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According to the American Heritage Dictionary of the English Language, ethics is defined as "the rules or standards governing the conduct of a person or the member of a profession." As one scholar states "this definition is ambiguous in that we could not easily differentiate right from wrong." "(Elnar, 1998, p.1). That is to say ethics depends on a group or society's consent upon certain values. This paper will examine a real life case of unethical behavior in a hospital in Kyrgyzstan from a cultural perspective.

In order to better understand the difference in ethical values between Kyrgyzstan and the West, the author took an ethical framework in the United States and compared with that of in Kyrgyzstan. The American Society for Public Administration Code of Ethics points out that "administrators in the public sector should demonstrate the highest standards of personal integrity, truthfulness, honesty, and fortitude in all public activities in order to inspire public confidence an trust in public institutions," (Center for the Study of Ethics in the Professions, American Society for Public Administration). The administrators should be models of behavior for the people. "The public clearly disapproves of its servants acting in a way that deviates from standards and expects public employees to be models of good behavior" (Cayer, 1996, p.120).

As stated, it is obvious that in the United States, abuse of power, wastage of public resources and diversion of resources other than what they are intended is not permissible. Within the workplace, if any employee detects any wrongdoing committed by the employer or fellow worker, s/he is encouraged and, in fact, protected by law to expose the misdeed. "Employees who responsibly call attention to wrongdoing will be encouraged" (Center for the Study of Ethics in the Professions, American Society for Public Administration). "It is the personal responsibility of colleagues or employees to call attention to someone indulging in an illegal activity so that the undesirable act can be corrected. Personal ties and relationships are not considered when public conduct or behavior is viewed as unethical" (Elnar, 1998, p.3).

If ethics is defined as an administrator's ability to demonstrate the highest standards of personal integrity, truthfulness, honesty etc. in the West, then ethics is understood differently in Kyrgyzstan. It requires an understanding of the cultural context of the Kyrgyz people, especially the "Urmat System"- The System of Respect. There are certain rules which guide us how to behave in the family and at the workplaces. I can name three aspects which are relevant for the paper. The first one is respect for elderly people. If an employee's boss is older than s/he is, then this employee should yield to the boss' opinion and actions. As it is noted by Gleason "elders are given deference without question" (Gleason, 1997, p.37). Also, a younger Kyrgyz turns to an elder person using always polite words, that is to say in formal way only (Jusupov, Kyrgyzdar, 1997). The second value is the obligation to those from whom one received/s favors. That is to say an employee, for instance, should repay the boss in some manner. The third one is called shamefulness (Seitaaly uulu, Kirgizdin Koonorbos Doolottoru, 2000). If an employee detects a wrongdoing by his boss or fellow worker at the workplace, the employee would have uncomfortable feelings to report it (blow the whistle) to the public.

To understand the "Urmat System", the following case scenario would be very useful. Damira Askarova has been the head of one local hospital in Bishkek. She is about 56 years old and was hailed from the southern part of Kyrgyzstan (it is worth mentioning her place of birth and work because the Hurmat system has deeper roots in the south than in the north). She had worked in the South for many years. Over there she was taught to respect and yield to her boss even if doing so may be promoting an unethical practice. When she came to Bishkek she installed the values that she has learnt at her new work place.

This case focuses on Damira Askarova's misrepresentation, misuse of governmental funds and intention of seeking payment in exchange for certain actions. She has been doing these dishonest acts since she became the head of the hospital, and everybody in the hospital knew about her actions. The staff has discussed among themselves the problem and some of them expressed resentment over her manipulation of themselves (her employees).

The hospital receives some money from governmental budget to provide free medical service for poor people. Askarova is reportedly known to have used this fund for people who are not deserving. Her "friends" and "relatives" who are not obviously poor have been benefiting this "fund". These people own luxurious and expensive Mercedes and BMWs. The staff of the hospital has a sense of obligation to follow Askarova's rules because they look up to her as a person in authority. If in the USA, as noted by American sociologist Kohls, the "directness and openness is appreciated," then in Kyrgyzstan direct confrontation and straightforwardness is at odds with Kyrgyzstan values. Instead, the indirectness is valued. The employees cannot directly say about the wrongdoings, instead would opt to patiently wait till the boss retires. In other places, a third person is used to settle this kind of issues. But this recourse is also not easily carried out because it is cumbersome and time consuming. There is also a danger for the one who exposed the wrongdoing to suffer reprisal or lose his face, in a case where the third person did not do his best to mediate in the process.

At the moment, there are a lot of graduate students from Medical Academy and Colleges who seek employment. They are usually offered to work in rural areas, but these new specialists prefer to stay at Bishkek, because they would earn more in the capital than in the regions. Since there are many doctors who are chasing after a few positions, it creates a ground for corruption. In order to get hired for a hospital one has to offer from 500 to 1500 $ and, in some cases, it does not matter whether a new doctor has enough qualification and professionalism. Anara Kazieva acquired her employment in the hospital, where Damira Askarova is the head, by offering a bribe, although she does not have necessary knowledge and experience to be a doctor. This doctor offers something of value on the holidays and birthdays of Askarova. This way she returns her favor. The head of hospital, in return, sent doctors like Anara Kazieva to conferences, seminars and work assignments. Here the second aspect of Hurmat system comes to play, which is the obligation to those from whom one received/s favors.

Moreover, many staff workers are Damira Askarova's relatives. They make personal favors like preparing her meal and washing her cloths using the hospital resources. If Damira Askarova invites guests in her house for certain occasions then these same employees are asked to do household chores.

After treating a sick person, a doctor may seek some rewards in the form of gifts, money or domestic animals (cow, sheep or horse). The most interesting thing about this is that when a cured person gives the "reward" s/he does not consider this action as unethical. Both the "recipient" and "contributor," consider the reward, not as corrupt practice, but as a sign of gratitude and appreciation. Here, again, the second aspect of Hurmat system comes to play.

Nevertheless, there are few good professionals, who know and see the problem at the hospital. They cannot do much about it. Firstly, they are minority; secondly, they do not want the hospital to be ridiculed (the third aspects comes to play here, which is a shamefulness); and finally, they are feared to go against powerful Damira Askarova who has viable connections with high-ranking officials. If these good professionals were to go against the influential boss then they would be unemployed and suffer reprisal.

Over many years, Damira Askarova misused and embezzled governmental resources. In addition, she has manipulated her employees by using their work to fulfill her goals and interests. There was a need to remedy the problem by applying ethics. Yet, because of above-mentioned aspects of Hurmat system, acting ethically was difficult for the staff. For instance, if the staff should expose the situation to outsiders, they themselves would be in danger of being ashamed or "losing face".

In the context of returning favors, the staff thought that ignoring Askarova's unethical practices was the thing to do. Most of employees felt grateful for the opportunity of being able to work at Bishkek and at the quite good hospital.

In the above-stated case, Damira Askarova is obviously guilty of violating the principles of ethics, especially integrity and truthfulness. She was deceiving her superiors (Ministry of Health and government) and manipulating her employees. Damira Askarova's wrongdoings led to an environment of dishonesty.

Her actions might result in negative consequences. Firstly, the assistance from government was used improperly, which meant that a lot of poor Kyrgyz would suffer more. Secondly, unqualified personnel might bring harm for the patients. Thirdly, since many of the staff members paid certain amount of money to get employed, the corruption would flourish. Also, her employees might participate in these wrongdoings by imitating their boss.

There could be some solutions to partly or fully resolve this kind of problems. One partly resolution is the increase of salaries of rural doctors. This way many graduate students would have incentives to work in remote areas. As a consequence, the number of doctors seeking employment in Bishkek would be substantially reduced and the bribe taking for a position would be decreased. However, this solution is not feasible, since there is not much money to increase the wages of medical workers in the governmental budget. Another solution is the performance of internal and external review procedures. This one is also impracticable in our case. Internal review procedure is impossible, because simply no one has enough courage and power to start it. Since Askarova has "friends" who own expensive cars and viable connections with high-ranking officials, external review is unacceptable too.

In the Askarova's case, I would propose resorting to whistleblowing. As it mentioned above, there are few good professionals with relatively high standards of moral, who would expose the misdeed of Damira Askarova if they knew that there exist a law and agency, which would protect and encourage them. I take a position of lobbying and encouraging law enforcement agencies to enact and implement a law to protect whistleblowers. When the law on whistleblowers is accepted, then only the internal and external review procedures would bring desirable outcomes.

To sum up, I've tried to show on the basis of real case study that ethical principles are to some extent culture-bound. Also I've mentioned that remedying ethical problems are not an easy effort, and only through lobbying and encouraging law on whistleblowers we could solve the above- mentioned problems.

References

Cayer, N.J. (1996). Public personnel Administration in the United States (3rd ed.). New York: St. Martin's Press, Inc.
Center for the Study of Ethics in the Professions. American Society for Public Administration. http://csep.iit.edu/codes/coe/aspa-c.htm.
Jusupov, K. (1997). Kyrgyzdar. Bishkek, Kyrgyzstan: Sham Press.
Seitaaly uulu, A.A. (2000). Kirgizdin Koonorbos Doolottoru. Bishkek, Kyrgyzstan: Sham Press.
Elnar, E., Unethical Behavior in a NGO: A Cultural Perspective (unpublished).
Kohls, The Values Americans Live By (unpublished).
Gleason, G. (1997). The Central Asian States. Boulder: Westview Press.
Starling, G. (1998). Managing the Public Sector (5th ed.). Fort Worth: Harcourt Brace College Publishers.
The American Heritage Dictionary of the English Language