Ethical thoughts

Coming to work in the developing world as a junior doctor raises some ethical issues, which became apparent this weekend. Several people said to me before I left that I would get to do loads of operating, work above my current level and generally have a great time doing things I wouldn't be allowed to do solo in the UK. The other way to interpret this is "you'll have great fun doing operations unsupervised that you wouldn't do in the UK, and no one would be any the wiser." That is obviously not what I was aiming for in coming out here, and indeed I chose to come to a hospital with a senior surgeon to provide oversight, training and support.

Having said that, there are occasions when the support is unavailable and difficult decisions have to be made. Referral is 8 hours away, and most can't afford it even if they would survive the journey. In these circumstances it is difficult to do nothing and say "I wouldn't do that on my own back home", particularly when you know the operation or treatment, and the outcome of inaction is likely to be a dead patient. I think that as a more junior trainee I would not have had the experience to say no and do nothing when that was the right decision, and likewise would have lacked the operative ability to deal with those cases beyond my normal scope. All I can do is tread the fine line of trying to do no harm, which at times seems nearly impossible.

There are also very difficult decisions about resource management. Often the sickest patients, with the highest chance of dying, are the ones using the most resources. At some point, a line has to be drawn to say when there is no point in continuing with expensive care. While it is not something that comes into our decision making, I am always mindful that the time spent in hospital with a sick relative, and then rehabilitating them, can be financially devastating for many of our patients' families, who are already destitute.

So while my logbook is undoubtedly getting padded with a huge amount of operating (50 cases in 2 weeks), I think I will learn more in the field of critical decision making out here.