it. We have identified the top 80 or so hospitals by overlaying GIS data with a population density map, but we will look to target pop-up clinics as well.

 

How do you plan to fund your venture? And who’s going to pay?

1. We will be pursuing grants for our project and donations from those doing work in or want to do work in Sierra Leone. Donors like NGOs, WHI, WHO and UNICEF will pay the extent of our launch costs.

 

How will you validate the usability of your device? 

1. We hope to return to Sierra Leone in Summer 2021 to begin alpha testing to validate the usability and basic accuracy of the device. To conduct this testing, the team has collaborated with Dr. Cheedy Jaja who currently has IRB approval to run a study on two other SCD screening devices, including the Sickle SCAN® device. Through Dr. Jaja, the team aims to carry out 10-20 trials for the device. These tests require no additional recruitment of human subjects beyond Dr. Jaja’s current patients.

 

How are you running future clinical trials?

1. Future clinical trials will emphasize establishing a treatment program at hospitals with health care workers and a follow-up study.

 

What are the metrics of success for your venture?

1. In the short term, within 5 years from launch, we can save over 5,000 lives per year, and reduce the percentage of under-five deaths in Sierra Leone due to Sickle Cell Disease (SCD) from 4.2% to 0.2%. In a steady state, 5-10 years in the future, our team wants our project to be absorbed into the Sierra Leonean Ministry of Health and strictly control the intellectual operations of the project. 

 

What determines our selling price per unit? 

1. A price that makes the device affordable for donors while allowing profits to be invested into SCD treatment methods like penicillin prophylaxis supplements.

 

How do we plan to integrate our devices into the hospitals?

1. Our relationship manager will gauge interest, and if interested, we will have our training expert come to the hospital’s hematology labs for the staff training. This allows us to integrate the device into their SOPs, not be involved directly.

 

1. How will we help patients throughout diagnosing sickle cell?
   1. The success of this project will not only be labeled by the completion of the screening device, but by the strengthened attitudes of communities’ towards the idea of diagnosing SCD. We have recognized the indigenous knowledge, traditional beliefs, and practices, hence our device is being customized to be non-disruptive to the current Sierra Leonean lifestyle. Therefore, the educational curriculum is aimed to provide locals with information on where and how to receive treatment.

 

1. What has been our plan to cope with the COVID-19 situation?
   1. Currently, there is a small team of us working hybridly at our on-campus lab to run tests, while in the meantime, we will also continue writing proposals for grants and competitions. 
   2. Some pieces we have worked on are the NIH Tech accelerator, DEBUT, GHTC IEEE and BMES. We also have plans to submit an article to either Lab on the Chip or the Journal of Hematology.

 

1. Why is this research important? What’s so significant about what you are doing?
   1. Everyone with sickle cell disease should be able to live a fulfilling life, BUT this is definitely not the case around the world right now. As mentioned before, in sub-Saharan Africa about 50-90% of individuals with SCA will die before the age of 5. Therefore, we make it our goal to promote early awareness of the disease’s presence and diagnose all children of 5 years or younger to lower child mortality rates.

 

1. Who is our main target consumer?
   1. For all children under the age of 5 who have sickle cell disease, our SCA diagnostic device is capable of identifying whether you have healthy blood, sickle cell disease or sickle cell trait, so they can take the necessary steps to get treatment.

 

Team Members: Gabriela Alves, Conner Calzone, Rebecca Gjini, Kendall Prime

 

Ethical Decision-Making Methodology 

Step 1: Determine the facts in the situation – obtain all of the unbiased facts possible. Clearly state the ethical issue. 

• • 35% of the children are stunted due to poor nutrition
  • Maize and bananas are the items most commonly made into a gruel and fed to infants beginning at ~2 months of age to 24 months of age
  • Mothers believe that the gruel is good for kids, but science says it lacks some key nutrients
  • High rate of HIV in mothers create risk of child getting HIV during prolonged breastfeeding
    • WHO recommends exclusive breastfeeding until an infant is 6 months of age
    • This increases the risk of the children having the HIV transmitted to them
    • They aren’t able to identify who has HIV and who doesn’t
  • We received a grant to help combat the poor nutrition of children in the area 
    • has sufficient funds for the women’s group to process and market a nutritious, shelf-stable porridge made from a large mix of locally grown produce
  • Nutritious porridge is supposed to wean children off of breast milk at 6 months of age
  • The foods used to make the porridge contain pesticides that can affect the health of infants
  • We need to figure out how to develop the cooperative
  • Women are skeptical because the porridge is something they haven’t used before (new product) 

 

• Ethical issue: We are choosing whether to potentially infect the children with HIV and/or run the risk of being nutritiously deficient with the gruel versus a better nutrition but potentially adverse health side effects from the pesticides that may be in the porridge, which is also a product that is not a cultural norm.  

 

 

Step 2 & 3: Define the Stakeholders and assess their motivations (personal and professional)

• Me (Grant Recipient): 
  • Professional: Wants a successful and sustainable venture to be achieved to boost credibility and improve reputation in the field (good publicity).  Want to earn money from grant
  • Personal: To improve the nutrition of children and the livelihood of households.  
• Donor : 
  • Professional: Gives the donor a good reputation of trying to do something impactful
  • Personal: The donor’s intent is to simultaneously improve the nutritional status of children and improve the livelihoods of rural households
• Women in the Cooperative: 
  • Professional: women’s group to process and market a nutritious, shelf-stable porridge made from a large mix of locally grown produce 
  • Personal: Want to improve the overall quality of life for their communities children and mothers
• Mothers: 
  • Professional: Work and revenue opportunities
  • Personal: Healthy children and to improve their livelihoods
• Infants: 
  • Professional: N.A
  • Personal: The children need to be given the proper nutrients from a young age while limiting their risk of contracting HIV.  Want to also prevent health effects from pesticides. 
• Farmers: 
  • Professional: Can make more money from selling produce to make the porridge 
  • Personal: Helping out the health and livelihood of mothers and children in the local communities

Step 4: Formulate (at least three) alternative solutions – based on information available, using basic ethical core values as guide Approaches 

1. Having the women of the cooperative take part in the porridge production, farming the crops without pesticides.
   1. Pros: 
      1. The women can make money from growing their own vegetables 
      2. The food they feed their children will be more nutritious 
      3. There won’t be any pesticides in the food or there will be significantly less depending on if the women can completely supplant the other cash crops 
      4. Reducing the children’s chances of getting HIV
      5. Less expensive to fund the production of food if the women are providing the crops
      6. The women will not need to breast-feed as much, reducing the chance of HIV being transmitted being transferred to the babies
   2. Cons: 
      1. There might be more inconsistency with crops
      2. The crops are more susceptible to infestation and can go bad
      3. There might not be enough women to farm to help grow crops 
      4. The women may not be as well trained to grow crops as the farmers
   3. Ethical Principle: The women are still feeding their children with nutritious food that will help their children reduce the chances of getting HIV and being affected by the impacts of pesticide consumption.

1. Use market power to pressure farmers to stop using pesticides by advertising certified pesticide free porridge
   1. Pros: 
      1. No more pesticides which are unhealthy for the infants and may cause further growth stunting
      2. This creates long term change around farm culture and pesticide use, making vegetables safer for the entire community
      3. Empowers women in our cooperative by showing the power of cooperative, making more women interested in joining
      4. The women will not need to breast-feed as much, reducing the chance of HIV being transmitted being transferred to the babies
   2. Cons:
      1. The women in the cooperative may not be able to penetrate the established crops market
      2. Farmers may lose sales due to this shift in technique
      3. Farmers might lie about pesticide usage for the sake of selling crops
      4. This is more of a long term movement, and does not satisfy immediate need for pesticide-free vegetables
   3. Ethical Principle: This is duty based thinking because it is our duty to deliver safe nutrition to the children of the mothers in our cooperative.

1. Create a gruel product that has additive nutrient supplements with the key nutrients the current recipe is lacking. We can create this gruel in place of the porridge, but still keep operations running.
2. 1. Pros:
      1. Already a loved product by the community, so there is no need to convince the community to feed it to their kids
      2. Nutritional supplements can be easily added to any food and does not have any flavor
      3. The kids will finally have the nutrients that the original gruel was lacking
      4. Mothers won’t have to buy separate ingredients for the gruel; it will be premade with the added nutrients
      5. The women will not need to breast-feed as much, reducing the chance of HIV being transmitted being transferred to the babies
   2. Cons:
      1. Similarly, the villagers may be skeptical of these premade products
      2. Mothers may want to just keep making gruel on their own instead of buying one that’s premade
      3. Depending on the grant funding, there might be an issue with buying the vitamin supplements if they are expensive (typically inexpensive, though, but since we don’t know the amount of the grant, there’s no way to know for sure)
      4. It may be hard to supplement this wide-spread
   3. Ethical Principle: Once again, we are using duty based thinking to try to provide the infants with nutritious food. In this scenario, we can use the unflavored additives to allow them to stick to their established routine while limiting HIV transmission risk and giving infants the proper nutrients.

Step 5: Seek additional assistance, as appropriate – engineering codes of ethics, previous cases, peers, reliance on personal experience, inner reflection

• Peers: The malnutrition team has discussed adding supplements to some of their recipes to make them more nutrient rich
• Inner reflection: the risk of HIV is in my opinion, worse than the risk of lacking some nutrients
• Engineering Code of Ethics: Our solution needs to follow the given ethical standards for an engineering/entrepreneurial venture 
  • Integrity, Objectivity, Professional Competence, Confidentiality and Professional behavior

Step 6: Select the best course of action – that which satisfies the highest core ethical values. Explain reasoning and justify. Discuss your stance vis-a-vis other approaches discussed in the class.

• In my opinion, alternative 3 is the best option, because it does not go against any cultural norms and delivers the proper nutrients to the children to wean off of breastfeeding.
• The mothers will already know what the product is and have it implemented in their day to day, so there is no introduction period.
• I chose alternative 3 in place of alternative 1 mainly because the women are hesitant to give their children the porridge. They would have to try something new and different to what they are currently using, which is the main reason the mothers are hesitant to switch from gruel to porridge. Also, alternative 3 does not change the taste of the current food product that is being given to the children; it simply adds to the nutritional value. 
• I chose alternative 3 in place of alternative 2 because there is no guarantee that using market power will effectively pressure the farmers to not use the pesticides. Even if it does, the lack of pesticides does not change the fact that it’s a new product that the mothers don’t want to try. Alternative 3 allows us to keep the gruel, but just fortify it. 
• One of the downsides to alternative 3 is that the mothers may be hesitant to purchase premade gruel. They may prefer to make it on their own. A possible solution to this hypothetical situation is to have the women in the cooperative all watch the making of this nutrient-fortified gruel and see for themselves that it’s extremely similar to the current gruel. Once they see it’s essentially the same, they will be inclined to use it on their own children, and tell others about it. Word of mouth is one of the most effective ways to advertise in African countries.
• If alternative 3 is not affordable by the terms of the grant, alternatives 1 or 2, whichever the women of the cooperative prefer, would be great solutions. It would require the families of the community change their nutritional substance from gruel to porridge, but if that is the best option, that change will have to be made.

Step 7: (If applicable) What are the implications of your solution on the venture?

 

•  Economic:
  • Money would be coming in for the cooperative due to the sales of gruel
  • The families may be able to make more money due to the extra time they will have, however, the cost of buying gruel may be higher than the raw materials and making of the gruel
• Social:
  • Less work for the mothers since the gruel is already premade
  • Children will receive the nutrients they need
  • Mothers don’t need to change what they are currently doing, so there is no expected cultural change
• Environmental:
  • The amount of pesticides used in the process can be limited and no additional pesticides will be used, unlike in the scenario where porridge was produced.

 

Part 2: Grassroots Diplomacy 

 

Grassroots Diplomacy Strategy Development Methodology 

Step 1: Determine the facts in the situation – obtain all of the unbiased facts possible 

 

• The women work for about nine hours every day and earn KES 300 (about $3)

 

• They have the opportunity to sell the produce grown on their small farms to the cooperative.
• The women like this arrangement because it saves them a trip (time + money) to the village market to sell their produce. 
• When a woman brings her hard earned money home, she has no choice but to turn it over to her husband, father, or brothers.
• The men do not use this money on their family, and spend it on frivolous things such as alcohol
• Social outcomes of the venture are not being achieved (improve women’s livelihood)
• I am one of seven members on the oversight committee this year and I have 6 months left of my position
• The other six members on the committee are also women and want things to change
• Women are convinced that this is the way things are and don’t see this as an issue that their money is being taken but:
  • They are upset their hard earning money is not used to feed the children

Step 2 & 3: Define the problem and the stakeholders, and their personal and professional motivations – 

• Me (the entrepreneur): 
  • Personal: Want the women to be happy and for their money to spent on their children, not frivolous things
  • Professional: Want to improve the venture so the women aren’t upset
• Women in the cooperative:
  • Personal: Want their husbands to stop spending money on frivolous things, want to spend their money on their children and other necessities
  • Professional: Want to get through each day on the job, they are enjoying their current jobs and want to keep them
• Oversight committee: 
  • Personal: They also want their children to be fed nutritious food and to prevent their husbands from overspending on alcohol or their friends families from being subject to alcoholism 
  • Professional: Some may want to get reelected, some 
• Families
  • Personal: They want their families to improve their overall quality of life by reducing how much the husbands are drinking and spending on alcohol
  • Professional: The women in the families want to continue working in the cooperative

Step 4: Formulate an alternative solution

1. Cooperative acts as an equity bank for the workers so that they can cash out directly, or through other products (family needs) and establish a general store that takes workers credit. This store is open to the public and the cooperative gets another stream of income. The store offers beer for credit but quota is 2 six packs a week. Caveat AND incentive for saving: you can only take out one third of your savings at once (unless reason for emergency)
   1. Pros:
      1. Incentivizes men to not take money because they get more if they wait
      2. Creates a long term savings plan for women’s livelihood
      3. By offering beer for credit but establishing a quota, the men are still satisfied and get their beer, but don’t overspend on it. This way, there is money left to be spent on necessities in the home
   2. Cons:  
      1. Women aren’t receiving all their money at once so it might be harder for them to trust the process of splitting their income up into thirds
      2. Limits spending to one-third of their savings, which can be good or bad.
   3. Saving face: 
      1. Me: This helps give a solution that caters towards the women on the committee while also benefiting women that are working in the cooperative
      2. Women in Cooperative: This helps the women keep some of their money without having their husbands waste it on alcohol.  It allows them to not have to hide the money from the husbands and feel like their money is being protected from not being in a bank.
      3. Oversight Committee: The oversight committee saves face as they are allowing women to access their money while still allowing them to spend within a finite range. 
      4. Families: This benefits families so that they can utilize the money being made by the women in smarter way and improve the overall quality of life for the family
   4. Relationship short-term implications: 
      1. Me:
         1. I am at first nervous to pitch this idea to the committee because I’m worried about how they may react. Once the committee approves, I will tell the other women in the cooperative about the decision – I’m assuming the women will like the idea but the men will be hesitant, so there may be a slight awkwardness in the beginning.
      2. Women in Cooperative:
         1. The women in the cooperative are happy because their money will be going towards their kids more. They are happy with me and the oversight committee for making this decision.
      3. Oversight Committee:
         1. The oversight committee also wants things to change, so my relationship with them is still great. They are excited that things are going to be different, especially because they thought they couldn’t do anything about it.
      4. Families:
         1. The families may feel some tension amongst themselves since the men won’t be able to spend their money frivolously anymore and will be upset about it.
   5. Relationship long-term implications:
      1. Me:
         1. My term on the committee ends on a good, successful note and I leave with a great reputation and long lasting relationship with the women on the cooperative. 
      2. Women in Cooperative:
         1.  They are  not to blame for the lack of spending money for alcohol and their kids are fed from their credit in the general store. They maintain a good standing within their home and the husbands do not take their aggression out on them for this new change. The women have the opportunity to save their money up and are able to plan for their future longevity. 
      3. Oversight Committee:
         1.  This decision demonstrates the committee’s role in the local community and if it does not go over well it could hurt the local interest in the cooperative, causing blowback on the committee. 
         2. If this decision works, the committee has proven their ability to adapt to the needs of their workers and they strengthen the relationship between them and the cooperative community. 
      4. Families:
         1. Since not all the money is immediately spent, families begin to save their money and build their fortunes up. Children are provided for and more healthy, and the mothers get to keep their earnings in the cooperatives equity bank to save for a better future for their children. At first, the men are angry about this change but they come around to it when they get used to having two six packs a week. Overall, the families begin to see the cooperative as a larger part of the community since they now shop at the general store. 
   6. Venture short-term implications:
      1. Me:
         1. The community reaction to this proposal can essentially make or break my reputation. Since it was my idea and my term is almost over, the committee might place the blame on me if this goes wrong. This venture can end my career if it fails. If it succeeds, however, my namesake will be passed on to the next committee and I will have a lasting impact on the cooperative.
      2. Women in Cooperative:
         1. In the short term, the women will have access to less money as their credit goes. They will still have enough for their family to eat, but this might put stress on their household in the earlier weeks of this change. 
      3. Oversight Committee:
         1. The oversight committee is put in a tense spot. This change affects the income of their workers and the family dynamics within the community. There is a tension towards the committee in the beginning, seeing that there is uncertainty in its impact.
      4. Families:
         1. The men will have less access to alcohol, which could make them take out their anger on their families. However, since we clearly explained the saving process they might be incentivized to wait longer before pulling money out of the equity bank for their drink. This means that there might be disturbance in the beginning of the venture that should be monitored, but it should level out in the long term.
   7. Venture long-term implications:
      1. Me:
         1. When this succeeds, my career flourishes and I write a publication on this grassroots cooperative management system which is featured in conferences across the globe. Once I leave my position as a chair I have no trouble getting a job in a similar field with my past experience.
      2. Women in Cooperative:
         1.  The women have more financial savings for their families. They are able to afford better healthcare and nutrition for their children. Since their families have more money they can afford better healthcare. Some of the women even get their HIV treated. 
      3. Oversight Committee:
         1. The oversight committee remains vested in its two goals and it begins to expand the cooperative as the credit system flourishes. Since they have a new stream of income, they begin to grow more of their own ingredients without the use of pesticides. The committee begins to have a more direct relationship to the community since they included that voice in their decision making. 
      4. Families:
         1. Families are healthier and wealthier. Men don’t spend as much of their wife’s money on alcohol and begin to see the incentive for keeping the money in the bank. Since the cooperative has grown and this decision strengthened the relationship between families and the cooperative, the product is more normalized and it has widespread use among the families in the community so baby’s are getting the proper nutrition.

Step 5: Seek additional assistance, as appropriate – previous cases, peers, reliance on personal experience, inner reflection 

• Inner Reflection: If I were in their shoes, I believe that sectioning off money available to spend would be the most efficient way to get all the needs in the house without overspending
• Engineering Code of Ethics: Our solution needs to follow the given ethical standards for an engineering/entrepreneurial venture 
  • Integrity, Objectivity, Professional Competence, Confidentiality and Professional behavior

Step 7: List the sequence of actions you will take to implement your solution.

1. Validate the idea with the council
2. Validate the idea with 25 men and 25 women one on one or in smaller group settings with people in the cooperative
3. After the idea is validated, we will announce the new system and get general feedback at a community meeting to directly engage community voice
4. We will implement the idea by obtaining funding for opening the store and obtaining vendors to supply the store. 
5. Then, we will hire workers for the store  and finalize the credit system with the women of the cooperative and do a trial run of the solution. 
6. If everything goes smoothly, we can open it up to the public.

Problem Statement: Jack is an American student who lived at a youth center in Kenya while working on a social venture. In this role, he lived and interacted with the children at the center and worked closely with the staff. One Saturday evening, kids under the age of 14 years were to receive presents that were sent by an international donor organization. A staff member at the youth center had picked up all the gifts the previous weekend and they were finally going to be distributed this Saturday. When it came time to give the gifts out after dinner, the staff members called Jack up to the front – as he was a guest – to assist in the gift-giving ceremony. The staff members had allocated the gifts for the children and labelled them – Jack’s job was to hand out the gifts to the kids. The only problem was that four children did not receive gifts and the staff members did not appear to be concerned about the four forgotten children. As kids began leaving the hall, they thanked Jack for the gifts. The kids were convinced that Jack had gotten the gifts for them. Jack felt a little awkward but at the same time reflected that a good relationship with the kids would help him in several ways during his five-month stay at the center. 

At the bottom of the boxes containing the gifts, there were a few black hats. The kids that did not get a present were brought over to the box and given a hat. However, they were upset about the fact that they were not given the hat as ceremoniously as the other kids. The staff gave them their hat and shooed them on their way as if they had some fault in this situation. As one of the little boys who did not receive a gift left the hall, he walked past Jack holding his black hat, and gave him a stare that clearly indicated that he blamed Jack for not receiving a gift. Jack met with the staff and discussed how the four kids were very upset and felt ‘left out’ after the incident. The staff did not acknowledge the problem and were a little piqued that they were being blamed for such a trivial matter. They were convinced that Jack was making a big deal out of the situation and were concerned that Jack would become a ‘children’s rights activist’ and create unnecessary problems for them. The only response they gave Jack was – “If you think there is a problem, then you go ahead and solve it”. If you were Jack, how would you proceed? 

 

Step 1: Determine the facts in the situation – obtain all of the unbiased facts possible. Clearly state the ethical issue.

• Jack, an American student, is a guest at a youth center in Kenya that is helping in giving out gifts during the ceremony
• Kids in the youth center are expecting gifts, the left out kids believe they are equally deserving of gifts
• Four children did not receive gifts, and with their level of maturity at this age, it is assumed that they will not be able to realize that it was a mistake.
• After the staff distributed the black hats, they did not further respond to the children who we assume are still upset from not receiving gifts.
• The kids blamed Jack for not getting gifts, even though the staff allocated the donated gifts.
• Jack discussed with the staff the kids felt upset and left out, but they didn’t acknowledge the problem at all and believed it was Jack’s problem
• Jack wants to accommodate the kids who did not receive gifts, but this may be a part of Kenyan, or the youth center’s culture, where some kids do not receive gifts.
• It is assumed that the black hat is not as good, or as special of a present as the other gifts

When Jack told the staff the children were disappointed, they did not seem to care. Jack implicitly took some credit for getting the gifts, even though he did not contribute to the gifts, which is why he took the blame. Now, Jack has to figure out how to solve the problem.

Steps 2 & 3: Define the stakeholders and assess their motivations

• Jack:
  • Personal: Jack believes the kids who did not get gifts need to be compensated better, unlike the staff; wants to maintain amiable relationships with the kids and staff, wants to do something for the kids
  • Professional: wants to continue his social work at the youth center, does not want to upset the staff nor the children, wants to save face
• The four children who did not receive presents:
  • Personal: Unhappy with their gifts, they believe Jack is to blame for this. They may be made fun of for not getting a gift, although it was an accident. They want to be included.
  • Professional: Children do not have professional motivations
• The children who received presents:
  • Personal: Happy to get a good gift, they believe Jack is a great person for “getting them” their gift
  • Professional: Children do not have professional motivations
• The Staff
  • Personal: Trying to save face by keeping blame on Jack. Many of the staff members grew up in the center themselves so they have personal ties to the center/families.
  • Professional: wanting their next paycheck, getting their job done every day. They do not want Jack to get out of control with his savior complex and they want to work within their limits.

Step 4: Formulate (at least three) alternative solutions – based on information available, using basic ethical core values as guide 

• Potential solution 1: Have a private (calm) discussion with the staff members involved being honest in a respectful manner. Kindly remind them what the big goal is, (the kids), and the best way to go about things
  • Ethical Principle or code
    • Fidelity and Responsibility, Justice, Respect for Persons and Dignity
  • Pros 
    • Private setting and calm environment allow for civilized, honest discussion
    • Hopefully will allow for a diplomatic, calm resolution
    • Stern reminder of nature of venture and that tension will only impede that goal
  • Cons 
    • Invitation to a private conversation could be seen as threatening
    • The kids still may not understand the problem and may still be upset
    • This does not directly help the fact that four kids did not get gifts and will feel neglected.

Implications on relationships/venture:

• • • • Short Term: Hopefully this will result in less tension between the staff and Jack and the children and Jack. This would be a good move for the youth center overall, but may be frowned upon in the short term.
      • Long Term: This conversation will hopefully lead to a long term solution that will satisfy all parties involved. Everyone’s voice can be heard in this discussion. 

2. Reach out to a donor organization like WHO and see if they can get gifts for the students

• • Pros: 
    • Jack would not have to pay for the gifts 
    • The kids would receive gifts 
    • The integrity of the youth center can be as Jack can save face, and the kids would no longer blame Jack
  • Cons: 
    • The gifts may not be personalized for the kids
    • It would take time for the kids to receive the gifts
    • The four gifts are not that costly. The organization may not uphold this request because of the lack of relevance and cost.
  • Implications on relationships/venture:
    • Short Term: Jack’s relationship with the staff may be tarnished due to his extreme efforts to get the children gifts. This would also be extra work for the donor organization which they may be unhappy about. However, everyone saves face overall
    • Long Term: In the long term, Jack solved a small problem for the youth center, and the staff will end up being grateful.

• Potential solution 3: Jack can purchase four presents on his own for the four children who were left out
  • Pros:
    • The children will get their presents
    • The children will continue their positive relationship with Jack
  • Cons: 
    • The children will not receive the same public receiving of the gifts like the other kids.
    • Jack has to pay out of his own pocket for the toys, which is a con for Jack
    • The other kids might see this as special treatment
    • The staff might feel uncomfortable if Jack does not tell them, feel as if he is taking matters into his own hands.
  • Implications on relationships/ venture:
    • Short Term: Kids will be happy they got gifts. Jack helps the youth center save face by fixing the problem. He will also not receive the blame anymore.
    • Long Term: Youth staff might appreciate Jack more for helping solve the problem, but this is not guaranteed, Jack saves his own face and the kids end up liking him more. The kids who did not receive presents will no longer feel excluded.

Step 5: Seek additional assistance, as appropriate – engineering codes of ethics, previous cases, peers, reliance on personal experience, inner reflection

• Ethics Principles (autonomy, non-maleficence, beneficence, justice, and fidelity)
  • The kids without presents are being unjustly treated in comparison 
  • The Engineering Code of Ethics does not apply here
• Inner Reflection: If I put myself in a kid’s shoes, I know that I would feel excluded if I did not receive a gift. I would feel as if I did something wrong. 
• Golden Rule: Treat others the way you want to be treated. As an extension of Inner Reflection, you would feel neglected if you were one of few who did not receive a gift

Step 6: Select the best course of action – that which satisfies the highest core ethical values. 

Best Solution: Combination of 1 and 2 or 3. The staff and children should be explained of the problem, and should have an open conversation about the solution. Jack can purchase the four gifts himself, or a donor organization could pay for the gifts. This is the long term goal. In the short term, Jack can wear the black hat in order to make the four kids feel included in a group.

This is the best solution (ethically and tangibly) because:

1. Kids that were neglected are given both an explanation and a comparable gift (Justice, Respect for Persons and Dignity). This means that they obtain a valuable learning experience and will eventually receive a gift.
2. The stakeholder relationship with the staff  is re-established and tension is diplomatically resolved (Fidelity and Responsibility)
3. A long term solution, not just a band aid fix
4. All stakeholders are satisfied, able to apologize and explain while allowing stakeholders to save face

Some Consequences may entail;

1. It may be incredibly difficult to get in contact with an organization who would donate toys to Kenya or even for Jack to get toys himself of the center is remote and far away from anywhere that would sell toys (However, in this case, he could make toys out of wood) 
2. Depending on the cost of the gifts, Jack may have to pay a significant amount out of pocket.
3. The ROI may not be worth it if using the donor funding route
4. The social impact of getting toys for the kids would be positive. The economic and environmental impact variable is negligible.

Step 7: List the sequence of actions you will take to implement your solution.

1. Find another donation center or pay out of pocket for 4 comparable gifts
2. Give to 4 children and explain that no one was meant to get hurt, it was an honest mistake and all parties are sorry while giving them some sort of public recognition without it seeming forced or special.
3. Mention the resolved situation and outcome to the staff members and have a diplomatic conversation to settle tensions and create a better understanding for the future
4. With these steps, all stakeholders have a clear understanding of the situation and next steps to solve the problem if it were to happen again.

Step 1: Facts

• There is a disease-causing pathogen only found in a small region of Lesotho 
• The testing is simple, but the trip/equipment will cost money, and community assistance is required
  • We are studying the life cycle/characteristics of a certain pathogen
• Characterizing pathogens can help further research into how to make water safer to drink
• We are expected to write some publications on what we find from our research
• We assume that the pathogen truly is present in some/all of their water sources
• We assume the people in Lesotho know where all water sources are and that there is not risk of further water contamination 
• Lesotho is endowed with abundant water resources, and after the passing of the Water Act in 2008, they are also very conscious about the “management, protection, conservation, development and sustainable utilisation of water resources”.
• We also assume we have received IRB, and all other necessary approvals to conduct research. 

Ethical Issue: 

• Is this study just an example of hit and run research or does this research actually help the people of Lesotho? Does the study have social value in general?
• Balance between ethics and rigor, not doing study rigorously enough is an ethical issue too as our mission is to characterize the pathogen effectively and correctly

Step 2-3: Define the Stakeholders/Assess Their Motivations

• Researchers -> academic clout😤😤😤, maintain jobs, create positive impact through their research/findings
• The University of the Academics -> maintain their reputation globally, advancing knowledge & delivering value to society
• Villagers of Lesotho -> obtain clean water supply, stay healthy, not have their lifestyle completely disrupted, lower risk of contracting disease, building connections and relationships, possible economic development w/ cleaner water in tourism and exporting water to South Africa
• Funders/Government Agency -> stake in developing an additive or water cleaning system, obtain more grants for future work, research might help their projects and development, creates a positive image of corporate social responsibility, develop their brand in this area
• Healthcare System/Providers in Lesotho -> less burden from waterborne diseases, more resources to devote to other conditions
• Academic Journal -> acquire new research (groundbreaking) that adds to general knowledge of pathogens, build reputation

We want to build a relationship with the locals. We are trying to negotiate entry to conduct future research in this community.

Step 4: Solutions

• Conduct experiments on how the pathogen affects health. Experiments would include testing the water with pathogens on rats. 
• Select guides which are knowledgeable of water sources, probably village women
• Test water from multiple sources; in villages with different socioeconomic statuses in order to make the study as just as possible
• Only collect the water samples in vials when doing field work; test the water later in labs to avoid contamination and disruption. 
• Educate the villagers of Lesotho about your findings while you are there about things they can do in their capacities & after the water has been tested, help them towards finding a solution to any disease-causing pathogens you found
  • Sharing information and results that would benefit the people of Lesotho (and those downstream of Lesotho) after the research gets published. Do not put the publication behind an expensive paywall, make it accessible to those in Lesotho.
  • Email the papers to the heads of communities to show that something came out of the research they assisted in.
  • Maximizing clinical value & making sure there is positive social impact/return

• Identify the source or the pathogen and how it is contaminating the lake.
• Conduct simple examinations on locals to identify symptoms and effects from drinking the lake’s water. 
• Once completing testing, drink the water to prove to civilians the water is safe.
• Attempt to provide a temporary cleaning solution or import purified water to the communities
• Request the right to access the water sources from legislation/leaders of each village while being conscious of any cultural practices/norms.
  • Appeal to community health workers in Lesotho who can help the community understand your work 
• Negotiate some way to incentivize the community, materially or immaterially, addresses the issue of beneficence, perhaps with some clean water solution.
  • Ensuring that you do the study right, focus on legitimacy

Pros: Working with the community, broadening knowledge of pathogens, potentially helping them in future and developing relationships, will allow for successful testing for the pathogen, helping us and the communities of Lesotho.

Cons: Not reporting back to them with enough information on our findings, they may not want to help us if we do not properly compensate them, process of requesting access to the water in Lesotho through the government may take longer than we anticipated, the community members in Lesotho have the right to turn us down (our funding sources would be mad).

Ethical Principles: The research is mostly consequence-based thinking because it is focused on discovering more about this pathogen to help people globally. However, our steps to request access to the water sources in Lesotho bring a more duty and virtue based approach because we are trying to get their approval, work with the community members, and hopefully bring back new information to them to help in the future. From a purely utilitarian perspective on face value, this seems like a worthwhile venture as we can make a crucial discovery, while helping those in Lesotho. It will be crucial to our reputation and our stakeholders that we do not conduct a hit and run research trial.

Step 5: Seek additional assistance, as appropriate

• NSPE Code of Ethics: This legislature enforces that engineers “hold paramount the safety, health, and welfare of the public” in their work. Hence, an engineer need note this when debating the ethics of this study.
• Who has approved the study? The university? Has it received IRB approval?
  • IRB Ethics:
    • Social or Scientific Value
    • Scientific Validity
    • Fair Subject Selection
    • Favorable Risk – Benefit
    • Independent Review
    • Informed Consent
    • Respect for Potential and Enrolled Subjects

We, as the researchers, believe that we fulfill all the requirements of the IRB Ethics protocol and can conduct meaningful research in Lesotho.

• Belmont Report 
  • Beneficence
  • Respect for persons
  • Justice
  • Protection of anonymity if desired

Step 6: Select the best course of action

Unlike the first case study, the best course of action here is not as simple as including the auto-disabler or scrapping it (with some added decisions for manufacturing and distribution). To conduct this study ethically, we have to ensure we follow the right protocols from start to finish.

• First, we have to ensure we only test in areas in which we have been granted access to and explain the benefits for society and their community in a culturally appropriate manner.
• We also need to describe to the villagers what we are doing and educate them on the risks/potential solutions while keeping CHWs informed of our progress. Integrating an educational aspect is a requisite for conducting this study. 
• In the short term, we will give them clean water sources and show them how we do our research. 
• In the long term, we are going to present them our findings and give them a solution to keeping their water clean and safe. We will be able to do this by maintaining a close relationship with Lesotho. 
• Finally we will conduct our research from several lakes in several areas with the help of willing community members, and not put any substances in their water sources so as to not violate the Water Act and other Lesotho water sanitation laws.
• We will take the water in vials to test elsewhere in a lab in-country.

This framework limits most of the listed ‘cons’ while fulfilling IRB ethics and the Belmont Report guidelines. The most glaring downside to this is the fact that the villagers of Lesotho may want more say in the testing protocols, while we would rather stick to our plan. However, we are willing to listen to ideas they have in order to make the testing more efficient. Our compensation should alleviate the second most glaring con.

Step 7: Venture Implications

• Improving community health by treating the water 
• Opportunity to market water treatment/cleaning solution to Lesotho and surrounding communities
• Adding to the global knowledge of this pathogen, and similarly structured ones.
• Potential positive or negative environmental implications if water treatment solution is derived from this research and introduced to the community
• Potential employment/volunteering of locals into protecting the lake and working with our venture apply our solutions.