Case Study 1: Water Pathogen in Lesotho

The Facts: of the case, provided by the case study

  • There are 11 researchers, including yourself, traveling to Lestho in South Africa for 10 days 
  • Their goal during there time there is to test the water from different locations for disease causing pathogens
    • They will also be learning about how the locals store their water and how they retrieve it 
  • There are no specific benefits to the community within the scope of the research planned by the team of 11
    • We were told this observation was wrong however, if you read the case study carefully it says “the ultimate goal of the project is to understand the lifecycle and characteristics of a specific pathogen” they do not mention any research or plans to find ways to combat this pathogen’s effects on humans 
    • In my opinion it is wrong to say this research will benefit anyone in the community of Lestho, if a pathogen is found to cause disease in humans, this research team has not explicitly stated they are going to do anything about it, other than publishing their findings
  • The community will be aiding the researchers by leading them to the water sources in the area

Stakeholders and Motivations

Stakeholder: Research team (including yourself) 

Motivations: To benefit professionally from the publications coming out of the research, the chance to say you have worked across different cultures and locations to potential employers  

Stakeholder: Community members

Motivations: To help foreigners find what they need because they will be able to help and bring a solution in the future for the contaminated water (possible thoughts of a community member).

Stakeholder: Community members that help you 

Motivations: They could potentially be receiving compensation for their time and work, or even just a tip. Working with the foreigners could give them a positive reputation/sigma and open up better jobs for them. 

Stakeholder: Organization behind the researchers

Motivations: The organization that backs the researchers and gives them credibility will gain even more respect and publicity if the researchers are able to publish meaningful work. The organization has a lot of money at stake however, these publications can lead to grants that will ultimately be awarded to the organization not the researchers. All in all, the organization will gain more respect and publicity from the researchers work they support. 

Stakeholder: Government of Lesotho

Motivations: To help the foreigners achieve what they set out to achieve in order to create a stigma that Lesotho is an easy, helpful place to work in for foreigners; ultimately increasing tourism which will benefit the economy. The communities of Lesotho also have the possibility of gaining clean water which the government can say they played a part in providing to them; gaining political clout. 

Stakeholder: Anyone who reads the report 

Motivations: To use the information published to find a solution to inhibit the pathogens effect on humans and to sell the solution to Lesotho and other places being affected by water pathogens. 

Ethical Questions

Is it ethical to conduct this study from a human standpoint?

Is it ethical to conduct this study at all? 

Should people (people of Lesotho) be compensated for their time and resources?

Solutions

  1. After their research is concluded, provide conclusions and results to the community members and relevant government departments for free and insure they understand the findings. 
    1. Pros: This solution will ensure that everyone involved/that could be affected by the possible pathogen is aware of its existence, ensures respect of the local stakeholders. With this solutions everyone is getting something out of the conclusions, the researchers are able to publish and the community has their water tested for free. 
    2. Cons: Leaves the country/community with potentially bad news and no way of immediately fixing the problem. People will be left to drink contaminated drinking water and the country does not have the means to find a solution. Could leave a bad impression on the country that foreigners are only there to benefit themselves. Community members/locals could possibly lose faith/trust in the government because they (possibly) can not help solve the problem.  
  2. Only provide conclusions and results from the research to the relevant government departments. 
    1. Pros: With this solution the government and leading bodies are informed and have gained something (knowledge) from the research groups presence. The relationship between the research group and the government could be solidified from sharing this information. By only providing the information to the government you are avoiding the situation were the citizens of Lesotho could possibly lose trust in government if they (the government) are not able to fix the water issue (if there is one). You are also avoiding possible panic from the people if they find out there is harmful bacteria in the water but no way to fix it/get clean water.  
    2. Cons: You are not telling the people who are directly affected by this research. This could be considered an ethical violation because withholding this information from them could possibly result in harm. If the citizens of Lesotho find out about the water situation but are not told by the government this could result in a political uprising. This situation would not be directly your fault, it would be the government’s fault because they withheld information, but this situation still needs to be taken into account. 
  3. To receive approval from the water ministry of Lesotho (or the equivalent) to conduct this test. 
    1. Pros: This solution will ensure that the researchers can get their testing done. If they are stopped or questioned by anyone in the community they can show them that they have approval from the government. Will allow the researchers to form a good relationship with the government. 
    2. Cons: Does not ensure the information is portrayed to the community members, the ones immediately affected by the pathogen. The community members/locals could view this situation as a bunch of foreigners barging into their community and doing whatever they want because the government told them they could. This situation could create a bad stigma for foreigners and potentially cause community member/locals to lose faith/trust in their government. 
  4. Pay the community members that help them achieve their goals (show them to various water sources). 
    1. Pros: Involves the least amount of planning/work before the trip. Can potentially save a lot of money on government approval submissions. Provides a few community members with a consistent, fair pay for a few days that will help them support their families. 
    2. Cons: Can not guarantee people will be willing to help them, especially if they have not received government approval. Once you pay someone for a job you can never take that back (decided to not pay them/someone). The other community members/rest of the people in the community do not benefit in any way from the foreigners research. It is possible that with this solution that Lesotho will never learn about the researchers findings and how it affects the country, even though the research will be publicly published. Poses the ethical question: is it okay to conduct an experiment and not explicitly state the results to everyone possibly affected by the results? 
  5. Do not pay the community members that show them to various water sources for testing. 
    1. Pros: If the community members are willing to help the researchers out without being paid that is one more expense that is eliminated (doing research overseas is very costly). Eliminates the situation where if you pay someone once for a task they never do anything for free again. Instead of having to walk to the water source that day the community members are being driven which saves them a bunch of time and is a form of payment that is not money.
    2. Cons: The community members could possibly think they are being compensated in a different way other than money (food, supplies). This miscommunication could cause tension and make it hard to work with the community members again. Another situation that could arise from not paying the community members is that the venture/researchers could be called out for taking advantage of the community members. This is a generalization: many citizens in developing countries go out of their way to help foreigners because it is believed the foreigners have a lot of money and they are there to help The researchers could be accused of taking advantage of this situation instead of paying the community members what is fair (especially since the researchers would most likely have to pay the community members back in their home country to help them do this same job). 

Previous cases and personal experience 

From what I know about clinical trials and the clinical trials they are running in Sierra Leone on sickle cell anemia. Researchers/doctors running clinical trials are not obligated to provide treatment or any follow up care after the trial is run. They must provide the patient with the outcome but they do not have to educate them on what the outcome means or the next steps they should be taking (unless they ask obviously). This can be applied to this case study. The researchers have no obligation to explain or provide any follow up assistance if the water is found to have a disease causing pathogen in it. The researcher do have to provide their finds, how they provide these findings is a slippery slope. Is publishing online publicly enough? Or should they have to provide the paper directly to the government? Should they have to provide the paper directly to the people? Should they send someone back to Lesotho to explain in person exactly what they found to ensure understanding? All these questions will be answered in my  best course of action plan. 

Best Course of Action 

The researchers best course of action would be to first receive permission from the government to conduct this research on their water. As for the community members, permission should be sought from the community leader and then volunteers from the community should be paid a fair wage for their time and knowledge (the people who will be taking them to the water sources). The community members must be paid for their time, there are too many cons that would greatly affect the relationship between the community members and the researchers and the researchers themselves (presented above) associated with not paying them. Once the research has concluded the researchers need to send a written concise/easy to understand letter of their findings on the water and possible pathogens to the government and local community leaders. These entities are then responsible for passing the message along to the rest of community or doing what they think is best with that information. This solution ensures that everyone involved has the opportunity to benefit from the researchers findings. By receiving permission and providing their findings to the government and local community leaders the foreigners are forming good relationships with every entity. If the research was only shared with the government trust could be lost between many relationships; between the people and the researchers/foreigners, between the government and their people. As for the local people themselves, the researchers have no way of ensuring they are conveyed the findings of the study, however, the people trust their local leaders and government and the researchers trust the community heads will provide information they deem as necessary to their people. By conducting their research in this manor all stakeholders are happy, the research is conducted (researchers, organization), a paper will be published (researchers, organizations), and what is learned is shared (researchers, organization, government, community members helping/not helping, people who read the paper). 

 

Implications of the best course of action 

A possible implication is that if the government and community members do not convey the findings to the people they will continue to get sick (possibly) and have the possibility of finding out the water is contaminated from someone else. If this happens they will lose trust in their leaders and foreigners which can cause major political unrest and make the country a hard place to work and visit, ultimately affecting the economy, for foreigners. 

Also if it is not explicitly stated/understood, the government/community may believe that the foreigners are going to find a solution to the water pathogen. The researchers do not have a plan to solve the pathogen contamination issue (per my interpretation of the case) therefore this could cause tension between the foreigner and local government relationship. This issue also has the potential to make the organization backing these researchers look bad and give them a back reputation. This miscommunication will not only have an impact on this venture but any other venture that tries to do work in Lesotho, all trust in foreigners could be lost. The interrelationship between the citizens, government and foreigners would crumble. All trust would be lost and the path to solving this miscommunication (not making it clear that the water situation would be solved) would be a he said she said situation. The citizens would be in the middle and have the most to lose; not only were they betrayed (possibly what they could be feeling from the situation) by the foreigners but they would be destroyed by their own government.

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