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

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

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

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

Modes of Misunderstanding Language Culture GenderPower

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

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)

Putting cultural humility into practice 8

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

References Chang, E., Simon, M., & Dong, X. (2012). Integrating cultural humility into health care professional education and training. Advances in Health Sciences Education, 17, 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):