PubMed · 15974279
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Rob Calnan. 2005. Making a difference.. https://pubmed.ncbi.nlm.nih.gov/15974279/
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The vesico-vaginal fistula from prolonged obstructed labor has become a rarity in the industrialized West but still continues to afflict millions of women in impoverished Third World countries. As awareness of this problem has grown more widespread, increasing numbers of American and European surgeons are volunteering to go on short-term medical mission trips to perform fistula repair operations in African and Asian countries. Although motivated by genuine humanitarian concerns, such projects may serve to promote 'fistula tourism' rather than significant improvements in the medical infrastructure of the countries where these problems exist. This article raises practical and ethical questions that ought to be asked about 'fistula trips' of this kind, and suggests strategies to help insure that unintended harm does not result from such projects. The importance of accurate data collection, thoughtful study design, critical ethical oversight, logistical and financial support systems, and the importance of nurturing local capacity are stressed. The most critical elements in the development of successful programs for treating obstetric vesico-vaginal fistulas are a commitment to developing holistic approaches that meet the multifaceted needs of the fistula victim and identifying and supporting a 'fistula champion' who can provide passionate advocacy for these women at the local level to sustain the momentum necessary to make long-term success a reality for such programs.
The ubiquity of cooperation has motivated a major research program over the last 50 years to discover ever more minimal conditions for the evolution of altruism. One important line of work is based on favoritism toward those who appear to be close relatives. Another important line is based on continuing interactions, whether between individuals (e.g., reciprocity) or between lines of descent in a viscous population. Here, we use an agent-based model to demonstrate a new mechanism that combines both lines of work to show when and how favoritism toward apparently similar others can evolve in the first place. The mechanism is the joint operation of viscosity and of tags (heritable, observable, and initially arbitrary characteristics), which serve as weak and potentially deceptive indicators of relatedness. Although tags are insufficient to support cooperation alone, we show that this joint mechanism vastly increases the range of environments in which contingent altruism can evolve in viscous populations. Even though our model is quite simple, the subtle dynamics underlying our results are not tractable using formal analytic tools (such as analysis of evolutionarily stable strategies), but are amenable to agent-based simulation.
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