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I do think that there should be established universal ethical guidlines for international collaboration for several reasons. Corruption and misuse of international aid is a pressing problem. Guidlines could be useful for individuals and entities wishing to provide assistance if they raised awareness of this problem and provided directives for avoiding any course of action that perpetuates and enables exploitation of resources and aid meant to improve the delivery of mental health care to Africans. The first step in addressing any ethical dilemma is generate awareness of the issue. I would suspect that this is the intention of those taking pictures of chained patients. It is interesting that you should mention this as I directly experienced this situation recently.
While staying in Freetown, Sierra Leone, I observed many instances of unethical and inhumane treatment of psychiatric patients. I did not consider taking any pictures of these things until towards the end of my stay when I was asked to do so by patients themselves. My reservations stemmed from respect for the privacy and well-being of the patients and concern and respect for the professionals who were gracious enough to allow me to experience the realities of the mental health care system in Sierra Leone. When patients begged me to take pictures of them so that I could "take them home to America" and show people how they were living I began to question my own integrity.
Is it ethical to avoid conflict and making others feel uncomfortable by refusing to acknowledge human suffering and hiding it from others who might be inclined to help bring about positive change? Can you share such pictures without bringing judgment upon involved psychiatric professionals and the nation's governemnent? The situation is very complicated and there is no clearly defined "good" and "bad guys." Such pictures do not convey all the extenuating factors and the intentions of those involved. Several of the patients expressed that if I did not take pictures that people would not believe me when I described what I saw. It is much easier to deny something when there is no tangible visible representation.
All said, I wish that I had had some type of resource available to me as I struggled with these decisions. I still feel conflicted about taking these pictures and using them as part of my efforts to generate assistance for further development of mental health care in Sierra Leone. I would have felt equally conflicted had I not taken the pictures as I would have questioned my own cowardice and unwillingness to take personal risk that might improve the well-being of these people who sincerely asked me for my help. It would have been nice to have had someone to discuss these issues with.
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