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.

Outcome of Very Low Birth Weight Infants with Abnormal Antenatal Doppler Flow Patterns: A Prospective Cohort Study.

Background: Fetal growth restriction and abnormal Doppler flow studies are commonly associated. Neonatal outcomes are not well known particularly in developing countries, where the burden of the disease is the highest. Objective: To determine outcomes of preterm infants with history of absent/reversed end-diastolic umbilical artery Doppler flow (AREDF) vs. infants with forward end-diastolic flow (FEDF). Design: Cohort study. Setting: Tertiary care perinatal center in India. Participants: 103 AREDF very low birth weight (<1500 gm) (VLBW) infants and 117 FEDF VLBW infants were prospectively enrolled. Results: At 40 weeks adjusted post-menstrual age, AREDF vs. FEDF group had a higher risk for death in the NICU (12% vs. 1%), respiratory distress syndrome (33% vs. 19%), and cystic periventricular leukomalacia (12% vs. 1%). At 12-18 months corrected age, AREDF vs. FEDF group had a trend towards increased risk for cerebral palsy (7% vs. 1%, P=0.06). After logistic regression analysis, adjusting for confounders, AREDF was independently associated only with mortality in the NICU. Conclusion: AREDF is an independent predictor of adverse outcomes in preterm infants in a developing country setting.

Vitamin E protects intestinal basolateral membrane from CMF-induced damages in rat.

CMF is a combination of anticancer chemotherapeutic agents Cyclophosphamide, Methotrexate and 5-Fluorouracil. Vitamin E protects the basolateral membrane (BSM) from CMF induced lipid peroxidative damages. Rats were treated intravenously with cyclophosphamide-10 mg, methotrexate-1.0 mg and 5-fluorouracil-10 mg per kg body weight for six cycles. Vitamin E (600 mg/kg body weight) was administered orally, daily. Intestinal basolateral membrane bound ATPases (3.6.1.3), Alkalinephosphatase (3.1.1) and 5'-Nucleotidase (3.1.3.5) were protected by co-administration of vitamin E with CMF. In CMF treated rats the lipid peroxidation levels were found to be elevated with a significant depletion in membrane sulfhydryl groups. In vitamin E co-administered animals, the enzyme activities were found to be restored with concomitant reduction in malondialdehyde levels and an increase in the sulfhydryl groups. The membrane cholesterol and phospholipid levels which were altered in CMF treated rats were bought back to the normal in co-administration of vitamin E.

Heriditary pattern of cancer.

Three thousand nine hundred and twelve patients with cancer in various sites reporting to the out patient department were questioned for history of cancer among blood relatives. A positive history of cancer was obtained in 154 of whom 89 were male and 65 female. Thirty nine patients gave history of cancer among siblings and five gave history of cancer among spouses related by consanguneous marriage. The other 110 gave history of cancer among second and third generation relatives. Sixty one percent maternal relatives of the female patients had cancer as compared to only 33 percent of paternal relatives. This difference was not seen among male patients where there were about 45 percent of maternal and 47 paternal relatives giving history of cancer. Further it was found that 6 of 20 patients with cancer of the breast, 7 of 22 with stomach cancer and 4 of 12 with cervix cancer had blood relatives with the same type of cancer.