16 Narrative Inquiry in Bioethics • Volume 13 • Number 3 • Winter 2023 was on the watch list and who was not, some took the risk and got away. Fortunately, I became one of them and am now physically safe. Since leaving the country, I have lived with the guilt of leaving my friends and family behind. My family feels safer without me, but the thought of not going to the liberated areas, knowing I could do a lot on the ground, burdened me with guilt. Even if I do not stop doing things for the democratic movement online, seeing patients remotely, or networking and coordinating remotely, it will never be enough. That is why, even after two years, I am still working remotely for the people of Burma, hoping that one day we will have the peace we deserve. Along the journey, I have learned many invaluable things, obtained many like-minded and genuine friends, and got to know many inspiring and selfless people. I had to leave a job and the income it provided for two years, then I lost many friends who failed to side with justice and witnessed many people lose their lives. There are a lot of people I have never met face-to-face, but we love and care for each other like blood-related brothers and sisters, just by having the same goal. Many medical professionals in Burma are doing online or on-the-ground medical work without getting paid. All we want is true democracy, the right to health, and for our people to live peacefully. We have been through a lot and learned a lot. Yes, we are exhausted and broken, but we will end this together to bring a beautiful new day for the people of Burma. “One friend here and one friend there Life-now differs, then memories shared Soon will be a day with no despair Just hugs and tears to be laid bare” This is my original poem for my friends who are behind bars. Many of them are waiting for ruthless and meaningless sentences. I hope we get enough international attention just in time so my friends will come out alive soon. For the medical students whose lives have been lost; the doctors who were killed during their medical assistance; the nurses who were sexually assaulted and killed afterward; my brother and sister-like friends who are now in the interrogation centers and in prisons for giving their help to the people—one day, I will see them again. Editor’s Note. NIB policy allows authors to publish anonymously when stories considerably contribute to a symposium but contain highly sensitive information that cannot be de-identified. However, stories are never submitted or accepted anonymously and all authors sign our publication agreement, which upholds standards for responsible authorship. B When a Conflict Collapses on a Child: An (Aborted) Medical Evacuation of a Hazara Toddler During the Kabul Airport Blast and the Taliban Takeover Ayesha Ahmad I work in the capacity of an academic researching conflict in Afghanistan. My commitment is rooted in the firm terrain of friendships that merged into sisterhood of the Afghan terra
{"title":"When a Conflict Collapses on a Child: An (Aborted) Medical Evacuation of a Hazara Toddler During the Kabul Airport Blast and the Taliban Takeover","authors":"Ayesha Ahmad","doi":"10.1353/nib.0.a911255","DOIUrl":"https://doi.org/10.1353/nib.0.a911255","url":null,"abstract":"16 Narrative Inquiry in Bioethics • Volume 13 • Number 3 • Winter 2023 was on the watch list and who was not, some took the risk and got away. Fortunately, I became one of them and am now physically safe. Since leaving the country, I have lived with the guilt of leaving my friends and family behind. My family feels safer without me, but the thought of not going to the liberated areas, knowing I could do a lot on the ground, burdened me with guilt. Even if I do not stop doing things for the democratic movement online, seeing patients remotely, or networking and coordinating remotely, it will never be enough. That is why, even after two years, I am still working remotely for the people of Burma, hoping that one day we will have the peace we deserve. Along the journey, I have learned many invaluable things, obtained many like-minded and genuine friends, and got to know many inspiring and selfless people. I had to leave a job and the income it provided for two years, then I lost many friends who failed to side with justice and witnessed many people lose their lives. There are a lot of people I have never met face-to-face, but we love and care for each other like blood-related brothers and sisters, just by having the same goal. Many medical professionals in Burma are doing online or on-the-ground medical work without getting paid. All we want is true democracy, the right to health, and for our people to live peacefully. We have been through a lot and learned a lot. Yes, we are exhausted and broken, but we will end this together to bring a beautiful new day for the people of Burma. “One friend here and one friend there Life-now differs, then memories shared Soon will be a day with no despair Just hugs and tears to be laid bare” This is my original poem for my friends who are behind bars. Many of them are waiting for ruthless and meaningless sentences. I hope we get enough international attention just in time so my friends will come out alive soon. For the medical students whose lives have been lost; the doctors who were killed during their medical assistance; the nurses who were sexually assaulted and killed afterward; my brother and sister-like friends who are now in the interrogation centers and in prisons for giving their help to the people—one day, I will see them again. Editor’s Note. NIB policy allows authors to publish anonymously when stories considerably contribute to a symposium but contain highly sensitive information that cannot be de-identified. However, stories are never submitted or accepted anonymously and all authors sign our publication agreement, which upholds standards for responsible authorship. B When a Conflict Collapses on a Child: An (Aborted) Medical Evacuation of a Hazara Toddler During the Kabul Airport Blast and the Taliban Takeover Ayesha Ahmad I work in the capacity of an academic researching conflict in Afghanistan. My commitment is rooted in the firm terrain of friendships that merged into sisterhood of the Afghan terra","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136094027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Healthcare Under Fire: Stories from Healthcare Workers During Armed Conflict 21 of feces in burn pits, and the dehydrating restless nights in the sweltering heat. I was depressed that I would likely miss the birth of my bride’s and my fifth child. The initial ambivalence of our efforts turned to hopefulness but now devolved into despair. We cared for epidemics of dysentery, renal stones from dehydration, and a child struck by a Humvee, looking to get an MRE. His father shared with me about his community’s exhaustion from decades of war, first with Iran, then amongst themselves , and now with the U.S. He longed for peace. Providence smiled into my small world, and my company commander told me while standing in his skivvies in the shower tent that I could re-deploy home with a convoy to Kuwait.After a long journey through the desert and a period of waiting in tents again in Kuwait, I took a 72-hour sleepless, convoluted journey home. We were treated like royalty by the lovely flight attendants on chartered commercial flights. We arrived on the parade deck, greeted as heroes, some of the first to return from war. Hours later, at 0530, our baby girl burst into this turbulent world. Sleep deprived again and overcome by a wave of joy interspersed with the ambivalence of what I just took part in, I sobbed uncontrollably on the phone with my mother. Then I was fine. I moved ahead, caring for my family, my patients, serving my country, and teaching the next generation of physicians. Before completing my Navy career, I deployed once more, this time to Afghanistan in 2011, another war that ended in futility. Years later as I reflect back on the Iraq war, I sometimes wonder if we received a divine, “You’ll reap what you sow,” for the debacle we embarked on in 2003. We did not usher in a new era of freedom in Iraq. Instead, over 4,000 allied troops perished and more than one hundred thousand Iraqis died violent deaths. Waves of suicide bombings continue to rock the country. Political instability checkered with terrorists persists. Thousands more American Veterans were permanently maimed—mentally or physically. As the aphorism declares, war is definitely hell on earth. I am thankful to have served my country even amongst the vagaries and vicissitudes of war, but perhaps Pope Saint John Paul II was right: war is a defeat for humanity. I now cling less to the ideals of political and economic freedom and more to the beatitude: Blessed are the peacemakers, for they will be called the children of God. B Providing Care to a Potential Aggressor: An Ethical Dilemma Handreen Mohammed Saeed F ollowing the abrupt fall of almost a third of its territory in 2014 to armed militias, Iraq fell into civil war turmoil. As a direct result of the armed conflicts, hundreds of thousands of Iraqis were displaced or subjected to atrocious human rights violations with physical, sexual, and psychosocial abuse. While the scenes on the TV provided only a glimpse of what was happening o
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28 Narrative Inquiry in Bioethics • Volume 13 • Number 3 • Winter 2023 York Times Magazine, 18 May 2012). This particular NGO refused to accept any patient who had received surgery at a NATO facility, with one of its leaders saying, “It’s better to let (a patient) die than to suffer while going from one hospital to another.” The article stung. We did care about those patients whom we sent to Mirwais and KRMH. We wanted to give them the best possible chance at recovery. We tried to send them along with enough information for their new caregivers to manage them, with enough supplies to make it work. Perhaps we would have had more success if we had a way to build professional connections with our counterparts at Mirwais, but security concerns made that nearly impossible. “Greenon -blue” attacks were common in 2012, when individual ANSF personnel would attack coalition personnel, and Mirwais Hospital had been attacked by militants more than once. Transitions of care, when a patient is transferred from the care of one team to another, are risky times even when they occur within a single hospital in the U.S. The risk is magnified when that transition occurs between two hospitals in an active war zone who speak different languages with widely divergent capabilities. The article did sting, but there was truth to it. We were failing these patients, or at least some of them. Over 16,000 civilian trauma victims received care at U.S. military hospitals during the wars in Afghanistan and Iraq. Over 90% of them survived their initial hospitalizations, although an unknown (to me, anyways) number succumbed to injury and infection later. All of our patients received the same standard of care at the time of presentation; it was the follow-up that diverged. I had no solution for this at the time, and I do not have a good one now. When you look at the spectrum of resources utilized across our patient groups (i.e., airborne ECMO for NATO forces versus ground transfer to an ICRC hospital for an Afghan villager), it troubled me that the wounded civilians seemed to come up last. So what are the limits of our obligations in war? NATO policy stated that our obligation was for emergency care only; we were not equipped to manage these patients for the long term. We did the best we could with the tools we had and hopefully gave them better odds than a local hospital. In other conflicts, NGOs might have been able to fill the void, but many of these groups prize their neutrality and are understandably reluctant to coordinate with the U.S. military. The deliberate targeting of medical facilities in war has also made their work increasingly hazardous, both for local caregivers or NGOs. While undoubtedly courageous people, I do question the morality of the NGO that refused to care for any patient we had touched before. I will not defend the wisdom of our discharge policies, but punishing these patients for our failures is also hard for me to defend. Before I went home, I updated
{"title":"A Liberating Breath","authors":"Elizabeth Dotsenko","doi":"10.1353/nib.0.a911240","DOIUrl":"https://doi.org/10.1353/nib.0.a911240","url":null,"abstract":"28 Narrative Inquiry in Bioethics • Volume 13 • Number 3 • Winter 2023 York Times Magazine, 18 May 2012). This particular NGO refused to accept any patient who had received surgery at a NATO facility, with one of its leaders saying, “It’s better to let (a patient) die than to suffer while going from one hospital to another.” The article stung. We did care about those patients whom we sent to Mirwais and KRMH. We wanted to give them the best possible chance at recovery. We tried to send them along with enough information for their new caregivers to manage them, with enough supplies to make it work. Perhaps we would have had more success if we had a way to build professional connections with our counterparts at Mirwais, but security concerns made that nearly impossible. “Greenon -blue” attacks were common in 2012, when individual ANSF personnel would attack coalition personnel, and Mirwais Hospital had been attacked by militants more than once. Transitions of care, when a patient is transferred from the care of one team to another, are risky times even when they occur within a single hospital in the U.S. The risk is magnified when that transition occurs between two hospitals in an active war zone who speak different languages with widely divergent capabilities. The article did sting, but there was truth to it. We were failing these patients, or at least some of them. Over 16,000 civilian trauma victims received care at U.S. military hospitals during the wars in Afghanistan and Iraq. Over 90% of them survived their initial hospitalizations, although an unknown (to me, anyways) number succumbed to injury and infection later. All of our patients received the same standard of care at the time of presentation; it was the follow-up that diverged. I had no solution for this at the time, and I do not have a good one now. When you look at the spectrum of resources utilized across our patient groups (i.e., airborne ECMO for NATO forces versus ground transfer to an ICRC hospital for an Afghan villager), it troubled me that the wounded civilians seemed to come up last. So what are the limits of our obligations in war? NATO policy stated that our obligation was for emergency care only; we were not equipped to manage these patients for the long term. We did the best we could with the tools we had and hopefully gave them better odds than a local hospital. In other conflicts, NGOs might have been able to fill the void, but many of these groups prize their neutrality and are understandably reluctant to coordinate with the U.S. military. The deliberate targeting of medical facilities in war has also made their work increasingly hazardous, both for local caregivers or NGOs. While undoubtedly courageous people, I do question the morality of the NGO that refused to care for any patient we had touched before. I will not defend the wisdom of our discharge policies, but punishing these patients for our failures is also hard for me to defend. Before I went home, I updated ","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136094215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Healthcare Under Fire: Stories from Healthcare Workers During Armed Conflict 13 asked for help with two things. I wanted to know what happened to the team and how to save them. The first request was met with appeasement, the second with hope for the best. Eventually, every organization had its limits and mandates. None of them had the mandate to save trapped data collectors in a village that was thought to be safe when randomly selected. Under fire, embarrassingly little is certain and what can be done is even less. Those were the hardest five days in the field. The task at hand was not only about finding my missing children but about keeping the survey running by the other teams who had to travel outside Nyala. I could see the fear in their eyes and feel it in their words. They had to make the hard choice between risking their lives and the payment they received that was at least four-fold what they would get from their governmental jobs. Finally, a call came. It was the one I was waiting for. The team leader told me in a tired voice, made even worse by the terrible signal that made his voice sound as if it were coming from a cave, that they managed to escape the village. They were all physically safe and he spared me the uncomfortable task of asking about the survey data by adding, ‘And we have the filled questionnaires with us.’ I cannot recall any comparable moment of relief. I called all the worried mothers and when the team arrived a day later, I joined them at each of their houses. No words could describe the feelings, the tears of joy, and the gaze of blame when the mothers saw their children safe. I gave them a break before asking them if they wanted to continue with the survey. I had to have an eye on the progress, the decaying budget spent on the daily payments, per diems, rentals, etc. and handle the growing feelings of concern. The headquarters in Khartoum was generous enough to send me an extra budget and a week’s extension. Seems like a happy end, right? I am not sure if a completed survey and well-paid yet traumatized young men and women counts as one. I had to move on and fly back to Khartoum, according to the plan for data entry and data analysis. The final reports had all the numbers the United Nations and the government needed. Very few people knew what the stories behind each of these numbers were. Even fewer people cared to know what the story is. We went to do a well-paid job and we did. When I returned to my office in Khartoum, one of my welcoming colleagues tried to tease me by saying, “Welcome the Lord of War!” with a smile on his face hinting at the generous payment I received. I smiled back and said, “You are right. I feel like one, but I bet you Nicholas Cage was paid much more.” I was referring to the movie that starred him with the same name. What made me feel less of a ‘Lord of War’ was a promise I gave to the people I left behind to make sure their stories remain alive and not hidden between the lines of the gra
战地医疗:武装冲突期间医护人员的故事我在两件事上寻求帮助。我想知道团队出了什么事，如何拯救他们。第一个请求得到了安抚，第二个请求得到了最好的希望。最终，每个组织都有其限制和授权。他们都没有任务去拯救被困在一个村庄的数据收集者，当随机选择时，他们被认为是安全的。在炮火之下，令人尴尬的是，几乎没有什么是确定的，而能做的事情就更少了。那是战场上最艰难的五天。手头的任务不仅是找到我失踪的孩子，还要让其他不得不离开尼亚拉的小组继续进行调查。我能看到他们眼中的恐惧，也能从他们的话中感受到。他们不得不做出艰难的选择，是冒着生命危险，还是领取至少是他们在政府工作所得四倍的报酬。最后，电话来了。这是我一直在等的。队长用疲惫的声音告诉我，他们设法逃离了村庄，他的声音听起来像是从山洞里发出来的可怕信号，使他的声音变得更糟。他们的身体都很安全，他免去了我询问调查数据的尴尬任务，他补充说:“我们带着填好的调查问卷。”“我想不起还有什么比这更轻松的时刻了。我给所有忧心忡忡的妈妈们打了电话，一天后救援队到达时，我去了她们每个人的家里。当母亲们看到自己的孩子安然无恙时，她们喜悦的泪水和责备的目光是无法用言语形容的。我让他们休息一下，然后问他们是否想继续调查。我必须密切关注事态的发展，关注日常支出、日常津贴、租金等方面的预算支出，并处理日益增长的担忧情绪。喀土穆的总部非常慷慨，给了我额外的预算和一周的延期。看起来是个皆大欢喜的结局，对吧?我不确定一项完整的调查和高薪但受到精神创伤的年轻男女是否算在一起。根据数据输入和数据分析的计划，我必须继续前进，飞回喀土穆。最终报告包含了联合国和政府需要的所有数据。很少有人知道这些数字背后的故事。更少的人关心这个故事是什么。我们去做一份高薪的工作，我们做到了。当我回到喀土穆的办公室时，一位欢迎我的同事试图取笑我说:“欢迎战争之主!他脸上带着微笑，暗示着我收到了丰厚的报酬。我也笑着说:“你说得对。我觉得自己是一个，但我敢打赌尼古拉斯·凯奇的薪水要高得多。”我指的是他主演的同名电影。让我觉得自己不那么像“战争之王”的是我给那些我离开的人的承诺，我要确保他们的故事继续存在，而不是隐藏在下一次调查报告的图表之间。我在多伦多大学生物伦理学硕士课程上提交的几乎所有作业都是关于达尔富尔和达尔富尔人民的。我在伯明翰大学(University of Birmingham)的生物伦理学博士学位就是关于它们的，并致力于研究它们。我在这里与你们分享这个故事，是希望当你们看到下一个在武装冲突中进行的调查报告时，你们会看到人们。你会听到人们的声音。你会感受到人们——不仅是那些被调查者，还有调查者。我们都是值得讲述的故事的一部分。我曾经在一个比许多大城市还不发达的邦当过医生…
{"title":"Healthcare Under Fire (Myanmar)","authors":"One Exiled Doctor","doi":"10.1353/nib.0.a911244","DOIUrl":"https://doi.org/10.1353/nib.0.a911244","url":null,"abstract":" Healthcare Under Fire: Stories from Healthcare Workers During Armed Conflict 13 asked for help with two things. I wanted to know what happened to the team and how to save them. The first request was met with appeasement, the second with hope for the best. Eventually, every organization had its limits and mandates. None of them had the mandate to save trapped data collectors in a village that was thought to be safe when randomly selected. Under fire, embarrassingly little is certain and what can be done is even less. Those were the hardest five days in the field. The task at hand was not only about finding my missing children but about keeping the survey running by the other teams who had to travel outside Nyala. I could see the fear in their eyes and feel it in their words. They had to make the hard choice between risking their lives and the payment they received that was at least four-fold what they would get from their governmental jobs. Finally, a call came. It was the one I was waiting for. The team leader told me in a tired voice, made even worse by the terrible signal that made his voice sound as if it were coming from a cave, that they managed to escape the village. They were all physically safe and he spared me the uncomfortable task of asking about the survey data by adding, ‘And we have the filled questionnaires with us.’ I cannot recall any comparable moment of relief. I called all the worried mothers and when the team arrived a day later, I joined them at each of their houses. No words could describe the feelings, the tears of joy, and the gaze of blame when the mothers saw their children safe. I gave them a break before asking them if they wanted to continue with the survey. I had to have an eye on the progress, the decaying budget spent on the daily payments, per diems, rentals, etc. and handle the growing feelings of concern. The headquarters in Khartoum was generous enough to send me an extra budget and a week’s extension. Seems like a happy end, right? I am not sure if a completed survey and well-paid yet traumatized young men and women counts as one. I had to move on and fly back to Khartoum, according to the plan for data entry and data analysis. The final reports had all the numbers the United Nations and the government needed. Very few people knew what the stories behind each of these numbers were. Even fewer people cared to know what the story is. We went to do a well-paid job and we did. When I returned to my office in Khartoum, one of my welcoming colleagues tried to tease me by saying, “Welcome the Lord of War!” with a smile on his face hinting at the generous payment I received. I smiled back and said, “You are right. I feel like one, but I bet you Nicholas Cage was paid much more.” I was referring to the movie that starred him with the same name. What made me feel less of a ‘Lord of War’ was a promise I gave to the people I left behind to make sure their stories remain alive and not hidden between the lines of the gra","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136094804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
26 Narrative Inquiry in Bioethics • Volume 13 • Number 3 • Winter 2023 my life, because I think that my story can add selfconfidence to other people in a military conflict and humanitarian crisis. B The Limits of Our Obligations Ryan C. Maves Disclaimers. No funding was utilized for this manuscript. Dr. Maves is a retired U.S. Navy officer, and the opinions contained herein are his own. The opinions in this manuscript do not reflect the official opinion of the Department of the Navy, Department of Defense, nor of the U.S. Government. I n 2012, I was a commander in the United States Navy, deployed to the NATO Role 3 Multinational Medical Unit in KandaharAirfield (KAF), Afghanistan. The KAF Role 3 began as a tent hospital under Canadian command, built along the flight line at Ahmad Shah Baba International Airport as part of an expanding NATO base. By the time of my arrival, it was a small but capable brick-andmortar building under U.S. Navy command, with four operating rooms, two CT scanners, and a busy intensive care unit (ICU). Not long before my deployment, the KAF Role 3 was described as one of the busiest trauma hospitals in the world. Casualties arrived every day, usually by helicopter. Blast injuries from improvised explosive devices (IEDs) were common, ranging in severity from concussions in passengers in armored vehicles, to multiple amputations from blast injuries with concomitant thoracic, abdominal, and pelvic trauma. KAF had a daytime population of over 30,000 in 2012, and our hospital was effectively the referral center for the region, so patients with non-surgical diagnoses were similarly common: myocardial infarctions, seizures, pulmonary emboli, and endemic infections, to name a few. As an infectious disease (I.D.) specialist, I functioned mainly as a hospitalist, managing patients postoperatively, but I also provided any consultative support when needed. During mass casualty events, the intensivists and I would act as backups in the trauma bay, freeing up the surgeons for the most acutely injured patients. It turned out that an I.D. doctor’s skillset lent itself well to acute trauma evaluations; we are well known for having an eye for fine details, combined with low-grade paranoia. These traits served me well during what I came to describe as “my involuntary trauma fellowship.” Our patients could be divided into five key groups: Afghan National Security Forces (ANSF, including the army and national police), nonAfghan coalition military (mostly U.S. and other NATO members), Afghan civilians, NATO civilian contract staff, and the Taliban. Our approach to each of these groups was different. For all patient groups, we would provide the same emergency care, including acute resuscitation and immediate life-saving surgery. It was after this emergency care period that our management plans diverged. For coalition forces, our next priority after acute resuscitation and stabilization was to assess whether a patient could remain in theater. S
{"title":"The Limits of Our Obligations","authors":"Ryan C. Maves","doi":"10.1353/nib.0.a911250","DOIUrl":"https://doi.org/10.1353/nib.0.a911250","url":null,"abstract":"26 Narrative Inquiry in Bioethics • Volume 13 • Number 3 • Winter 2023 my life, because I think that my story can add selfconfidence to other people in a military conflict and humanitarian crisis. B The Limits of Our Obligations Ryan C. Maves Disclaimers. No funding was utilized for this manuscript. Dr. Maves is a retired U.S. Navy officer, and the opinions contained herein are his own. The opinions in this manuscript do not reflect the official opinion of the Department of the Navy, Department of Defense, nor of the U.S. Government. I n 2012, I was a commander in the United States Navy, deployed to the NATO Role 3 Multinational Medical Unit in KandaharAirfield (KAF), Afghanistan. The KAF Role 3 began as a tent hospital under Canadian command, built along the flight line at Ahmad Shah Baba International Airport as part of an expanding NATO base. By the time of my arrival, it was a small but capable brick-andmortar building under U.S. Navy command, with four operating rooms, two CT scanners, and a busy intensive care unit (ICU). Not long before my deployment, the KAF Role 3 was described as one of the busiest trauma hospitals in the world. Casualties arrived every day, usually by helicopter. Blast injuries from improvised explosive devices (IEDs) were common, ranging in severity from concussions in passengers in armored vehicles, to multiple amputations from blast injuries with concomitant thoracic, abdominal, and pelvic trauma. KAF had a daytime population of over 30,000 in 2012, and our hospital was effectively the referral center for the region, so patients with non-surgical diagnoses were similarly common: myocardial infarctions, seizures, pulmonary emboli, and endemic infections, to name a few. As an infectious disease (I.D.) specialist, I functioned mainly as a hospitalist, managing patients postoperatively, but I also provided any consultative support when needed. During mass casualty events, the intensivists and I would act as backups in the trauma bay, freeing up the surgeons for the most acutely injured patients. It turned out that an I.D. doctor’s skillset lent itself well to acute trauma evaluations; we are well known for having an eye for fine details, combined with low-grade paranoia. These traits served me well during what I came to describe as “my involuntary trauma fellowship.” Our patients could be divided into five key groups: Afghan National Security Forces (ANSF, including the army and national police), nonAfghan coalition military (mostly U.S. and other NATO members), Afghan civilians, NATO civilian contract staff, and the Taliban. Our approach to each of these groups was different. For all patient groups, we would provide the same emergency care, including acute resuscitation and immediate life-saving surgery. It was after this emergency care period that our management plans diverged. For coalition forces, our next priority after acute resuscitation and stabilization was to assess whether a patient could remain in theater. S","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136094807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Healthcare Under Fire: Stories from Healthcare Workers During Armed Conflict 23 heightened emotions, the fundamental principles of healthcare services rooted in medical ethics and the obligation to provide impartial and neutral treatment to all patients without discrimination or judgement , as per the Hippocratic Oath, were clearly at stake. While this situation provided us all in the humanitarian agency with an opportunity to reflect as human beings first and as humanitarian workers second, we were determined to tackle the ethical dilemma sensitively while upholding the principles of medical ethics. These principles required us to provide care without discrimination to anybody seeking medical assistance in our facilities. Therefore , we held several meetings with staff members. The primary objective of these group meetings was to reorient staff members about medical ethics and their roles as healthcare professionals and to truly listen to their stories, thoughts, and feelings as we embarked on the emotionally charged and sensitive mission of providing care to our patients. We reviewed our organization’s code of conduct and discussed medical ethics as professionals, exploring our perspectives on similar situations. One of the agency’s international workers remarked, “This is a very unique and unprecedented situation that I have not encountered previously”. Finding a balance between emotional reactions and medical ethics was challenging at the beginning . However, as we deeply reflected on our duties and responsibilities as healthcare providers, we began to realize that medical facilities are not courtrooms, and we should never assume the roles of judges or law enforcement agents. While we were all deeply affected by listening to our coworkers’ stories, feelings, and emotions, we agreed that the duty of care, a fundamental principle guiding our work as healthcare professionals, needed to be our overarching guide in this situation. We understood that those who committed crimes or violated human rights deserved to be prosecuted by law once outside the medical facility. This situation served as a reminder to me personally that we, as healthcare workers, are human beings after all, with our own emotions and feelings. These aspects can be affected and have an impact on our work. We are not simply robotic creatures expected to work and serve neutrally one hundred percent of the time; however, we need to have flexibility, courage, and willingness to reflect on our daily interactions with our patients and coworkers to expand our understanding of the emotions and feelings of all involved in order to create an understanding and resilient way of thinking at our workplaces. B One Surgeon’s Experience During Armed Conflict In Ukraine Artem Riga S hortly before the war, I completed my postgraduate studies for my PhD degree and became a young teacher at a medical university , gaining academic experience. And I carried out my surgical clinical practice on duty
{"title":"One Surgeon’s Experience During Armed Conflict In Ukraine","authors":"Artem Riga","doi":"10.1353/nib.0.a911246","DOIUrl":"https://doi.org/10.1353/nib.0.a911246","url":null,"abstract":" Healthcare Under Fire: Stories from Healthcare Workers During Armed Conflict 23 heightened emotions, the fundamental principles of healthcare services rooted in medical ethics and the obligation to provide impartial and neutral treatment to all patients without discrimination or judgement , as per the Hippocratic Oath, were clearly at stake. While this situation provided us all in the humanitarian agency with an opportunity to reflect as human beings first and as humanitarian workers second, we were determined to tackle the ethical dilemma sensitively while upholding the principles of medical ethics. These principles required us to provide care without discrimination to anybody seeking medical assistance in our facilities. Therefore , we held several meetings with staff members. The primary objective of these group meetings was to reorient staff members about medical ethics and their roles as healthcare professionals and to truly listen to their stories, thoughts, and feelings as we embarked on the emotionally charged and sensitive mission of providing care to our patients. We reviewed our organization’s code of conduct and discussed medical ethics as professionals, exploring our perspectives on similar situations. One of the agency’s international workers remarked, “This is a very unique and unprecedented situation that I have not encountered previously”. Finding a balance between emotional reactions and medical ethics was challenging at the beginning . However, as we deeply reflected on our duties and responsibilities as healthcare providers, we began to realize that medical facilities are not courtrooms, and we should never assume the roles of judges or law enforcement agents. While we were all deeply affected by listening to our coworkers’ stories, feelings, and emotions, we agreed that the duty of care, a fundamental principle guiding our work as healthcare professionals, needed to be our overarching guide in this situation. We understood that those who committed crimes or violated human rights deserved to be prosecuted by law once outside the medical facility. This situation served as a reminder to me personally that we, as healthcare workers, are human beings after all, with our own emotions and feelings. These aspects can be affected and have an impact on our work. We are not simply robotic creatures expected to work and serve neutrally one hundred percent of the time; however, we need to have flexibility, courage, and willingness to reflect on our daily interactions with our patients and coworkers to expand our understanding of the emotions and feelings of all involved in order to create an understanding and resilient way of thinking at our workplaces. B One Surgeon’s Experience During Armed Conflict In Ukraine Artem Riga S hortly before the war, I completed my postgraduate studies for my PhD degree and became a young teacher at a medical university , gaining academic experience. And I carried out my surgical clinical practice on duty ","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136094034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vladyslava Kachkovska, Iryna Dudchenko, Anna Kovchun, Lyudmyla Prystupa
Healthcare Under Fire: Stories from Healthcare Workers During Armed Conflict 7 and defined genetic alterations for further targeted treatment in Ukraine or abroad. Lastly, our laboratory provided free-of-charge laboratory testing for servicemen of the armed forces of Ukraine and started social action to help people with mental health problems. On June 27, 2023, Post Traumatic Stress Disorder (PTSD) Awareness Day, we arranged a conference on PTSD and Post Traumatic Growth (PTG) to promote knowledge about PTSD among general practice physicians and military doctors. The conference gathered more than 300 physicians, psychologists, psychotherapists, psychiatrists, volunteers, social workers, and international experts in the field of mental health. It allowed the attendees to share knowledge and best practices and build a strong professional community in Ukraine committed to helping people with mental health challenges under continuous war-related psychological traumas and uncertainty. We thank all our laboratory staff for their selfless work despite these many challenges and threats. Under such extraordinary conditions, we have been able to keep up with the demand for our services, performing all necessary testing to give patients and physicians timely and precise laboratory diagnostics. Slava Ukraini! Acknowledgement. The authors thank Dr. Emily Anderson, Professor, Neiswanger Institute for Bioethics, Stritch School of Medicine, Loyola University Chicago for her continuous spiritual and professional support. B Why We Stay Vladyslava Kachkovska, Iryna Dudchenko, Anna Kovchun & Lyudmyla Prystupa W e are a group of physicians and professors in the Department of internal medicine at Sumy State University in Ukraine, located 20 miles from the border with Russia. We have been working together for ten years and, against the background of the war, have become more than colleagues, more than a hematologist , an allergist, a pulmonologist and a rheumatologist . We are now one organism that works for the benefit of patients, coordinating humanitarian supplies, teaching medical students, and at the same time worrying incredibly about our children, but trying to maintain our psychological homeostasis. Over the past year and a half, we have learned many things. Dividing everything that surrounds us into primary and secondary concerns, we learn how to live without electricity during the winter and how to preserve the water supply. We realize material possessions are not important, as at any moment you may lose everything. After covering the basic needs of our families, we do not try to save money, but rather the opposite: we spend all the rest on drugs and supplies for those who are in need now. Of all that we have learned, one thing we have not learned is indifference, which is not possible during this time of constant loss of acquaintances, colleagues, and friends. We find balance only in our constant work. We have patients with medically complex conditions, an
{"title":"Why We Stay","authors":"Vladyslava Kachkovska, Iryna Dudchenko, Anna Kovchun, Lyudmyla Prystupa","doi":"10.1353/nib.0.a911254","DOIUrl":"https://doi.org/10.1353/nib.0.a911254","url":null,"abstract":" Healthcare Under Fire: Stories from Healthcare Workers During Armed Conflict 7 and defined genetic alterations for further targeted treatment in Ukraine or abroad. Lastly, our laboratory provided free-of-charge laboratory testing for servicemen of the armed forces of Ukraine and started social action to help people with mental health problems. On June 27, 2023, Post Traumatic Stress Disorder (PTSD) Awareness Day, we arranged a conference on PTSD and Post Traumatic Growth (PTG) to promote knowledge about PTSD among general practice physicians and military doctors. The conference gathered more than 300 physicians, psychologists, psychotherapists, psychiatrists, volunteers, social workers, and international experts in the field of mental health. It allowed the attendees to share knowledge and best practices and build a strong professional community in Ukraine committed to helping people with mental health challenges under continuous war-related psychological traumas and uncertainty. We thank all our laboratory staff for their selfless work despite these many challenges and threats. Under such extraordinary conditions, we have been able to keep up with the demand for our services, performing all necessary testing to give patients and physicians timely and precise laboratory diagnostics. Slava Ukraini! Acknowledgement. The authors thank Dr. Emily Anderson, Professor, Neiswanger Institute for Bioethics, Stritch School of Medicine, Loyola University Chicago for her continuous spiritual and professional support. B Why We Stay Vladyslava Kachkovska, Iryna Dudchenko, Anna Kovchun & Lyudmyla Prystupa W e are a group of physicians and professors in the Department of internal medicine at Sumy State University in Ukraine, located 20 miles from the border with Russia. We have been working together for ten years and, against the background of the war, have become more than colleagues, more than a hematologist , an allergist, a pulmonologist and a rheumatologist . We are now one organism that works for the benefit of patients, coordinating humanitarian supplies, teaching medical students, and at the same time worrying incredibly about our children, but trying to maintain our psychological homeostasis. Over the past year and a half, we have learned many things. Dividing everything that surrounds us into primary and secondary concerns, we learn how to live without electricity during the winter and how to preserve the water supply. We realize material possessions are not important, as at any moment you may lose everything. After covering the basic needs of our families, we do not try to save money, but rather the opposite: we spend all the rest on drugs and supplies for those who are in need now. Of all that we have learned, one thing we have not learned is indifference, which is not possible during this time of constant loss of acquaintances, colleagues, and friends. We find balance only in our constant work. We have patients with medically complex conditions, an","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136094820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oksana Sulaieva, Anna Shcherbakova, Oleksandr Dudin
4 Narrative Inquiry in Bioethics • Volume 13 • Number 3 • Winter 2023 there supporting them, fighting for them? There are intense feelings of guilt that dwell within. ********** Spring 2021, Spring 2023, The ‘Shorter’ Wars: How To Feel Worthless And How To Seek Distraction I keep working in the offices of humanitarian organisations during deadly attacks. The shorter wars. My hospital colleagues leave home and go to work exactly as they always do, as I used to do. They risk travelling through bombardment, venturing into target sites for military attacks to get to the places meant to cure and care. Fearing they will not see their families again, they compose their faces. As they always do, as I used to do. I am safer at home now. My conscience weighs heavily again. I should be in the hospital with them, facing their challenges through attacks. Does this make me worthless in war? I cannot be distracted now by tending to babies. I sit at my computer. I do not sleep. The night times are the worst. I drown myself in work tasks. I try from afar to mobilise medical teams to respond. There is little satisfaction in this if I cannot be there with them, helping, serving, accompanying. I decide to bake a cake. ********** Winter, Spring, Autumn, Summer, Any Day: How We Keep Caring Living here and working here as a doctor brings physical and mental burdens. The crushing exhaustion , the personal risks, the harrowing choices, the helplessness, the guilt, the unworthiness, the terror of seeing death and becoming dead. We all need a break. We all need a holiday. We all need to go outside. Where can we even go? Who is looking after us? But the burden and the dread are always swallowed by the deepest urge to care. Because it is within us. Because we do not want to see their families grieve. Because their families are us. Because we love. Because that is what we have to do. What alternative do we have? We must keep caring while walking through our pain. Autumn 2023 Now: How Can We Keep Caring? This was all before. The now has changed everything. I have doctor friends who have died under bombs whilst holding their children or their mothers . I have doctor friends forced to choose between remaining with patients and evacuating their families. Those who stay work to save lives, triage injuries and write the names of babies on the torsos of tiny lifeless bodies, over, and over. Without supplies, sleep, food or water, without their homes left standing, with nothing left but their grace and their humanity. As doctors in Gaza now, we weep an unbearable grief. We no longer know if we can keep caring. B Adjusting Laboratory Practices to the Challenges of Wartime Oksana Sulaieva, Anna Shcherbakova & Oleksandr Dudin A fter 500 days of the unjust war initiated by the Russians, we look back to reflect on the challenges our medical laboratory faced during these early days. On the morning of February 24th , we were awakened by the dreadful roar of sirens, the sound of which filled
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Healthcare Under Fire: Stories from Healthcare Workers During Armed Conflict 31 that situation could be classified as so. I took some time to analyse the situation and consult with others . The ethics of the situation were ambiguous—if we helped one patient to shortcut the patient route system, should we be prepared to help all our patients in the same way? Nevertheless, I decided to ask the director for help and support for Lady S. We agreed, that she would arrive on the scheduled day for tests, and the hospital would take care of her during all the next stages of care. At the time, I was in the other region, therefore all those agreements were done by phone. In the end, Lady S was hospitalized and received all the necessary treatment and surgery. The time of her surgery was around the invasion anniversary. It was a difficult time for everyone. Some patients reported that they felt an irrational urge to flee even from the safer western Ukraine. Lady S also had a mentally difficult period, but she wanted to return to her home in the Kharkiv region, some 50 kilometers from the Russian border and much closer to the frontline. Once she disappeared from the region, the hospital administration was searching for her and called us. The psychotherapist and I didn’t know how to approach this situation. On the one hand, we had more of a history with her and knew more personal information about her. On the other hand, not being part of the hospital administration , it was not our responsibility to search for her. Even though, at one time we crossed our usual scope of the help we provide, should we do it one more time? We had a long conversation with the psychotherapist and discussed all possible options. We even discussed the prospect that she returned to a heavily shelled home because she was tired of being an IDP. We decided to provide our private numbers for her relatives, so in case lady S wanted to reach out, she could and knew we were open to hearing from her despite her relocation back to the Kharkiv region. We were very happy to hear that all went well. She came back to the guesthouse for a few days. She is one of the patients with whom I became fairly close. Even though I didn’t visit the field for a while as I was doing other work, very often, our psychotherapist reported back to me about how Lady’s S was doing. Some eyes of the patients I remember more than others, and some kid’s paintings remain with me always. Sometimes I wonder if it is just to feel more compassion for some people than for others. I sincerely hope that each of the people we work with has at least one person in the world to share their worries and thoughts with even if they are far away because only our relations with other people make us humans. B Soldiers of the Invisible Front: How Ukrainian Therapists Are Fighting for the Mental Health of the Nation Under Fire Irina Deyneka & Eva Regel Irina Deyneka W hen the Russian army attacked my country , I became a volunteer for a h
{"title":"Soldiers of the Invisible Front: How Ukrainian Therapists Are Fighting for the Mental Health of the Nation Under Fire","authors":"Irina Deyneka, Eva Regel","doi":"10.1353/nib.0.a911248","DOIUrl":"https://doi.org/10.1353/nib.0.a911248","url":null,"abstract":" Healthcare Under Fire: Stories from Healthcare Workers During Armed Conflict 31 that situation could be classified as so. I took some time to analyse the situation and consult with others . The ethics of the situation were ambiguous—if we helped one patient to shortcut the patient route system, should we be prepared to help all our patients in the same way? Nevertheless, I decided to ask the director for help and support for Lady S. We agreed, that she would arrive on the scheduled day for tests, and the hospital would take care of her during all the next stages of care. At the time, I was in the other region, therefore all those agreements were done by phone. In the end, Lady S was hospitalized and received all the necessary treatment and surgery. The time of her surgery was around the invasion anniversary. It was a difficult time for everyone. Some patients reported that they felt an irrational urge to flee even from the safer western Ukraine. Lady S also had a mentally difficult period, but she wanted to return to her home in the Kharkiv region, some 50 kilometers from the Russian border and much closer to the frontline. Once she disappeared from the region, the hospital administration was searching for her and called us. The psychotherapist and I didn’t know how to approach this situation. On the one hand, we had more of a history with her and knew more personal information about her. On the other hand, not being part of the hospital administration , it was not our responsibility to search for her. Even though, at one time we crossed our usual scope of the help we provide, should we do it one more time? We had a long conversation with the psychotherapist and discussed all possible options. We even discussed the prospect that she returned to a heavily shelled home because she was tired of being an IDP. We decided to provide our private numbers for her relatives, so in case lady S wanted to reach out, she could and knew we were open to hearing from her despite her relocation back to the Kharkiv region. We were very happy to hear that all went well. She came back to the guesthouse for a few days. She is one of the patients with whom I became fairly close. Even though I didn’t visit the field for a while as I was doing other work, very often, our psychotherapist reported back to me about how Lady’s S was doing. Some eyes of the patients I remember more than others, and some kid’s paintings remain with me always. Sometimes I wonder if it is just to feel more compassion for some people than for others. I sincerely hope that each of the people we work with has at least one person in the world to share their worries and thoughts with even if they are far away because only our relations with other people make us humans. B Soldiers of the Invisible Front: How Ukrainian Therapists Are Fighting for the Mental Health of the Nation Under Fire Irina Deyneka & Eva Regel Irina Deyneka W hen the Russian army attacked my country , I became a volunteer for a h","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136094829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel H. Kim, Emily R. Berkman, Jonna D. Clark, N. Saifee, D. Diekema, M. Lewis-Newby
There is a growing trend of refusal of blood transfusions from COVID-19 vaccinated donors. We highlight three cases where parents have refused blood transfusions from COVID-19 vaccinated donors on behalf of their children in the setting of congenital cardiac surgery. These families have also requested accommodations such as explicit identification of blood from COVID-19 vaccinated donors, directed donation from a COVID19 unvaccinated family member, or use of a non-standard blood supplier. We address the ethical challenges posed by these issues. We describe the current screening and safety processes for standard blood donation and explore the importance of donor anonymity and challenges with directed donation and non-standard blood suppliers. We present an ethical framework using the Best Interest Standard, the Zone of Parental Discretion, and the Harm Principle when considering these refusals. Finally, we provide recommendations for how to approach these requests as they potentially become more commonplace in pediatrics.
{"title":"Parental Refusals of Blood Transfusions from COVID-19 Vaccinated Donors for Children Needing Cardiac Surgery","authors":"Daniel H. Kim, Emily R. Berkman, Jonna D. Clark, N. Saifee, D. Diekema, M. Lewis-Newby","doi":"10.1353/nib.0.a904612","DOIUrl":"https://doi.org/10.1353/nib.0.a904612","url":null,"abstract":"There is a growing trend of refusal of blood transfusions from COVID-19 vaccinated donors. We highlight three cases where parents have refused blood transfusions from COVID-19 vaccinated donors on behalf of their children in the setting of congenital cardiac surgery. These families have also requested accommodations such as explicit identification of blood from COVID-19 vaccinated donors, directed donation from a COVID19 unvaccinated family member, or use of a non-standard blood supplier. We address the ethical challenges posed by these issues. We describe the current screening and safety processes for standard blood donation and explore the importance of donor anonymity and challenges with directed donation and non-standard blood suppliers. We present an ethical framework using the Best Interest Standard, the Zone of Parental Discretion, and the Harm Principle when considering these refusals. Finally, we provide recommendations for how to approach these requests as they potentially become more commonplace in pediatrics.","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90618365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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