Ethical Challenges in Short-Term Global Health Training

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CASE 1: Developing Cultural Understanding

Vignette 2: A few days later at the clinic.

In this case, Jane was unaware of a major difference between her culture’s norms and the culture where she was engaged in a short-term training experience. Upon reflection, however, Jane begins to wonder whether she should conform to this culture’s gender norms if she finds them offensive.

Jane and Dr. Mohamed discuss the reasons why having a male over to her house is culturally inappropriate.

Jane is wondering how she should approach this issue during her training program.

Jane should ensure she makes public her dissatisfaction with gender inequality and try to empower women in the community to discuss the issue.
In cases where cultural standards conflict, one must consider the impact of raising such issues. In some instances, doing so could hurt or even destroy an ongoing collaboration and actually prevent future dialogue on the issue. In other instances, raising such issues can lead to fruitful discussions and positive change on both sides of a collaborative program. For Jane to brazenly express her views seems inappropriate in this case. Please choose another answer.
Jane should always keep quiet about such issues to avoid offending locals or criticizing cultural norms.
While this may end up being the action taken, the idea that any discussion of cultural norms should be avoided is incorrect. Under some circumstances, not saying anything could prevent the increased mutual understanding or progress that might come through dialogue. On the other hand, the timing, method, and rationale behind starting such a dialogue can be critical to its success. Please choose another answer.
Jane should discuss the issue with her advisors, local colleagues, and peers for advice on how she can reconcile these differing norms.
This is the best approach when cultural conflict arises. Some differing cultural norms have to be accepted to effectively work in the area, others might need to be discussed within a collaborative program, and still others might be best left undiscussed for a time. Determining when a situation requires either of these latter approaches cannot be solved within this brief case. Being aware of one’s own culture, having a working knowledge of the other culture’s norms, and practicing the skills necessary to navigate such differences – such as discussing the issue with more experienced team members – are key components of cultural understanding.
Jane should not worry about what her team or the community thinks. This incident occurred "after hours," when she is free to "be herself."
While it might be simpler for Jane if she could make a clear division between her professional training experience and her personal time in the community, the reality is that her behavior outside her formal training time reflects on her team, sending institution, and sponsor. Because of this, her behavior might hamper both her training experience and her institution’s or sponsor’s long-term collaboration. Either can prevent the experience from meeting its goals. Please choose another answer.
© Stanford University Center for Global Health and the Johns Hopkins University Berman Institute of Bioethics.

Project funding provided by Doris Duke Charitable Foundation (DDCF)