Understanding culture and environment may be two of the most important yet least focused-on factors in global health. Without a true knowledge of beliefs, gaining the trust of the people in other countries, and developing necessary lines of communication, making sustainable improvements in health can prove to be a tough challenge. During the pandemic, when travel to low- and middle-income countries nearly stopped, the role of ethics in global health research became integral to successfully interacting with people in communities around the world.
Sarah Michels, YSPH ’22, and Brian Fleischer, YSM ’24, shared their experiences in two very different contexts as part of research programs at Yale and how participating in the Global Health Ethics Program (GHEP) training was essential in their ability to better communicate among other cultures.
Before they began fieldwork, Michels and Fleischer completed the Yale global health practical ethics pre-departure workshop. Led by Laura Bothwell, Ph.D., and Tracy Rabin, M.D., S.M., both faculty from the Yale Institute for Global Health’s GHEP Clinical Ethics team and focused on using a case-based approach to teach about navigating cross-cultural communication in global health practice. Rabin says little is written about standards of ethics training in preparation for global public health internships, so the existence and content of this type of training may vary widely across institutions. “We emphasize respect for local expertise, cultural humility, awareness of linguistic limitations which may impede communications, and the importance of learning about the environment well before you interact in the field or with the country team.”
Among its many teaching objectives, the training provides techniques on how to navigate complex situations in low- and middle-income countries with cultural sensitivity. Participants are taught key components to be successful in global health including humility, introspection (e.g., what are their motives for being in this work) and ensuring that goals are aligned with that of the community.
Fleischer participated in the training to prepare him for research he would be conducting in Uganda. He had previously worked in Ghana but recognized that he needed to better understand the culture in a new country. “There is an increase of distrust for health care systems,” said Fleischer. “We need to encourage conversation in the field, especially surrounding vaccines. The training provided me with better communications tactics to help me have a positive impact. I really learned so much going through the ethics training process.”
Michels says the training helped her to be informed before beginning conversations within the community. She was working with Indigenous populations in Montana and shared that because of historical traumas and ongoing discrimination, she had to continually reflect on her role as a researcher. Michels says Indigenous health is understudied, and one of her biggest challenges was disseminating information and deciphering the best channels to reach key audiences. “It is important to never lose sight of the overarching goal of research: to better support the health and cultural strengths of diverse communities,” she said. “Asking thoughtful questions, engaging in conversation, and doing my own research helped me be sensitive to the social, economic, and political conditions that continue to shape health access and outcomes.”
“The workshops helped me reword my sentences to make sure my meaning was correct,” added Fleischer. “I relied quite a bit on my notes from class to help me communicate with my Ugandan colleagues.” In particular, he said the training helped with trying to explain why the time and effort of the Uganda workers is positive and will be worthwhile for them. “I need to be transparent in my purpose, but also ensure that they understood the benefits and any complications that could potentially arise with our project in order to be respectful and gain trust.”
Michels and Fleischer both agreed that although global health has you taking a step outside of your comfort zone to seize all the work is very rewarding. The next steps for both students are to sift through data and share their findings with partners and collaborators. Both are also hoping to embark on similar projects soon.