1. My Bad: Cultural Misunderstandings in Global Health Elizabeth Kvach, MD MA James Conniff, MD Cindy Haq, MD

2. 2 Activity Disclaimer Elizabeth Kvach, James Conniff, and Cindy Haq have conflicts of interest and no relevant financial relationships to disclose.

3. Objectives Review types of cultural misunderstanding Utilize ‘cultural humility’ as a conceptual tool for analysis and prevention of miscommunication in global health work Offer appreciative inquiry as a method of reflection on experiences of cultural misunderstanding 3

4. Cultural miscommunication: If you practice global health long enough, it will happen to you. 4

5. Modes of Misunderstanding Language Culture GenderPower

6. Cultural humility… …incorporates a lifelong commitment to: self- evaluation and critique, to redressing the power imbalances in [relationships], and to developing mutually beneficial and non- paternalistic partnerships with communities on behalf of individuals and defined populations. -Adapted from Telvalon and Murray-Garcia (1998) 6

7. Cultural Humility as a Lifelong Process Q uestioning and critique of self I mmersion in culture (bidirectional) A ctive listening N egotiating flexibly Qian = ‘humbleness’ 7 (Chang, et al. 2012, Integrating cultural humility into health care professional education and training)

8. Putting cultural humility into practice 8

9. Appreciative inquiry regarding cross-cultural experience 1.Self reflection: write a story about an experience of cross-cultural miscommunication. 2.Story telling: Relay this narrative to a partner. 3.Active listener: Partner explores the mind and experience of the writer, helping to develop and bring forward thoughts, feelings and insights 4.Switch roles 9

10. 10 “It takes decades to develop cultural understanding…but what we can and should develop is cultural humility.” -Paul Farmer

11. References Chang, E., Simon, M., & Dong, X. (2012). Integrating cultural humility into health care professional education and training. Advances in Health Sciences Education, 17, 269-278. Epstein R, Quill T, Krasner M, McDonald S, and Marshall F; A Curriculum in Mindful Practice, University of Rochester, 2009 Foronda, C, et al. Cultural Humility: A Concept Analysis. (2015) Journal of Transcultural Nursing. 1–8. Kagawa-Singer, M and Kassim-Lakha, S. A Strategy to Reduce Cross-cultural Miscommunication and Increase the Likelihood of Improving Health Outcomes. (2003) Acad. Med. 78:577–587. Telvalon, M and Murray-Garcia, J. Cultural Humility vs Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education. Journal of Health Care for the Poor and Underserved (1998). 9(2): 117-125. 11