What is a conscience? For Pinocchio, it came in the tiny form of Jiminy Cricket. But for others, it is a combination of morals, avoidance of societal taboos, and most importantly, knowledge of ethics. As students in a global health program, we are very familiar with ethics. Especially in research settings. We are always reminded of the importance of personal autonomy and anonymity, and at this point writing consent forms has become second nature. But our recent forays into the field of medicine have left me with, well, a troubled conscience.
Flash back to our first day in San Jose after a week in Nicaragua. There we had hands-on experience helping doctors conduct mobile primary care clinics in rural communities. Occasionally, we would sit down with our supervising doctors to discuss interesting cases of the day, of course without revealing names and personal identifiers. Now that we were back in San Jose, we were taking a look at another side of health care: public and private hospitals. The first stop of the day was the San Juan del Dios public hospital. San Juan was humming with activity. In fact, we entered only a small number of buildings and none of the diagnostic rooms in the interest of not disturbing patients and doctors inside. Mostly we explored the exteriors of the buildings and took note of the large quantity of patients waiting for treatment.
Clinica Biblica, the private hospital, was an entirely different story. To draw a comparison between the two hospitals, imagine San Juan del Dios as a beige freighter train, solid, functional, and used to supporting large loads. Clinica Biblica is a spotlessly sleek, magnetically levitated train straight out of Japan. And like said train, it was quite silent. Compared to the crowds at the public hospital, the private one was almost empty. Because every citizen is guaranteed free medical treatment from the public hospitals, not many people are willing or able to pay extra for private care.
Our tour with a PR representative from the hospital covered the state of the art emergency rooms, the helicopter pad, inpatient rooms that we would take over our college dorms in an instant, and lots of modern medical equipment. All in all, everything was quite impressive. However, we were in for a bit of a shock. When we were learning about the mammogram machine, one member of our group asked what a tumor looked like. The attendant then swiveled the screen around to show us scans of womens' breasts. Scans that had personal identifiers on them, including full names. My first thought was that I could never imagine this happening in the states: private personal information is kept under strict lock and key. Granted, ethical codes in medicine may differ from country to country, but if I knew strangers could potentially see scans of my breasts along with my name, I would not be inclined to return to that hospital. It made me wonder about the numerous tours this hospital may have conducted in the past, and how strange it is to treat hospitals as an attraction for strangers to wander around and take photographs in. My mind was in a whirl long before we stepped out of Clinica Biblica.
Can a balance be found between learning too little and learning too much? That is what I believe ethics should decide. I've always tacitly accepted the importance of codes of conduct and laws protecting patient privacy, relegating it in my mind to more paperwork and online modules to do before working in medical settings. Never before have I been so aware of what would happen in a world without them. Though I am but an observer in Costa Rica's health care system, in the United States, I will always strive to do more than pay lip service to the ethics of working with people and always let my conscience be my guide.
Emily Yang
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