Pub Date : 2024-01-01DOI: 10.1353/nib.2024.a947864
Linda Pollack-Johnson
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Healthcare Under Fire: Stories from Healthcare Workers During Armed Conflict 11 weredisrupted.Ahealthcaresystemwithoutpatients is like a cardiovascular system without blood. My family returned to Kyiv in August 2022 for our daughters to continue their schooling. There were (and still are) only five to seven kids in a class; other children left Ukraine or switched to online studies. My husband and I decided that our children will attend school offline—despite the regular missile attacks. This is a private school; we pay for it. In such a way, we want to support local businesses. Sending our kids to school every day (it takes 1.5 hours one way) and paying for their studies is a personal act of patriotism. We lived through a very challenging autumn and winter with regular blackouts, cold meals, stuck elevators, melted fridges, and uncharged smartphones and laptops. Sometimes we had no water or heat. We have learnt how terrifying and ghostly a three-million-person city looks when submerged in full darkness—with no traffic lights, glaring signboards, or luminous windows. I recollect that in November, I had a meeting with representatives from a large international charity foundation who were considering giving us a grant. The day before that meeting, Kyiv was subject to the most severe missile attack, and there was neither power, nor water, nor heating at my home. In the midst of our meeting—when I was being told that we had to introduce a more sophisticated bidding procedure and have bidders send their offers in sealed envelopes—I burst out crying. Their procedure mandates were so irrelevant! In my mind, I was seeking a solution to how my family would defecate and urinate in our apartment on the 13th floor with no power and water if the situation persisted.1 At that moment, I hated all international donors for being so absolutely out of touch with what Ukrainians were going through. Only the looming prospect of getting USD $342,000 for our assistance programs kept me at that meeting. 1 Incidentally, I found a solution to my challenge and will share it with you—this is a valuable piece of knowledge—not like that bull sheet about bidding procedures. You must buy plastic garbage bags and pet litter. And here you are! I am writing this piece at the end of May 2023. Almost every night in May, we had a missile and drone attack. It is a very bizarre feeling—in the daytime, the city looks perfectly peaceful, merry, sunlit, and busy: with kids, ice cream, scooters, blooming lilacs, and chestnut trees. At night, “the city falls asleep and the mafia gets up”. We are living two parallel lives—sunlit peaceful days and then the horror of nights full of air strike alarms, explosions, and flashes of downed missiles in the dark sky. Some people spend nights in the metro stations, sheltering their kids there. Others sleep in corridors or bathrooms where there are no windows . I opt to stay in bed and let my kids sleep. I do not want them to be traumatized—they still
{"title":"When Ethics Survives Where People Do Not: A Story From Darfur","authors":"Ghaiath Hussein","doi":"10.1353/nib.0.a911253","DOIUrl":"https://doi.org/10.1353/nib.0.a911253","url":null,"abstract":" Healthcare Under Fire: Stories from Healthcare Workers During Armed Conflict 11 weredisrupted.Ahealthcaresystemwithoutpatients is like a cardiovascular system without blood. My family returned to Kyiv in August 2022 for our daughters to continue their schooling. There were (and still are) only five to seven kids in a class; other children left Ukraine or switched to online studies. My husband and I decided that our children will attend school offline—despite the regular missile attacks. This is a private school; we pay for it. In such a way, we want to support local businesses. Sending our kids to school every day (it takes 1.5 hours one way) and paying for their studies is a personal act of patriotism. We lived through a very challenging autumn and winter with regular blackouts, cold meals, stuck elevators, melted fridges, and uncharged smartphones and laptops. Sometimes we had no water or heat. We have learnt how terrifying and ghostly a three-million-person city looks when submerged in full darkness—with no traffic lights, glaring signboards, or luminous windows. I recollect that in November, I had a meeting with representatives from a large international charity foundation who were considering giving us a grant. The day before that meeting, Kyiv was subject to the most severe missile attack, and there was neither power, nor water, nor heating at my home. In the midst of our meeting—when I was being told that we had to introduce a more sophisticated bidding procedure and have bidders send their offers in sealed envelopes—I burst out crying. Their procedure mandates were so irrelevant! In my mind, I was seeking a solution to how my family would defecate and urinate in our apartment on the 13th floor with no power and water if the situation persisted.1 At that moment, I hated all international donors for being so absolutely out of touch with what Ukrainians were going through. Only the looming prospect of getting USD $342,000 for our assistance programs kept me at that meeting. 1 Incidentally, I found a solution to my challenge and will share it with you—this is a valuable piece of knowledge—not like that bull sheet about bidding procedures. You must buy plastic garbage bags and pet litter. And here you are! I am writing this piece at the end of May 2023. Almost every night in May, we had a missile and drone attack. It is a very bizarre feeling—in the daytime, the city looks perfectly peaceful, merry, sunlit, and busy: with kids, ice cream, scooters, blooming lilacs, and chestnut trees. At night, “the city falls asleep and the mafia gets up”. We are living two parallel lives—sunlit peaceful days and then the horror of nights full of air strike alarms, explosions, and flashes of downed missiles in the dark sky. Some people spend nights in the metro stations, sheltering their kids there. Others sleep in corridors or bathrooms where there are no windows . I opt to stay in bed and let my kids sleep. I do not want them to be traumatized—they still ","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":"132 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136094026","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 19 supposed to facilitate the family’s passageway through Iran into Iraq, again under disguise as part of a moving caravan of religious pilgrims. From there, they would be met by a non-governmental organisation operation who would fly the family in a military plane to a processing camp for refugees in Albania with no further destination in place for Azad to receive healthcare. Should I relay this option to the family even in the face of its futility, or should I deny the family their agency and refuse? Was I making a decision about the child’s fate? I stayed silent. With a few dedicated colleagues, I continued to pressure the British government while considering whether I should draw on the connections of an Afghan colleague based in the United Kingdom with a medical background. I was cautious about approaching my colleague. The cultures of conflict travel. I couldn’t be sure about any discriminatory views my colleague might have towards Hazaras. One phone call or one wrong move from me could lead to the family’s execution. The formal route of a government-supported medical evacuation to specialist surgeons collapsed. It did not reach a sudden death; rather, the leash to hope retreated and ebbed away silently as if the leaders with the key to power were ashamed. Their indifference was pitiful. The family escaped to another neighbouring country, where I met them some months later. The child would only cry. Cries were his only sounds. Or silence. Silence of a story that was beyond any words he would form. The father was bereft. At the moment of the blast, the child was sitting in the sky on his father’s shoulders. The legacy of trauma took away the child’s trust in his father’s embrace, the arms that had tried to lift him to another country, another life, another world. Now, the family is in exile in their third country in two years. Another language. Another culture. Another government. A child in conflict is never disentangled from war. Azad’s birth and near-death were imprisoned in the cradle of a conflict-ridden land. Will Azad return and live through the meaning of his name—freedom—in his lifetime, or will he, like his parents, forever be a war child? My final reflection is towards healthcare. My gaze now sees that healing is an ethical endeavour. The philosophy of medicine clashed with the confrontation of conflict, and for Azad, attacked and violated by indiscriminate armed actors, his story of suffering was written by the governments who failed to free him. B The Vagaries and Vicissitudes of War Richard W Sams II I remember standing in the kitchen of our home on Camp Pendleton—a United States Marine Corps base in Southern California—listening to National Public Radio (NPR) and doing dishes in the fall of 2002. President Bush announced to the world that he was considering a pre-emptive invasion of Iraq on the pretext of Saddam Hussein harboring weapons of mass des
{"title":"The Vagaries and Vicissitudes of War","authors":"Richard W Sams","doi":"10.1353/nib.0.a911251","DOIUrl":"https://doi.org/10.1353/nib.0.a911251","url":null,"abstract":" Healthcare Under Fire: Stories from Healthcare Workers During Armed Conflict 19 supposed to facilitate the family’s passageway through Iran into Iraq, again under disguise as part of a moving caravan of religious pilgrims. From there, they would be met by a non-governmental organisation operation who would fly the family in a military plane to a processing camp for refugees in Albania with no further destination in place for Azad to receive healthcare. Should I relay this option to the family even in the face of its futility, or should I deny the family their agency and refuse? Was I making a decision about the child’s fate? I stayed silent. With a few dedicated colleagues, I continued to pressure the British government while considering whether I should draw on the connections of an Afghan colleague based in the United Kingdom with a medical background. I was cautious about approaching my colleague. The cultures of conflict travel. I couldn’t be sure about any discriminatory views my colleague might have towards Hazaras. One phone call or one wrong move from me could lead to the family’s execution. The formal route of a government-supported medical evacuation to specialist surgeons collapsed. It did not reach a sudden death; rather, the leash to hope retreated and ebbed away silently as if the leaders with the key to power were ashamed. Their indifference was pitiful. The family escaped to another neighbouring country, where I met them some months later. The child would only cry. Cries were his only sounds. Or silence. Silence of a story that was beyond any words he would form. The father was bereft. At the moment of the blast, the child was sitting in the sky on his father’s shoulders. The legacy of trauma took away the child’s trust in his father’s embrace, the arms that had tried to lift him to another country, another life, another world. Now, the family is in exile in their third country in two years. Another language. Another culture. Another government. A child in conflict is never disentangled from war. Azad’s birth and near-death were imprisoned in the cradle of a conflict-ridden land. Will Azad return and live through the meaning of his name—freedom—in his lifetime, or will he, like his parents, forever be a war child? My final reflection is towards healthcare. My gaze now sees that healing is an ethical endeavour. The philosophy of medicine clashed with the confrontation of conflict, and for Azad, attacked and violated by indiscriminate armed actors, his story of suffering was written by the governments who failed to free him. B The Vagaries and Vicissitudes of War Richard W Sams II I remember standing in the kitchen of our home on Camp Pendleton—a United States Marine Corps base in Southern California—listening to National Public Radio (NPR) and doing dishes in the fall of 2002. President Bush announced to the world that he was considering a pre-emptive invasion of Iraq on the pretext of Saddam Hussein harboring weapons of mass des","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136093890","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}
2 Narrative Inquiry in Bioethics • Volume 13 • Number 3 • Winter 2023 a tiny bit of your soul and makes you question your role in the world. By being the best physician I can be, I hope to prevent future cruel, unjust, and untimely deaths, one person at a time. But there is only so much a physician can do. Similarly to others working in bioethics, my research spans several topics, from clinical to public health ethics.Afew topics, however, are particularly close to my heart, and the Israeli occupation is one of them. The untimely death of the baby drives this passion. I could not save that baby. No one could. But as a physician and a privileged academic I can choose to channel my efforts to make them count towards preventing other cruel, untimely, and unjust deaths. Through effective scholarship that focuses on the Israeli occupation and health conditions of Palestinians in the Occupied Palestinian Territory, I seek to give voice to those who often go unheard. In this specific instance, that voice belonged to a Jewish Israeli baby, whereas in most other instances, it is the voice of Palestinians. Academia sometimes makes us forget the real reasons we do what we do. We become embroiled in the ‘publish or perish’ game and focus on publishing for the mere sake of publishing and of professional promotion. Rejections sadden us, making us doubt our aptitude as writers and thinkers. Grant application and administrative work weigh us down. It seems that almost all of us have considered abandoning academic life at some point, following perhaps some job interview that went sour. For me, it is exactly during these instances that the image of the pale baby, covered by the ambulance ’s orange blanket, reminds me why I do what I do. Humanity’s past, present, and future are packed with unjust and untimely deaths, and all individuals have a responsibility to remember, attend to, and prevent them, respectively. The responsibility of healthcare workers and academics to do so is even greater. Naturally, the Israeli occupation is personally closer to my heart, but wherever unjust deaths occur, there healthcare workers and academics should be. Healthcare workers then have several roles during armed conflicts. First, they ought to provide care whenever care is due and as long as their safety is assured. Second, they ought to bear witness and speak truth to power. Through professional and popular outlets, they should warn the world that these events are occurring and urge that they should not happen again. Everything I do, both as an academic and as a physician, I do for him. B How We Keep Caring While Walking Through Our Pain Ola Ziara with support from Rachel Coghlan P alestinian-American poet, Suheir Hammad, writes: Occupation means that every day you die, and the world watches in silence. As if your death was nothing, as if you were a stone falling in the earth, water falling over water. And if you face all of this death and indifference and keep your humanity, and
{"title":"How We Keep Caring While Walking Through Our Pain","authors":"Ola Ziara","doi":"10.1353/nib.0.a911245","DOIUrl":"https://doi.org/10.1353/nib.0.a911245","url":null,"abstract":"2 Narrative Inquiry in Bioethics • Volume 13 • Number 3 • Winter 2023 a tiny bit of your soul and makes you question your role in the world. By being the best physician I can be, I hope to prevent future cruel, unjust, and untimely deaths, one person at a time. But there is only so much a physician can do. Similarly to others working in bioethics, my research spans several topics, from clinical to public health ethics.Afew topics, however, are particularly close to my heart, and the Israeli occupation is one of them. The untimely death of the baby drives this passion. I could not save that baby. No one could. But as a physician and a privileged academic I can choose to channel my efforts to make them count towards preventing other cruel, untimely, and unjust deaths. Through effective scholarship that focuses on the Israeli occupation and health conditions of Palestinians in the Occupied Palestinian Territory, I seek to give voice to those who often go unheard. In this specific instance, that voice belonged to a Jewish Israeli baby, whereas in most other instances, it is the voice of Palestinians. Academia sometimes makes us forget the real reasons we do what we do. We become embroiled in the ‘publish or perish’ game and focus on publishing for the mere sake of publishing and of professional promotion. Rejections sadden us, making us doubt our aptitude as writers and thinkers. Grant application and administrative work weigh us down. It seems that almost all of us have considered abandoning academic life at some point, following perhaps some job interview that went sour. For me, it is exactly during these instances that the image of the pale baby, covered by the ambulance ’s orange blanket, reminds me why I do what I do. Humanity’s past, present, and future are packed with unjust and untimely deaths, and all individuals have a responsibility to remember, attend to, and prevent them, respectively. The responsibility of healthcare workers and academics to do so is even greater. Naturally, the Israeli occupation is personally closer to my heart, but wherever unjust deaths occur, there healthcare workers and academics should be. Healthcare workers then have several roles during armed conflicts. First, they ought to provide care whenever care is due and as long as their safety is assured. Second, they ought to bear witness and speak truth to power. Through professional and popular outlets, they should warn the world that these events are occurring and urge that they should not happen again. Everything I do, both as an academic and as a physician, I do for him. B How We Keep Caring While Walking Through Our Pain Ola Ziara with support from Rachel Coghlan P alestinian-American poet, Suheir Hammad, writes: Occupation means that every day you die, and the world watches in silence. As if your death was nothing, as if you were a stone falling in the earth, water falling over water. And if you face all of this death and indifference and keep your humanity, and","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136094693","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 33 Adhering to professional and moral ethos during armed conflicts like the one in Ukraine can be challenging and demands a significant reorientation of personal and professional identity. The responsibility to provide each of their clients with as much support and emotional resources, without the ability for a referral or a treatment plan, is very difficult for those whose professional identity is about helping others, non-abandonment, restoration of mental health, and support their clients through the most challenging times of their lives. Furthermore, there is still much prejudice toward psychotherapy; many Ukrainian people worry about being stigmatized or called “crazy” if they see a psychotherapist. This attitude towards mental health changes, but the process is slow. Day in and day out, Ukrainian mental health clinicians witness the trauma of war, hear the stories filled with grief and desperation, and see the emotional aftermath and devastation the war has on people of all ages. The mental health clinicians work in environments that are not typical for therapy sessions; in hallways, in cramped offices with other therapists separated only by a thin fabric curtain to give some appearance of privacy. Despite all that, they continue to create space for hope and a future for those who felt they lost both. The Ukrainian mental health clinicians are soldiers fighting one of the most critical battles of our times, and they will win. B Stories of Families with Chronically Ill Pediatric Patients during the War in Ukraine Vita Voloshchuk F ebruary 24th was a day that has left a mark in the memory and on the lives of every Ukrainian person. My husband and I work together in a hospital. He had gone into work early to conduct a kidney transplant that had been scheduled for that day. Suddenly, whilst on my way to work that morning, I heard a strange sound—it was an air-raid siren. Before that, I had never heard such a sound. I went through all the possible options of what it could be. Of course, watching the morning news had never been a habit either. The next thing that astonished me was that the taxi I had ordered was taking an unnaturally long time to turn up. When I got into the taxi, I noticed that the taxi driver was really upset and silent for half of the journey. He then said, “A war has begun . . .” “War? So? The war has been going on since 2014.” “You don’t understand,” he said. “Russia is launching missile attacks all over the territory of Ukraine; Russian troops are coming from the east and north of Ukraine. They want to capture the capital of Ukraine.” (Kyiv). Arriving at the hospital, I saw confused faces everywhere. The morning meeting began with a discussion of how we were to act in any possible situation that may occur. We were to discharge patients from the hospital, as many as possible. The arrangement of a bomb shelter began (although I didn’t even think th
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10 Narrative Inquiry in Bioethics • Volume 13 • Number 3 • Winter 2023 Medicine, Loyola University Chicago, for motivating and providing us with strong support, and for her editorial work on this narrative. B A Semi-Personal Story from a Ukrainian NGO Professional (or a Semi-Professional Story from a Ukrainian Person) Living through the War Yuliya Nogovitsyna I live in Kyiv with my husband and two daughters . On 24 February 2022, my husband woke me up at 5 am tapping me on the shoulder and saying, “Yulia, wake up. There are bombings outside . The war started”. That day was our younger daughter’s birthday. She turned six. We had planned a birthday party for her with friends, cake, candles and birthday gifts. Instead, we had to move both daughters to the bathroom where there are no windows so that broken glass did not hurt them if a missile hit. I am the Program Director at Tabletochki Charity Foundation, Ukraine’s largest childhood cancer NGO (https:/ /tabletochki.org/en/). For 11 years before the war, we have been fostering childhood cancer care in Ukraine—through our direct assistance to families, support of pediatric oncology units, professional development of medical personnel , and advocacy. The Russian invasion of Ukraine in February 2022 dramatically changed the healthcare system landscape in Ukraine. The physical threat, treatment disruption, exposure of immunosuppressed patients to improper conditions in bomb shelters and cellars, interruption in supplies, infrastructure damage, logistics failure, and funding constraints have been among the most manifested immediate and deferred implications of the war for the healthcare system in Ukraine. That said, the biggest professional challenge was uncertainty and inability to plan. You have nothing to rely on in developing at least a short-term strategy. This may sound speculative and unimportant (who bothers about uncertainty when there is a physical threat to your life?) But this is a wrong perception—uncertainty paralyzes and disables long before a bullet or missile reaches you. War also brings the collapse of relationships, partnerships, and coalitions. It depletes and limits resources, whether human, financial, or emotional. Scarce resources make hospitals, healthcare professionals , and NGOs compete for patients, donors, and financing. The war and the external threat unite only for a short period of emergency response. Once the situation transitions to a protracted conflict, people and institutions start fighting for their own survival. My family stayed in Ukraine but moved to Lviv, a city in Western Ukraine, which turned into an evacuation hub for children with cancer. More than 1,000 children with cancer were evacuated and referred for treatment abroad through the SAFER Ukraine collaborative initiative by St. Jude Global, Tabletochki, West-Ukrainian Specialized Children’s Medical Center (WUSCMC), and other international and local partners. During the first months of the war, we worked hand
{"title":"A Semi-Personal Story from a Ukrainian NGO Professional (or a Semi-Professional Story from a Ukrainian Person) Living through the War","authors":"Yuliya Nogovitsyna","doi":"10.1353/nib.0.a911241","DOIUrl":"https://doi.org/10.1353/nib.0.a911241","url":null,"abstract":"10 Narrative Inquiry in Bioethics • Volume 13 • Number 3 • Winter 2023 Medicine, Loyola University Chicago, for motivating and providing us with strong support, and for her editorial work on this narrative. B A Semi-Personal Story from a Ukrainian NGO Professional (or a Semi-Professional Story from a Ukrainian Person) Living through the War Yuliya Nogovitsyna I live in Kyiv with my husband and two daughters . On 24 February 2022, my husband woke me up at 5 am tapping me on the shoulder and saying, “Yulia, wake up. There are bombings outside . The war started”. That day was our younger daughter’s birthday. She turned six. We had planned a birthday party for her with friends, cake, candles and birthday gifts. Instead, we had to move both daughters to the bathroom where there are no windows so that broken glass did not hurt them if a missile hit. I am the Program Director at Tabletochki Charity Foundation, Ukraine’s largest childhood cancer NGO (https:/ /tabletochki.org/en/). For 11 years before the war, we have been fostering childhood cancer care in Ukraine—through our direct assistance to families, support of pediatric oncology units, professional development of medical personnel , and advocacy. The Russian invasion of Ukraine in February 2022 dramatically changed the healthcare system landscape in Ukraine. The physical threat, treatment disruption, exposure of immunosuppressed patients to improper conditions in bomb shelters and cellars, interruption in supplies, infrastructure damage, logistics failure, and funding constraints have been among the most manifested immediate and deferred implications of the war for the healthcare system in Ukraine. That said, the biggest professional challenge was uncertainty and inability to plan. You have nothing to rely on in developing at least a short-term strategy. This may sound speculative and unimportant (who bothers about uncertainty when there is a physical threat to your life?) But this is a wrong perception—uncertainty paralyzes and disables long before a bullet or missile reaches you. War also brings the collapse of relationships, partnerships, and coalitions. It depletes and limits resources, whether human, financial, or emotional. Scarce resources make hospitals, healthcare professionals , and NGOs compete for patients, donors, and financing. The war and the external threat unite only for a short period of emergency response. Once the situation transitions to a protracted conflict, people and institutions start fighting for their own survival. My family stayed in Ukraine but moved to Lviv, a city in Western Ukraine, which turned into an evacuation hub for children with cancer. More than 1,000 children with cancer were evacuated and referred for treatment abroad through the SAFER Ukraine collaborative initiative by St. Jude Global, Tabletochki, West-Ukrainian Specialized Children’s Medical Center (WUSCMC), and other international and local partners. During the first months of the war, we worked hand","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136093888","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}
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
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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":"52 1","pages":"0"},"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}
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