Social media has revolutionized communications globally and has become a dominant tool for instant communication and connection through text, photographs, and videos. According to Kelil and colleagues, estimates suggest that 3.8 billion people, or nearly 60% of the world’s population, use various social media platforms. Web-based platforms, such as Facebook, X (formerly Twitter), Instagram, and LinkedIn, have emerged as prominent tools in digital communication and augmented the exchange of ideas and stories.
Social media usage also has permeated the landscape of clinical and global health. The ability to instantaneously disseminate information to large and diverse audiences with a click of a button makes social media a powerful and promising tool for global health. Facebook, TikTok, Instagram, and YouTube are inexpensive ways to communicate and strategically promote health. Through these channels, organizations can conserve financial resources traditionally allocated to expensive informational campaigns and conventional mass media. Many health and allied health professionals also use these platforms for networking, teaching about intriguing or complex case studies, and documenting altruistic actions. Over the last few decades, social media has also garnered attention for fundraising efforts for medical volunteering and short-term medical missions, especially in host countries that are developing nations of the Global South.
The problem
When health organizations or professionals use these tools, the ethical conundrum surrounding sharing images – whether positive or negative – of the population they work with exists.
Many readers may be familiar with several fundraising campaigns, on television or online, curated by health organizations, depicting Black and Brown children in marginalized communities, with flies around their mouths and eyes, squatting and passively waiting for food, healthcare, and water relief. To bring it a bit closer to home, in global health missions and medical volunteering trips to developing countries, it’s not uncommon to see social media posts of health practitioners, and sometimes students, surrounded by adorable, sometimes scantily dressed children.
Sometimes, shared images include before and after clinical photos of cleft lip/palate bridges and dental surgeries, which try to capture a glimpse into the patient’s situation and are shared to evoke strong emotions or prompt favorable monetary actions. One may also have come across Instagram posts by healthcare practitioners depicting queuing patients in nations like the Dominican Republic or Haiti as they await vaccines, blood pressure readings, and glucose tests. I’ve attended global health lectures where the projected images of patients on the screen show their full faces and clothes, providing no anonymity or demystification.
These examples highlight a larger concern regarding how vulnerable populations are portrayed on social media by nurses and nursing students on short-term global health projects. According to McDermott-Levy, it appears that “for many healthcare workers engaged in international service or global health experiences, there is a lack of guidance for ethical practice and respect of host partners.”
This criticism may come as a surprise; many may argue that sharing these photographs is motivated by noble intentions of compassion, social justice awareness, and monetary requests to help the injured and sick in developing countries. However, these arguments fall short, and it’s important to consider the potential implications and ethical considerations for our patients.
Nursing implications
A major ethical component of training as an RN emphasizes the importance of maintaining patient privacy and confidentiality. This frequently means sharing information only on a need-to-know basis and refraining from posting identifiable patient images on social media. However, when working in the Global South, many nurses and healthcare practitioners fall short of these standards and uphold them inconsistently, which raises concerns about justice, dignity, and respect.
Everyone who enters the nursing profession takes an oath “to hold in confidence all matters in the practice of our calling.” We demonstrate respect for privacy and dignity when administering a flu vaccine to a patient in a hospital in Tucson, Arizona, so why is that same dignity, respect, and privacy stripped away when administering a tetanus vaccine to a patient in Haiti? As a nurse in the United States applying a wound dressing for a stage two pressure injury, is the first inclination to take images for social media education and awareness? Then why would that be a nurse’s first inclination when treating a similar case in Ghana? The universal nature of nursing ethics doesn’t suddenly change in a different population or setting of service, and we as nurses have the responsibility for serving and upholding our pledge, regardless of service in a setting of luxury or poverty.
Sharing the clinical images of these patients also raises questions about the quality of informed consent—not just consenting to the medical procedures, but also agreeing to be photographed and posted on any social media platform. Or is this latter often implied? Sometimes, patients may be persuaded to give informed consent for media use by highlighting the potential benefits of sharing images; ultimately, they retain the autonomy to consent, especially if their identities are protected. However, if in our altruistic efforts, we highlight a caveat to encourage participation, and if the potential benefits of participation are emphasized, there’s a risk that patients may not fully understand or be aware of the potential risks, or may feel pressured to consent in ways that compromise their autonomy.
Finally, photography and media, like a double-edged sword, can either capture the strengths and capabilities of the communities being served or reinforce negative, reductionist, and one-dimensional Western stereotypes of people in developing countries, particularly among Black and Brown individuals. Although some of these stereotypes may be true, they don’t represent the full scope of health realities or target the systemic barriers that remain a hindrance to the healthcare systems of these individuals.
A potential way forward
Big things often have small beginnings. Although our services in developing nations are appreciated, it’s important to emphasize that these are not acts of charity, but opportunities for meaningful collaboration and community engagement. One of the provisions of the American Nurses Association Code of Ethics for Nurses states that the “nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.” Working with vulnerable individuals in poor health requires significant oversight and collaboration from culturally and medically competent health authorities within the host country.
In case studies that present an intriguing or challenging health problem, health professionals must ensure that clinical photographs bear no identifying information, personal characteristics, or easily identifiable clothing item. They also must ensure that a quality framework for informed consent, including for treatment and media use, is developed and shared among the healthcare team, the host countries’ health authorities, and the patients receiving care. We must ensure that the consent process is truly informed, that individuals understand the implications of their decisions—including how their images or clinical results might be used—and have the ability to make those decisions freely, without undue influence.
When back in our home countries, nurses should seek volunteer opportunities, simulations, or training workshops in cross-cultural, diverse healthcare settings, where we can sharpen our cultural competency and sensitivity and apply nursing ethics universally. Where possible, institutions and health organizations that fundraise through global health missions should strive to build and develop more sustainable fundraising frameworks, rather than short-term, contrail-like fundraising that occurs during these missions.
Concluding thoughts
Social media is here to stay, and its use in healthcare is inevitable. However, nurses who participate in global health must remember the ethical responsibility to protect the dignity and privacy of the communities they serve, above the tempting desire for professional validation, fund raising, or the media documentation of sensitive situations.
While we may step into these medical missions with well-intentioned thoughts, we must be careful not to reinforce negative stereotypes of lack and pity that frequently overshadow these nations. Healthcare professionals must remain mindful that their actions, whether in providing care or capturing images, can directly influence how communities are perceived globally.
The responsibility of healthcare professionals extends beyond just providing care—it includes advocating for fair and accurate representations of the people and communities they work with.
Chidiebere Iwunwa BSPH, MSN, RN is a nurse at Mercy Medical Center in Baltimore, MD
References
Haddad LM, Geiger RA. Nursing ethical considerations. StatPearls. August 14, 2023. ncbi.nlm.nih.gov/books/NBK526054/.
Kelil T, Jaswal S, Matalon SA. Social media and global health: Promise and pitfalls. Radiographics. 2022;42(4):E109-10. doi:10.1148/rg.220038
Mantovani G. Is poverty porn over? Towards a new era of fundraising campaigns. Eye on Global Health. January 23, 2023. eyeonglobalhealth.com/2023/01/23/is-poverty-porn-over-towards-a-new-era-of-fundraising-campaigns
McDermott-Levy R, Leffers J, Mayaka J. Ethical principles and guidelines of global health nursing practice. Nurs Outlook. 2018;66(5):473-81. doi:10.1016/j.outlook.2018.06.013
Nurse.com. Understanding the Nightingale pledge. August 21, 2024. nurse.com/nursing-resources/nursing-history/what-is-the-nightingale-pledge/?srsltid=AfmBOoo8AyTV3eH-LHUR1LEphUOk5QJ3H7ndNFik_N1vUJ4bvT-BljmJ.
Tabb Z, Hyle L, Haq H. Pursuit to post: Ethical issues of social media use by international medical volunteers. Dev World Bioeth. 2021;21(3):102-10. doi:10.1111/dewb.12267
Van der Boon RM, Camm JA, Aguiar C, et al. Risks and benefits of sharing patient information on social media: a digital dilemma. Eur Heart J Digit Health. 2024;5(3):199-207. doi:10.1093/ehjdh/ztae009
