Assignment

Read "Allocating Resources: Fifty pills for 100 people," Case study on course textbook.

Examine this situation involving a public health problem and argue your stance on the ethical and legal implications, including whether the government should become involved or stay removed from the situation. Support your statements with logic and argument, citing any sources referenced

• Attached the case study
• 2-3 pages
• Formatted according to APA writing guidelines.

• Provide support for your statements with in-text citations from a minimum of four scholarly articles. Two of these sources may be from the class readings, textbook, or lectures,

Case study: Allocating resources: fifty pills for 100 people

Sangita is working at a rural district referral hospital in Zimbabwe. Her responsibilities include managing the medical wards with fifty beds, as well as staffing the outpatient HIV and TB clinic. She is expected to be on call once every four nights, alternating with two general medical officers and the Chief Medical Officer.

Although the health infrastructure had been strong historically, with well-trained professional health staff, the health system is in the midst of extraordinary challenges. In addition to the significant "brain drain" that has occurred to neighboring countries, Europeand North America, there is currently a strike in the public sector. Due to the economic situation, there are persistent shortages of commodities (including commercial food supply and drugs), fuel shortages and electricity blackouts. The district hospital is run administratively by a missionary organization and so is not prioritized to receive a regular supply of medicines from the government based on their service agreement with the Ministry of Health and Social Welfare. Stocks at the hospital, as well as salary top-ups to support staff retention, are supported primarily by small private donations from charitable organizations in Canada and Europe, and from supplies brought in by volunteering physicians. One night, Sangita's on call and is urgently asked to see a pediatric patient who was admitted to the hospital during the day. She has just finished admitting a twenty-five-yearold dehydrated, HIV-positive man who is on antiretroviral therapy (ART) and cotrimoxazole preventive therapy (CPT) and has a CD4 of 200 suggesting his immune system is quite compromised.

He presented with fever, myalgia, headache and vomiting, and has a presumptive diagnosis of malaria, as his malaria smear is positive. After rehydrating the gentleman, she has asked the medicine nurse to see if there are any vials of IV quinine on any of the wards in the hospital. Immediately after, a nurse has asked Sangita to come immediately because the child is seizing in the pediatric ward. A three-year-old girl was brought in by her mother after five days of a febrile illness and headache. She had been complaining of headache and nausea and was transferred to the referral hospital yesterday, when she started to develop decreased level of consciousness and jaundice. She was started on broad-spectrum oral antibiotics and sulfadoxine-pyremethamine plus chloroquine in a rural health post for possible malaria and sepsis of unknown origin. Upon arrival at the hospital, she was obtunded and so the clinical officer during the day started the child on IV antibiotics due to possible meningitis. The lumbar puncture results that came back look normal with zero white blood cells. Chemistry is not available. Gram stain and India ink are negative.

The child's HIV status is unknown although the child's mother is HIV-positive and on antiretroviral therapy. Sangita assesses the child and is able to give her diazepam to stop the seizures, however she is extremely concerned that the child may have cerebral malaria. The nurse from the medicine ward comes to find her and tells her that there is only enough IV quinine for a single individual. The only other antimalarials in hospital are oral sulfadoxine-pyramethamine and chloroquine, to both of which the fellow is certain there are high levels of Plasmodium falciparum resistance. Sangita knows from experience that she will be unable to obtain IV quinine from other health facilities or NGOs, due to the absence of fuel. When she assesses the child, her pupils are fixed and dilated and she is decerebrating; she strongly suspects the prognosis is poor due to anoxia. She decides to give the quinine to the adult male, who recovers and is discharged in a day, and palliate the child. The child dies in the morning.