Lindsey's Blog Post #16 | Lindsey Hunsicker's Blog

Class 4: 9/15/2020

Group: Lindsey, Grace, Michelle, Noah

Part 1: Ethical Decision-Making

In a certain region of East Africa, the growth of ~35% of the children is stunted due to poor nutrition. Traditionally, maize and bananas are the items most commonly made into a gruel and fed to infants beginning at ~2 months of age. The gruel is integrated into a child’s diet to complement breastfeeding until they are ~24 months of age. Mothers in the area firmly believe that the gruel is highly beneficial for their children, but scientific research has shown that it does not provide some key nutrients. HIV/AIDS is very prevalent in this region. The World Health Organization recommends exclusive breastfeeding until an infant is six months of age, but the longer a child nurses when the mother is HIV+, the greater the chance that the virus will be transmitted to the child. You have received a grant to establish a women’s cooperative in this region. The donor’s intent is to simultaneously improve the nutritional status of children and improve the livelihoods of rural households. The grant for the women’s cooperative 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. The nutritious porridge is intended to wean children off of breast milk at about 6 months of age.

Approximately 500 women from three contiguous sub-locations have indicated their interest in joining the cooperative, in hopes of improving their livelihoods. However, they are skeptical of the porridge and its use as an early weaning food. Cash crops as well as subsistence crops are grown in the area, including maize, sorghum, cassava, several varieties of legumes (dried beans), French beans, coffee, pineapple, bananas, pumpkins, tomatoes, carrots, kale, white (Irish) potatoes, and sweet potatoes. Pesticides are typically used in growing some of these crops and can result in adverse health implications for infants. How would you address the ethical health issues associated with prolonged breastfeeding in an area where there is a high prevalence of HIV/AIDS and few women are tested for the virus, very early introduction of supplemental foods to the diets of infants, and the possibility of pesticide residues in foods developed for infants and young children.

What are your next specific steps to develop this cooperative?

Case Study:

Ethical: Give children formula that might contain pesticides or have them drink breast milk that contains HIV.

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

The growth of ~35% if the children is stunted due to poor nutrition
Maize and bananas are most commonly made into a gruel
These are fed to infants at the beginning of 2 months of age
HIV/AIDS are prevalent in this area
The longer a child nurses with a mother with AIDS/HIV the greater the chance that it will be transmitted to the child
The mothers are skeptical of giving the children the gruel
A donor provided money to build a cooperative.

Step 2: Define the Stakeholders – those with a vested interest in the outcome

Mothers (Primary)
Children (Primary)
Research team (Primary)
Donors (Secondary)

Step 3: Assess the motivations of the Stakeholders

Mothers: Decrease the chances of their child getting aids and receiving the proper amounts of nutrition. They can make money by selling the crops they grow.
Children: Want to live a healthier life. They need their basic needs to be met.
Donors: They want to simultaneously improve the nutritional status of children and improve the livelihoods of rural households.
Research Team: The research team aims to help the local community. Primarily by providing an alternative to gruel which will be more nutritious for children whose growth may be stunted. They want to build up their own credibility.

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

Approaches

Potential solution 1: Continue on with the Cooperative (Create our own porridge, which we will grow using local crops and then distribute)
- Ethical Principle or code
  - Justice: We want to be able to create a product that is fair and safe for the children.
  - Beneficence: We want to help the children be as healthy as possible
- Pros
  - Children will not be exposed to HIV/AIDS
  - Children will be able to receive the proper amount of nutrition
  - Wider variety of food
- Cons
  - Children may be exposed to pesticides
  - Could lead to a decline a child’s health
  - Children may not like it because it might not taste well
Potential solution 2: Continue to feeding the children gruel
- Ethical Principle or code
  - Non-maleficence: we will be minimizing harm to the children by not possibly feeding them pesticides
- Pros
  - No risk of pesticides
  - Children are already accustomed to the gruel
  - The mothers would already be accepting of it because they have been feeding it already
- Cons
  - Children would not be receiving the proper amount of nutrition
  - Only a few varieties (maize and bananas)
  - Further research will be needed, which can be costly
Potential solution 3: Provide education to the community members about HIV/AIDS
- Safe Sex Education
- Condom handouts
- How this disease affects their children
- Targeting males within the community
- Partner with Ministry of Health to accomplish this
  - Potentially help subsidize condom sales
- Ethical Principle or code
  - Justice: We are providing these educational resources to everyone in the community, in order to treat everyone equally and possibly provide for a reduction in the transmission of HIV/AIDS
  - Beneficence: We will be maximizing health benefits to the community by targeting the HIV/AIDS epidemic in order to address the root of the problem
- Pros
  - It will decrease the amount of people with HIV/AIDS.
  - The babies will be able to ingest the mother’s breast milk safely
  - It will decrease the amount of deaths and number of illnesses within the communities.
  - Eliminating the need to find a supplement because the mother’s can provide their breast milk
- Cons
  - We would need to find more funding
  - The community may not be accepting of it
  - Time: It will take a lot of time to go around the community and to teach people about how they can decrease it but will it take so long that it may end up hurting the community more in the shorter term

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

The links above support our initial thought which would be to target the BIG problem, which is to get rid of the HIV/AIDS factor. However, after presenting this solution, we realized that it is a good idea, but may take extra time and resources that we do not have at the moment. We discussed a second option that would fix the current issue shared in the case study. Our team worked well together, but there were times where we needed to come together to decide on the best course of action. We were able to find data to support our solutions, and our thought processes of how to solve the issues.

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.

The best course of action, based on the potential solutions we developed, at this time would be to keep feeding the children the gruel. This has been proven to help children receive nutrients along with their mother’s breast milk. I would continue to feed the children the gruel until we can ensure we have a pesticide-free recipe for the porridge. Unfortunately with this approach, there is still the potential for the children being exposed to HIV/AIDS through their mother’s breast milk. This approach has the ethical value of non-maleficence because we will be minimizing harm to the children by not possibly feeding them pesticides. Our group feels that at this time, until there is a way to test for HIV/AIDS, the best option would be to continue with the gruel. Our initial thought would be to fix the overall source of the problem which is to get rid of the HIV/AIDS factor. However, that is a task that will take many, many years to fix. After our class-wide discussion, our group realized that we need to target the current problem and try and find a solution for this problem at hand.

Step 7: (If applicable) What are the implications of your solution on the venture. Explain the impact of your proposed solution on the venture’s technology, economic, social and environmental aspects.

The solution that was chosen for the venture was to continue with the gruel until we can ensure there is a pesticide-free recipe for the porridge. This solution has an impact on the venture’s technology, economic, social and environmental aspects. This solution could impact the economic aspect because we would need to develop a way to test the produce for pesticides. This would affect the time and money that the donor has provided for the venture. Our solution would have a positive impact socially and environmentally. Not only finding a way to ensure the produce pesticide free for the porridge, but it will also help the rest of the community members who will be consuming the produce to know that they are not ingesting pesticides.

Part 2:

Grassroots Diplomacy Six months after launch, the efforts of the women working in the cooperative you established are paying off, and business is thriving. The women work for about nine hours every day and earn KES 300 (about $3). Besides the wages earned, they have the opportunity to sell the produce grown on their small farms to the cooperative. This transaction is done at the prevailing market rate and helps the women make a little money on the side. The women like this arrangement because it saves them a trip (time + money) to the village market to sell their produce. The women enjoy working with each other and are happy with the cooperative; they have a strong sense of community and identity. However, there is one big problem. When a woman brings her hard earned money home, she has no choice but to turn it over to her husband, father, or brothers. Rather than using the money to support their families, the men waste it on alcohol and frivolous things. Though the cooperative is thriving, it is not achieving the twin social outcomes of improving the nutritional status of children and the livelihoods of rural households.

As the entrepreneur who helped establish the cooperative, you are pained about the situation. Though you are loved and respected by the entire community, you do not have a direct say in the cooperative’s functioning. You are one of the seven members of the leadership committee that oversees all operations. The committee is elected on an annual basis and you have six months left on the committee, after which you will practically leave the cooperative completely. The other six members of this committee are local women who understand the problems and want things to change. They are not necessarily opposed to the men taking away their money but are upset that their hard-earned money is not used to feed their children. They are convinced that nothing can be done about it because that’s just the way it works in their community. What is your strategy to get the cooperative back on track to meet the twin social outcomes for the cooperative on a sustainable basis?

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

Women work for 9 hours a day and make KES 300 ($3).
The women have the opportunity to sell the product to make an additional income on the side.
When the women come home from work they give the money to the man of the household (husband, father, brother)
The men of the household spend the money on alcohol or frivolous items and not to support their families.
The women are upset that the men are not using the money for the families.

Step 2: Define the problem and the stakeholders – those with a vested interest in the outcome

Problem: 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 in the household use the money on alcohol or frivolous items instead of using it to support their families.

Mothers (Primary)
Fathers (Primary)
Entrepreneur of the cooperative

Step 3: Determine and distinguish between the personal and professional motivations of the stakeholders.

Mothers
- Personal: They want their children to be safe and nutritious and also collect their wages.
- Professional: They can make money for selling the produce they grow.
Men of the household
- Personal:
- Professional:
Entrepreneur of the cooperative
- Personal: The research team aims to help the local community. Primarily by providing an alternative to gruel which will be more nutritious for children whose growth may be stunted.
- Professional: They want to build up their own credibility.

Step 4: Formulate an alternative solution – based on information available, to have a win-win situation for your relationship and your venture.

Potential Solution: Cooperative creates accounts for the women which puts a portion of the funds to a “gift card” for them to use at the store. The total funds can be updated daily.
- How does it solve the problem?
  - Pros
    - The women will have money available to spend on supplies for the family
    - The men won’t be able to take all of the money because some of it is on the gift card
    - The men will still be able to buy their alcohol
  - Cons
    - The men will still be able to take some of the money
    - The men still have the option to sell the giftcard on the black market
- How does it save face of those involved?
  - The men are still getting money to spend on alcohol and frivolous items, but the women have money to spend on resources for their families.
- Implications on relationships
  - Short-term: The women are still turning over money to the men of the households and getting. The men are still happy with receiving the funds.
  - Long-term: The women can provide resources to help their family live healthier lives due to the accessibility of funds for resources. The men will no longer be withholding money, which will take away the important needs for the families.
- Implications on the venture
  - Short-term: It is a short and easy fix, which will be finished and implemented before the last 6 months is complete at the venture.
  - Long-term: The women continue to work for the venture, and feel a sense of community. They still feel as though they are providing funds to the men of the household, but the resources for their families will continue to develop because of the food/bank accounts through the cooperative.

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

This was a very interesting double case. I was familiar with other cultures that turn their money over to the men of the households, but never considered the women turning all of the money over. I figured they would buy the resources needed to their families, and then give the rest to the men. I can see this is a big issue when it comes to getting resources for the families, especially in developing world countries where it is difficult enough to find resources. Our group worked together very well when deciding on a solution. Also, I got an idea from a classmate to merge with our solution. Together, I feel that this is the best solution for the women because they are still providing most of the money to the men of the household to buy the alcohol and frivolous items, but they have money set aside from the cooperative to buy food and resources for their families. This website below provides insights from women in Africa about gender disparities and the economic impact of being a working woman in Africa. This article and the features provided even more information about the hardships that women endure in Africa.

https://www.un.org/africarenewal/magazine/july-2005/african-women-battle-equality

Step 6: Select the best course of action – that solves the problem, saves face and has the best short-term and long-term implications for your relationship and venture. Explain reasoning and discuss your solution vis-a-vis other approaches discussed in class.

The solution we chose involved having the women that were working set up a bank or savings account with some of their profit money. This money would be set on a food gift card that they could use to buy food and resources with. The women would still go home with most of, but not all of, their profit from working. This money would be given to the men of the household to buy their alcohol and frivolous items. This saves face because the men are still getting what they want and money is being put aside for the women to get food for their families. However, with our option there is the potential for the men taking the gift cards and selling it on the black market. However, I feel that any of the solutions we proposed always had the possibility for a negative implication. Our team was hoping that the men would allow the women to keep the gift card because they would still be turning over a majority of the money to the men.

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

The women get the jobs to work for the cooperative.
The women set up bank/card accounts with the cooperative.
Everyday there is a dollar put on the card to use for food items and resources.
The leftover two dollars is given to the men of the household.
If the dollar is not used that day, it will stay on the card and accumulate until used.

Lindsey’s Blog Post #16

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