- Editors' Note
We are very pleased to publish our fifth issue of Narrative Inquiry in Bioethics featuring a symposium edited by Paul Farmer and Sadath Sayeed entitled "Delivering Health Care in Severely Resource-Constrained Settings." In their call for stories Farmer and Sayeed wrote:
We believe the soul of global health work can be recaptured by story-telling. Narratives remind us of the immense challenges—programmatic and moral—involved in this work, and why global health demands of its practitioners an alternate mode of audit than sterile academic methodologies.
The physicians who wrote for this issue worked in: Algeria, Haiti, India, Nepal, Rwanda, Sudan, Tanzania, Uganda, and within the continental United States on a Navajo Indian reservation. Three authors worked in their own home countries; others provided a sustained presence in the settings they describe. In addition to the stories found in the print edition, four narratives are published online only through Project MUSE,1 describing care provided in Gabon, Guatemala, Mexico, and Russia.
The symposium commentaries were written by Renée Fox and by Bryan Good and Mary-Jo DelVecchio Good. Many of the stories in this symposium are very different from anything clinicians in North America or other wealthy parts of the world would normally face but others are more familiar. Clinicians in the United States are familiar with families trying to get the best possible care for their children. Almost half of the stories collected for this issue focus on just such families, except these families are in resource-constrained settings, which deeply affects the kind of care provided and the outcomes expected. Renee Fox's commentary discusses the divided lives many of these physicians live—working part of the time in well-funded United States academic hospitals while part of their time is spent in these resource-constrained setting—and how emotionally difficult this kind of lifestyle is for them. She also draws out the feelings of social justice that motivate these physicians and what these ideals mean for medicine all over the world. She illuminates the fact that even in the United States many families must deal with the problems of poverty, hunger, and access to medical care. Byron Good and Mary-Jo DelVeccio Good focus their commentary on how complicated it can be to strive for global justice. They discuss the difficulty of desiring to live a moral life in a world divided by wealth and poverty.
Growing International Reach
As we prepared for this issue we looked at what kind of international presence the journal has developed in its first five issues.
• Our first research article, "Perspective of Adolescents and Young Adults with Cerebral Palsy on the Ethical and Social Challenges Encountered in Healthcare Services," came from a group of scholars in Montreal, Canada [End Page v]
• Our most recent call for stories for the symposium, "Taking Bioethics Personally," edited by Tod Chambers, attracted responses from authors living in six countries: the United States, Canada, United Kingdom, Hong Kong (Special Administrative Region of China), Australia, and Germany.
• Readers have accessed Narrative Inquiry in Bioethics online via Project MUSE from the United States of America, Canada, the United Kingdom, Netherlands, Australia, India, Spain, China, Greece, Pakistan, Korean Republic, and Brazil.
• Readers of the Forum and the Narrative Inquiry in Bioethics Facebook page come from many additional nations, including the Philippines, Sweden, South Africa, Switzerland, Lithuania, Norway, Turkey, New Zealand, France, Iraq, Taiwan R.O.C., Germany, Belgium, Ireland, Israel, Kenya, Egypt, Hungary, Jamaica—Trinidad & Tobago, Finland, Italy, Childe, Bangladesh, Slovak Republic, Japan, Hong Kong S.A.R., and Denmark.
As we move forward we will continue to strive for international collaboration. We currently have a call for stories, "Living with the Label 'Disability'," being edited by an Australian scholar, Naomi Sunderland, and an American scholar, Jeffrey Bishop, which will solicit stories worldwide.
Research Article and Case Study
This issue also contains a research article by Rachel A. Schuster and her colleagues who recorded and transcribed discussions between physicians and surrogate decision makers to better understand how or if physicians conveyed prognostic uncertainty for their critically ill patients.
The case study is by David M...