Policy of COVID-19 in your setting

[Wirichada Pan-ngum]

I would like you to identify and share with the classmates some ethical principals or good practices in your current job or position you need to have to contribute to the control policy of COVID-19 in your setting. (10 marks)

———— Deadline 6 February 2023 Pls reply before ————-

[Zarni Lynn Kyaw]

In general, my organization, Community Partners International (CPI) is an organization that works to improve the health and well-being of communities in Myanmar by implementing community-based programs and activities.

We have a strong focus on community engagement, and we work closely with local partners to ensure that their programs are appropriate and responsive to the needs of the communities they serve.

In terms of the control policy of COVID-19, we follows the guidelines and recommendations of the World Health Organization (WHO) and the Myanmar Ministry of Health and Sports (MOHS).

We also works to ensure that our partners’ programs are culturally appropriate, and they are sensitive to the unique needs of the communities they serve. Additionally, we works with the local partners and communities to provide the necessary information and education to prevent the spread of the virus, provide early detection and response to COVID-19 cases and ensure that communities are aware of the risks and protective measures.

We has focused on several ethical principles and good practices in their response to the COVID-19 pandemic in Myanmar. These include:

Community engagement: We works closely with local communities and partners to understand the unique needs and challenges of the communities they serve and to ensure that their programs are appropriate and responsive to those needs.

Fairness and equity: We are committed to ensuring that everyone, regardless of their socioeconomic status, has access to COVID-19 prevention and treatment.

Transparency and accountability: We are committed to being transparent in our COVID-19 response, and to ensuring that their programs are effective and efficient.

Cultural appropriateness: We work to ensure that their programs are culturally appropriate and sensitive to the unique needs of the communities they serve.

Protecting the most vulnerable communities: We are committed to protecting the most vulnerable communities, particularly those who are at higher risk of COVID-19 due to underlying health conditions or other factors.

Collaboration and partnership: We are committed to working closely with local partners and organizations to ensure that their programs are effective and efficient and to ensure that they are responsive to the needs of the communities they serve.

Education and awareness raising: We are providing the necessary information and education to prevent the spread of the virus, provide early detection and response to COVID-19 cases, and ensure that communities are aware of the risks and protective measures.

Human rights-based approach: We are committed to a human rights-based approach in their work and ensuring that the rights of communities are respected and protected during the COVID-19 pandemic.

These ethical principles and good practices are our commitment to ensuring that the response to the COVID-19 pandemic in Myanmar is fair, equitable, and responsive to the needs of the communities they serve.

We regularly update our work in Myanmar through this channel.

[Hazem Abouelfetouh]

It is crucial to promote ethical standards and best practices in clinical research in order to participate responsibly and effectively as a Clinical Research Associate (CRA) in the COVID-19 control policy. A CRA should adhere to the following significant ethical principles and best practices.

Knowledge and Adherence to Guidelines: CRA should has a good understanding of the relevant regulations, and laws related to clinical research conduction and make sure that the study is carried out in accordance with the pertinent guidelines, such as the World Health Organization (WHO) guidelines for clinical research during the pandemic.

Beneficence: A CRA has a responsibility to act responsibly to protect research participants from harm. In the case of COVID-19, it is the CRA’s duty to ensure that the study is planned and designed to maximize benefits and minimize risks to participants. This involves making sure that the research is conducted safely, and ethically, and that participants are treated fairly for any unfavorable incidents.

Non-maleficence: CRA must ensure that participants are not harmed during the research out of a sense of non-maleficence. This involves ensuring that the study is carried out in accordance with best clinical practices and that participants receive the appropriate medical care if any unfavorable outcomes occur.

Data security: CRA should ensure the security of participant data and respect their privacy. This involves removing any unnecessary data and putting in place suitable data security measures, such as password protection and encryption.

Justice: Justice requires that clinical research be carried out in a fair and equitable manner, making sure that the advantages and disadvantages of the research are distributed fairly among all participants. The CRA must guarantee that the research is conducted fairly and pays particular attention to those who are most impacted by COVID-19. This includes ensuring that individuals from underrepresented groups are not unjustly left out of the study.

Respect for Persons: It is one of the most crucial ethical principles in clinical research. The CRA should obtain informed consent from participants and respect their rights prior to conducting any study. This involves making sure that participants’ privacy is protected and that they are fully informed of the risks and advantages of the research.

Transparency: The CRA should promote transparency in data collection and reporting, ensure that study results are reported accurately and objectively and communicate with participants and other stakeholders in a transparent manner by giving clear and precise information about the research’s objective.

Continuous learning and improvement: CRA should continuously improve their knowledge and skills, and stay up-to-date with the latest developments in clinical research and ethical guidelines.

By adhering to these ethical considerations, a CRA can contribute to the development of a control policy for COVID-19 that promotes ethical and good practice in clinical research.

[Boonyarat Kanjanapongporn]

Thank you for sharing many points of good practice from CRA position. I agree that every positions which were direct/non-direct involved with patients, could promote ethical work process from awareness of good practice.

[ABDILLAH FARKHAN]

I am now assigned as technical staff for the surveillance of PHEIC (Public Health Emergency of International Concern) in the Directorate General of Disease Prevention and Control under the Indonesia Ministry of Health. This office was one of the busiest agencies during Covid-19 instead of hospitals, airports, and quarantine settlements. So, it is true to acknowledge that here we are working for a service-oriented that is policy-driven. These are the core value we have to perform in any situation:

1. Service-oriented: understand and fulfill community needs, being fully friendly, humble, and never stop making improvements.
2. Accountable: carry out all duties honestly, responsibly, meticulously, high discipline and integrity.
3. Competent: increase self-competence to respond to-changing challenges. Help others learn, and demonstrate the best performance.
4. Harmonious: respect for diversity. Excites to offer assistance and build a harmonious working ecosystem.
5. Loyal: loyal to the country and legitimate government.
6. Adaptive: quickly adapt to changes. Continue to innovate and develop creativity, and act proactively.
7. Collaborative: provide opportunities for various parties to contribute and being open to working together.

[Kansiri Apinantanakul]

Thank you for sharing.
Your work is quite interesting.
I like the way you bring service-oriented to the top list.
Among the tension of COVID-19, the kindness, and friendliness of all staff is the most appreciative thing.

[Boonyarat Kanjanapongporn]

I didn’t have direct experience on controlling or creating work processes to deal with COVID-19 but I have experienced being a user of the program which I think supports ethical healthcare. During COVID-19, ATK dispensing for free via Pao-Tang application was one of the COVID management policies which was supported by NHSO. My pharmacy store was involved with this program and I was in charge of dispensing management.

This program was built to enhance the opportunity to approach ATK test-kits. Without regard of healthcare scheme, as long as people were in the infection risk group, they could get three free ATK sets each month. Previously, ATK were available for sale which could possibly be considered as inequality to reach diagnosis. Because people who could afford to get ATK themselves would have the chance to test and received healthcare treatment earlier if they were infected. Moreover, ATK test result was considered a necessity, proven in many places including schools, which increased cost of living in struggling families.

This program provided invaluable support to induce good practice in Covid-19 management in increasing justification. Sixty days after implementing, 1.6 million people received ATK. The program could diminish some inequality to reach healthcare benefits. However, because of the varieties of population and possibly some limitations of programs, using mobile applications was unfair to people who won’t have internet or mobile phones. Besides, some manual dispensing units were too far for people to reach and discriminate people who lived in suburbs. Only Thai over 18 years old was allowed to get ATK which excluded children and migrants with social schemes.

Overall, this program was great to provide ethical health and reduced inequality under limited resources. However, creating good practice which cover all unfairness and unethical issues will still be challenged for the policy design.

[Siriphak Pongthai]

Thank you for sharing your information. The program was great as you told.
I think it would be better if the government allowed ATK to be marketed and self test since the beginning of an outbreak. Yet, they should enact a price control policy for this issue because ATK price was so expensive and most of people couldn’t afford it. In addition, it makes financial burden to population to have PCR test only at the hospital.

[Siriphak Pongthai]

I honestly tell you that my current position/job is not the one that can contribute to the control policy of COVID-19 in my setting. But I would like to share you some perspective that I have learnt during COVID-19 pandemic outbreak.

We strongly and strictly followed Thai MOPH and CDC policy. We ensured that our employees and participants are safe from COVID-19 cluster.

We encouraged people, who are closed contact with confirmed case, to report direct supervisor and self-quarantine. In addition, my organization culture assures privacy and confidentiality of those who confirmed case positive. They did not announce or report individual or unrevealed timeline. This is because they make sure that it is some kind of patient (individual)’s health information, which is sensitive and must not be disclosed, unless individuals will inform by themselves.

The abovementioned considered me what Thai MOPH did during an early outbreak, by revealing personal timeline publicly which it could make one’s stigma for the whole life. Unlike when the number of cases escalated, timeline revealing process was missing. At this point, human right should be taken into account for protecting and respecting individual. Nobody wants to be infected and blamed publicly. Nobody wants to have stigma through the whole lifetime because he/she got infected unintentionally. If the government started raising awareness and community engagement to participate in control measures, it would be better than what happened in Thailand during 2020-2021.

[Kansiri Apinantanakul]

Thank you for sharing, my situation is quite the same as yours.

[Kansiri Apinantanakul]

Dear All,

As same as Siriphak, I am also not directly involved with the contribution of COVID-19 policy in my setting. I’m working as a Clinical Research Associate (CRA). I mostly play the role of the follower of the policy.
I would divide my practice into 2 main settings.

At my office/my organization:
Adherence to the company measure: My organization has a policy of ATK-testing prior to entering the office and the policy of wearing mask during working in an office. I always obey the policy of my organization. I also emphasized to my colleague to follow this policy.

Empathy and Social responsibility: In Thailand, we were in the panic phase of the COVID-19 phase for a while. During that phase, we usually blame someone who get infected with COVID-19. I always keep in mind that infected people did not want the get infected. We should not blame them on that. However, we are all responsible to protect ourselves and our society from infection. My office has the office of not blaming and encouraging the social responsibility.

At study site (during study site visit):
This setting is quite the same within organization policy. Each study site has its own policy of COVID-19 screening and protection. As CRA, we should strictly follow the policy of the study site as well as keep in my on society responsibility.

[Tanatorn Tilkanont]

Thank you for sharing. During the COVID-19 pandemic, my company has the similar policy as you mentioned.

[ABDILLAH FARKHAN]

Thanks for sharing your experience. Covid-19 has made everyone work to break the chain of transmission. I am sure that whatever our profession and institution, we have worked and actualized the appropriate ethical principles as best we can.

[Tanatorn Tilkanont]

During the COVID-19 pandemic, I worked at a clinical research organization and was not directly involved in the control policy for COVID-19. I used to work the same job as K.Kansiri and my practice under the organization is quite similar. As a Clinical Research Associate (CRA), I had the opportunity to be responsible for monitoring a COVID-19 vaccine study. I would like to share some ideas for practices that I believe can contribute to the COVID-19 policy.

First, policy should be based on evidence support. With the disease rapidly spreading, research must also respond quickly. The data collected during research should be accurate, reliable, and used ethically and responsibly, with patient safety and well-being are the primary concern. Data sharing and monitoring might be used to evaluate the effectiveness of COVID-19 policy in some aspects.

Additionally, multi-disciplinary collaboration is crucial. COVID-19 research should involve collaboration between experts from multiple disciplines, including public health, epidemiology, virology, and economics, to inform policy decisions.

[Tanyawat Saisongcroh]

So in my setting, a large public healthcare institute, we have been strictly following governance policy, then transformed into action plan on our organization policy which mainly controlled by hospital infection control (IC) unit and then also adjusted to department policy level. As a worker under department and hospital policy, here are some issues that I have observed during COVID-19 pandemic

Beneficence/non-maleficence : All department follow the hospital policy and guideline, but in fact we have different context of work and environment, so for action plan, each department has its own control policy of COVID-19 to achieve the most benefit especially for the safety training and services for everyone; patients, doctors, residents, nurses, medical students and also back office workers.

Transparency : As the pandemic situation still continue, there are new statistical evidences published and it’s dynamic, the policy was contributed based on those scientific data and clearly documented. The action plan is clearly informed to follow, in term of resource preparation for providing service both treatment and vaccination for patients and workers.

Justice : the control policy of COVID-19 has to be fair for everyone. The hospital provides prevention supply (eg mask, gloves, ATK kits) for every level worker in the hospital. They prepared proper vaccine for all and everyone can access the proper treatment. Control policy is strictly used by everyone in the workplace.

[Kawin Wongthamarin]

Thank you to all my friends for sharing their interesting perspectives on working ethically.

As a physician, we are guided by four core ethics in our practice – Beneficence (doing good), Non-maleficence (to do no harm), Autonomy (giving the patient the freedom to choose freely), and Justice (ensuring fairness). However, the COVID-19 pandemic has presented a new set of challenges that test our belief in these principles.

One of the biggest ethical dilemmas faced by healthcare workers during the pandemic is triage and allocation of scarce resources. With limited hospital beds, ventilators, and personal protective equipment (PPE), healthcare workers must make difficult decisions on who will receive life-saving treatments and who will not. This raises questions of fairness and justice. and maybe it puts healthcare workers in a moral bind.

The distribution of vaccines has presented another ethical dilemma during the pandemic. The question arises as to who should receive the vaccine first and which vaccine should be given priority. While the government has mandated vaccination, recipients may still not have enough information and/or affect their work if they do not agree to the vaccination as required. This raises questions about patient autonomy and also highlights the need for clear and transparent communication with patients.

In conclusion, the COVID-19 pandemic has challenged us to balance the four core ethics of beneficence, non-maleficence, autonomy, and justice. It is important for healthcare workers, policymakers, and the general public to work together to ensure that ethical values are intact, even in the most challenging of circumstances.

[Kawin Wongthamarin]

I forgot that if I didn’t answer Ajarn question, I probably wouldn’t get a point. So let’s answer once again.

As I work on the frontline, I may not be able to play a main role in COVID-19 containment. But I do my job in providing appropriate treatment and advice to COVID-19 patients.

I treat patients based on updated COVID-19 guidelines, not inventing treatment guidelines by myself for maximum benefit to patients and also not harm to patients.

I recommend pros and cons and let patients make their own treatment choices. (Even sometimes I convince patients to select the best choice for themself.)

And finally, I honestly write the information in the COVID-19 reimbursement form to be fair to both insurance companies and patients.

[SIPPAPAS WANGSRI]

I see many fabulous work and interesting point of view from you guys! So impressive and comprehensive. Thanks!

For me, as a physician, my current and perhaps forever job would be treating patients! Like many of our doctor friends here said, “First, Do No Harm”. I have treated most patients the same way without taking the patient’s socioeconomic status as a judgement of providing treatment. However, in reality, they may have some limitations that we cannot provide the ultimate treatment for all of them whether the limited budget or resources, yet the minimum life-saving condition must be given at all costs.

Clinical Practice Guideline (CPG) is the ultimate guide for the practitioners. It is approved for use and adjusted for use in the specific context, depending on the availability of budget and resources. Some CPGs might not be suitable for other contexts, but it is the best choice we have to properly allocate the limited resources. I often follow them, because
1. It provides an optimal outcome for the patients
2. It can be use for reimbursement
Some patients may need special or extra treatment, then I sometimes readjust the treatment differently from the provided guideline. In order to do that, the hospital needs to pay for the extra cost themselves. Giving the hospital administrator a proper and enough reason, it can be exclusively permitted on per-case basis.

[Zarni Lynn Kyaw]

Thanks for sharing about the CPG, I tried to Google the document you are referring but since many are written in Thai, is there an English version?

Is this CPG what you are referring?
http://dmsic.moph.go.th/index/detail/9140

[PREUT ASSAWAWORRARIT]

Sorry all, I forgot to answer this topic on yesterday.

During the Covid-19 pandemics, I worked as a physician who contribute to care for severe Covid-19 infection in the intensive care unit. The major problem that many hospitals around the world has to deal with was intensive care unit shortage although we had tried to construct new intensive care units or transform the operating rooms to critical care units. In order to maintain the good practice standards, we have to be aware four fundamental principles of biomedical ethics: autonomy, beneficence, non-maleficence, and justice.

Autonomy
If the patient was fully conscious, we had to respect their decision. We, the physicians, had to provide all information needed for making a decision to the patient. Some patients, especially very elderly patients, did not want to receive any invasive treatment if the long-term outcome did not change.

Beneficence/non-maleficence
We had to adhere to provide the most beneficial treatment to the patients. However, many treatment against Covid-19 infection had only few evidence. We had to follow to the newest research to give the benefit treatment without doing harm to the patients.

Justice
Every patient has the right to reach every treatment, for example, intensive care unit admission, antiviral medication. However, there was the very high intensive care unit demand during Covid-19 pandemics, we had to consider to admit the patients who had the great chance of having good long-term outcome to the intensive care unit.

[Boonyarat Kanjanapongporn]

Thank you for sharing the idea of good practice standards from hospital setting.

[Wirichada Pan-ngum]

Thanks all for sharing your experience. Very inspiring and I am very proud! This course is coming to the end and I think we have learned a lot from each other. I am very happy with all your participation. Well done!

[Author]

Posts