Ethical Challenges in Short-Term Global Health Training

Jane now better understands the differing cultural norms.  Here, she is seen witnessing a colleague’s actions.

CASE 1: Developing Cultural Understanding

Vignette 3: Over time, Jane has recognized the need to be aware of differing cultural norms, to have better knowledge of the local community, and to develop her skills at navigating complicated cultural differences (including the need to ask for guidance!). In clinic one day she notices that her colleague Samantha is alone in a clinic room with Jonathan, another medical resident laughing about a joke. Jane observes that the local hospital staff seem upset with this behavior, which is a shame because it is Samantha’s last day.

What should Jane’s approach be in this case?

Don’t say anything to Samantha since it would only offend her.
This approach is faulty because it leaves the local community with unresolved feelings that could fester and harm future collaboration. Please choose another answer.
Explain the situation to Samantha.
While this may be a component of the solution, trainees in short-term experiences abroad should not to attempt to interpret events in isolation. Jane could instead attempt to understand better the relevant nuances of cultural appropriateness in this vignette. Please choose another answer.
Explain to the clinic staff that being alone with a male is acceptable in the United States.
This is not the best strategy; applying one’s own cultural norms that are different from the community’s can be seen as disrespectful, potentially endangering a long-term collaboration. Please choose another answer.
Discuss the issue with advisors, such as Dr. Mohamed, ensuring Samantha is included in the discussion.
This is the most effective approach since it involves using the expertise of someone familiar with both cultures to assist with resolving the cultural conflict. In addition, this solution allows the conflict to be interpreted in the context of the service being provided to the community and helps to ensure that future trainees and the long-term collaboration are not impacted by such actions. Furthermore, it involves Samantha in the resolution of the conflict while not placing an undue burden on her to resolve the situation.
© Stanford University Center for Global Health and the Johns Hopkins University Berman Institute of Bioethics.

Project funding provided by Doris Duke Charitable Foundation (DDCF)