Guest Spotlight: Melissa Kleine-Bingham of WHO, writes about compassion in global health and the genesis of FACE

“Seeing compassion as a global health issue through the faces of people” – This piece was originally published as a Pulse Blog.

“Compassion – the desire to relive suffering – is a fundamental motivation for many who are drawn to the field of global health, whether they work at the community level or in large international organizations. Indeed, compassion can fuel and sustain their pursuit of social justice and global health equity” – Dr David Addiss.

“Seeing the faces of people” I saw jotted down in my notebook, “changes the way we treat them.” I leafed quickly through the pages, looking for my notes on the latest conference I had just attended in Ethiopia. My team was eagerly waiting for the update on a session which featured compassion in a conference on neglected tropical diseases (NTDs) (WHO).

“The session was fantastic – there were a lot of questions!” I announced to my team, still thinking about what it means to see the faces of people. “The discussion focused on compassion in global health. We talked about the roles of NGOs and health professionals in compassion and how this applies to the treatment and prevention of NTDs. We also heard how compassion became a crucial part of the health sector transformation strategy in Ethiopia.” I continued, “the audience was thoughtful and passionate. The discussion included ideas of how pity, which arises from a position of distance and superiority can masquerade as, or be mistaken for, compassion, which is rooted in solidarity and mutual respect. It also addressed how compassion can fuel and sustain the work of social justice and human rights. The room was full of energy.”

This session on compassion was organized by public health and NTD physician, Dr David Addiss. David is the director of the Focus Area for Compassion and Ethics (FACE) at the Taskforce for Global Health in Decatur, Georgia. The aim of FACE is to deepen understanding of ethical issues in global health and to “uphold social justice, solidarity, compassion and respect for all persons2”. FACE shines a light on ethical dilemmas in current programmes, works to see well-reasoned solutions, and encourages global health experts not to turn away from suffering. FACE works towards health as a human right, to infuse compassion into global health programs, and to promote ethical decision-making.

The idea of FACE, although not known to the participants at that time, was born out of a meeting in 2010 at The Carter Center. At that meeting, preeminent global health leaders all spoke about how compassion motivated their lives and their work – but about which they had never spoken collectively. David became intrigued by this disconnect. “As health professionals,” David confided when we spoke on the phone, “we are motivated by compassion – a desire to alleviate suffering.” “But,” David continued, “in global health – as in clinical care – we can lose touch with that compassionate impulse, caught up in the demands of our work and other pressures. Consequently, we don’t take time to understand the patient’s suffering or our own limitations and needs.”

David came to The Taskforce for Global Health in 2011 after working at the Centers for Disease Control and Prevention in Atlanta. At the time, David’s work focused on the prevention and control of NTDs such as lymphatic filariasis, soil-transmitted helminths, and onchocerciasis (also known as River Blindness). The ethical dilemmas in this work slowly became apparent. “It’s true,” David says, “the global health community assumes good intent but we all – individuals and organizations – also have ethical and cultural blind spots. We need courage to sit together and explore these blind spots and positions so that we can develop effective, compassionate programmes.”

To make his case, David shared his work on River blindness and the dilemma facing efforts to eliminate that disease in areas that are also endemic for Loa loa, or African Eye Worm. “People who have very high levels of Loa loa in the blood can develop severe and sometimes fatal adverse reactions when they participate in mass treatment programmes with ivermectin to eliminate onchocerciasis,” David explained. “Their presence in communities targeted for onchocerciasis elimination, and the technical difficulty and potential costs of identifying at-risk persons in advance of mass treatment, have stymied elimination efforts. How do we weigh the potential for serious harm to these relatively few individuals against the tremendous population-level benefit of eliminating onchocerciasis? Opinions differ within the onchocerciasis community.”

According to FACE, one of the key challenges of global health is to consistently approach communities with respect, in a way that affirms their dignity. “We are often working to improve the health of communities far away, without actually meeting the people,” David said. “When we befriend them, really see them, and listen to their needs and aspirations, we become motivated to engage as partners to support them in their efforts to achieve health equity and pursue social justice in their context.”

After highlighting a few of the main points from the conference to my team, I finished with the words from David, ‘Seeing the faces of people, changes the way we treat them. It opens the door to understanding, empathy, and compassion.’ “You know,” I told my team, “I used to think compassion was a personality trait or just an afterthought when giving care. But now I understand that compassion is the action behind empathy. ‘Seeing the face of a person’ brings a sense of responsibility to try and understand the whole person, their needs and their wants. It’s not pity, it is looking at the eyes of another and recognizing that human desires and needs are universal.”

David Addiss, MD, heads FACE and is a public health physician whose work has focused on the prevention and treatment of neglected tropical diseases. Addiss started his career as a medical practitioner in a migrant health clinic, and later joined the Centers for Disease Control and Prevention. He has been at The Task Force for Global Health since 2011.

The author, Melissa Kleine-Bingham, is a member of the Service Delivery and Safety Department at WHO. She co-leads on the WHO Global Learning Laboratory and wants compassion to be a fundamental element to providing quality service delivery.

 

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