Ethical Challenges in Short-Term Global Health Training

Jane is an American medical resident in a short-term training program in the Middle East.  She and a fellow trainee are having dinner together. Click image to start video.

CASE 1: Developing Cultural Understanding

Vignette 1: Jane is an American medical resident who is doing a 6-week rotation in a hospital clinic in the Middle East. During her stay, she and another medical resident, Ryan have become friends. They live in the same apartment complex and frequently walk to the hospital together. They often find themselves sharing their experiences of the rotation.

In this case, Jane is training in a location where cultural norms prohibit her from having a male friend over for dinner.

Did Jane make a mistake by having a male colleague over to dinner despite local customs?

No. Jane and Ryan are both Americans, and it was after “hospital hours”.
Although Jane and her male friend are not locals, while they are living in a different culture they should be aware of, and in most cases respect, the norms of the local community. Doing so shows respect for the local community, helps build rapport in their collaborative efforts, and is likely to enhance Jane’s experience. Please choose another answer.
No. Jane did not know she was causing a problem and thus cannot be held accountable for this incident.
This is not an acceptable reason. In some cases, unanticipated differences in cultural norms will arise. However, major cultural differences – such as those involving gender – are typically apparent and knowable in advance. Trainees, like Jane, sending institutions, and sponsors all share responsibility for advance preparation to minimize the likelihood of unforeseen differences. Please choose another answer.
Yes. Jane violated cultural norms thereby perhaps jeopardizing her personal safety by casting her as having loose morals.
While violating cultural standards can expose an individual to risk of retaliation in the form of physical, verbal or social aggression, this answer fails to acknowledge the potential impact of her mistake on the community, her colleagues, and the overall collaborative effort. All of these stakeholders are affected, not just Jane. Please choose another answer.
Yes. At the very least, Jane’s biggest mistake was not knowing about this cultural difference in the first place.
This is the best answer. However, the responsibility to know about this cultural difference does not fall exclusively on Jane. Even if Jane has the responsibility to take an active interest in learning about the place in which she will be training and critically assess her own culture’s practice, her sending institution and sponsor share this responsibility with her. This responsibility continues in-country as Jane continually reflects on her behaviors, observes other cultural norms in practice, and maintains dialogue with colleagues and advisors about their experience.
© Stanford University Center for Global Health and the Johns Hopkins University Berman Institute of Bioethics.

Project funding provided by Doris Duke Charitable Foundation (DDCF)