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Intern Med J. 2019 Jun;49(6):777-780. doi: 10.1111/imj.14310.

Ethical aspects of collateral clinical services by non-credentialled personnel in international medical crises.

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Weill Cornell Medicine, New York, New York, USA.


The study of global responses to medical crises in developing and under-developed countries demands reflection about the ethical engagement of non-credentialled medical personnel in the context of clinical care. The need for, and the desire to contribute by, people and organisations that lack demonstrable or readily transferable credentialed skills must be reconciled with the ethical administration of collateral clinical services. The urgent need for the provision of such services must neither preclude their use nor permit their use irrespective of salient ethical considerations. One way to explore these issues is to examine a recent exemplar of a non-governmental organisation's utilisation of non-credentialled medical personnel during the Ebola outbreak in Sierra Leone. Although the group lacked clinical proficiency (apart from community health workers), it collaborated with experts in interment to train staff to bury those who had succumbed to the disease in respectful and hygienic individually marked graves. The group leveraged its cultural competency and in-country presence to deploy staff judiciously, support the workers to combat social ostracism and offer vocational and other education to help them assimilate back into the workforce once the outbreak subsided. The non-governmental organisation stepped up to do the work that others shunned, and to do it ethically and proficiently. I offer the work to show a compelling and innovative blueprint for ethical mobilisation of non-credentialed healthcare personnel in a global medical crisis.


ethical; global; international; medical crises; non-credentialed


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