Ethics and professionalism of a community health worker: A virtue ethics approach

Community health workers are the link between the community and the health system, delivering primary care services at the frontline. Every profession has its own ethics and professional values, and there is a need to formulate the ethics of community health work which should be informed by their rich experiential wisdom. In one such effort, we interviewed a senior community health worker in the Tamil Nadu health system and present it here as a virtue ethics case study. Several situations of ethical conflict arising in her work, and her process for resolving these conflicts were discussed during the interview. The worker discussed some ethical principles: doing good, not doing any harm, maintaining justice, being honest, providing respectful care, maintaining self-respect, being accessible, earning the community's trust, and building solidarity. This interview confirms the assumption that ethics and professionalism are inherent in this community health worker, and emphasises the need for systematic research to document the experiences of such frontline workers, and to frame relevant standards of ethics and professionalism in the local context.

Response of peg IFN and ribavarin in HIV-HCV co-infection.

Background: Hepatitis C infection is one of most common co-infection in HIV. HIV infection influences the natural evolution of chronic hepatitis by higher rate of viral persistence, accelerating fibrosis, cirrhosis progressing to end-stage liver disease. Objective: This retrospective study was conducted in order to see the response to Peg- IFN α-2b with Ribavarin in HIV HCV co-infection. Material and Methods: Alanine aminotransferase and Aspartate Aminotransferase, HCV RNA quantitative and Genotype study, Fibroscan, CD4 were collected from the medical records of ART centre. Results: The mean baseline viral load (log10) was 5.76, 3.00 at 1st month, 0.44 at 3rd month, 0 at 6th month and 12th month. RVR was observed in 77.7%, EVR in 88.8%, SVR of 100% at 6th and 12th month. The mean OT and PT reduction at 3rd month was 116.11(57.79%) and 132 (61.68%) respectively, at 6 month was 158 (78.65%) and 177.56 (82.97%) respectively, at 12th month was 159(79.14%) and 176.56 (82.50%). Fibrosis at the start of treatment was 19.0 KPa, 10.00 KPa at 6th month and 8.20 KPa at 12th month. Conclusion: Study shows that SVR can be achieved in HCV HIV co infected patients with IFN and Ribavarin therapy which in turn reduces the morbidity and mortality due to liver disease. Inspite of virological response, few patients continue to have deranged AST and ALT and progressive liver fibrosis.