Ethics of medical photography with children in developing countries

Almost back from the summer hiatus, and now staying somewhere (Montpellier) where there is internet to be had. Note: when in France, and you ask for an internet cafe, you will invariably sent to some dreary dungeon that does photocopies, faxes and laminates family photos, and where there is dusty workstation in the back from the year je-ne-sais-quand. You have to ask for an actual coffee-dispensing cafe which -- reluctantly giving in to this century -- is equipped wifi (pronounced WEE-FEE). To this end, I found a sweet little cafe near the Place de la Comedie, equipped with (gasp) air-con. Normally this convenience is a luxury, but after ten days straight of temperatures of 34C, it may be the only thing stopping me from becoming a poulet roti.

Fumbling through my inbox I noticed that BMC Medical Ethics published an article (open access) on the ethics of taking medicine-related photographs of children. Often you see photos of children in presentations at universities, particularly among faculty and students who have gone global, where for 'global' read: low-income countries with high disease burdens. Sometimes the photos are there for obviously medical purposes, e.g. to visually illustrate a morbidity, a symptom. But sometimes you wonder: some photos are just scene setting (and look a lot like tourist snapshots) and others look like decorative features of powerpoint slides, aiming to give a literally human face to some far flung region. And do those photographed know what happens to their images? Do they know that, in our new media landscape, it might be impossible to precisely track where their images may go and what may be done to them? When parents in low-income countries freely allow researchers to take pictures of their children, should that consent be taken au serieux?

The article is partly based on qualitative research, though only samples the views of a small number of researchers and medical practitioners in England who work in the developed world. It would be interesting to get opinions about the ethics of medical photography and push forward a robust debate on  best ethical practices worldwide.

Let us compare epidemics

There is always something a bit distasteful about comparing human tragedies, but it is also inevitable. The tsunami in 2004 was terrible, but was it as bad as the ongoing HIV/AIDS epidemic in Africa, which has taken millions of lives over the last decades? Darfur is bad, but has it really reached Rwandan genocidal proportions? We inevitably make these sorts of comparisons in order to get some sort of grip on what people ought to care about, and what nations ought to respond to with their finite resources. And we often lose our way.

The H1N1 virus has captured media attention, as well as substantial funding for task forces, response plans and research, particularly as increasingly more deaths have been linked to it. As has been observed many times, the 'media life' of a virus depends in large part on the extent to which citizens (especially ordinary citizens) of North America and Europe are affected by it, or are likely to be affected by it. When the centers of the world's power is under viral threat, vast resources may be mobilized, even if the numbers in terms of morbidity and mortality are, relatively speaking, small. Worse epidemics, elsewhere, receive much less press and support.

The point was not lost on those aware that today was World Pneumonia Day. Pneumonia is the greater killer of children worldwide. It is responsible for more deaths in children (2 million a year) than HIV/AIDS, measles and malaria combined. The tragedy is that we long ago developed effective vaccines to prevent it, and antibiotics to treat it, but it generally affects children away from the centers of the world's power, particularly in sub-Saharan Africa and South-East Asia. While many lives could be saved in delivering known effective medicines to these populations, there is not much money to be made in the endeavor, so rallying support for pneumonia initiatives tends to be an uphill battle. But it is a matter of fighting the good fight, a matter of trying to regain some sense of proportion, and a matter of not being entirely distracted by the latest virus on the 24-hour news cycle.