Cultural humility when dealing with health

Cultural Humility: understanding and respecting before doing, and more importantly in global health, integrating communities into projects to truly assess their needs.

In Zambia, culture is a big part of identity. In my most recent role as Project Manager, I have learnt that understanding a certain group of people or a particular culture is key to project success. Cultural humility requires a willingness to relinquish preconceived notions and to consider what your work actually means to the people you are serving. In project management, it is about creating a project that collaborates with the community to integrate their needs. Projects that do not consider what a community truly needs and what is culturally acceptable are bound to fail. As a believer in health equality I feel cultural humility is an integral part of us seeing and embracing a better tomorrow for all.

The project which I have been privileged to work on during my fellowship year is CoRE (Community Led Responses for Elimination of Malaria), a cluster randomized control trail in Southern Province, Zambia. Coming into my role I was very excited to make a difference and quickly set the ball rolling in our (my boss and I) quest to eliminate malaria. Little did I know it would take numerous ethical approvals and multiple visits to district offices to ask for their support in assisting us to get the community to accept this project. These visits paid off in that we were given a strategy on how to win over communities in Southern Province.

One critical step we didn’t foresee was how the introduction of a new drug, Dihydroartemisinin Piperaquine (DHAp) would be received by community, though it is safe and more effective than Artemether lumefantrine (Coartem) which they have used for a long time. We assumed that communities would be as excited as we were, that a more effective and long lasting drug would be made available to them at no cost at all.

We quickly learnt that people normally tend to be more comfortable with what is familiar to them, hence the need for sensitizing them on the benefits of an alternative option. One cannot do without first sensitizing the community on why they would like to carry out a certain project especially a randomized control trial in which very quickly persons assume they are being used as guinea pigs for experimental drugs. In our quest to win this battle we engaged traditional leaders (chiefs, headmen and headwomen) who are greatly respected in their communities to influence their communities to consider participating in our project. You see one needs to be humble enough to learn and know that communities know themselves best and we know little to nothing at all about what is best for them. A person who does not live in a village would be perplexed as to why a traditional leader should be a key stakeholder in preparing the grounds for implementation. In the African culture traditional leaders as seen as prominent figures of society and their voice counts in a matter even one affecting their health and that of their family members. Traditional leaders are more like a ladder a team will need to cross a bridge, without them the project might fail.

Apart from traditional leaders it is critical to note that volunteers from the community (popularly known as Community Health Workers) play a critical role as well. They are seen as “part of the people”. So when approaching a household to response to a case of malaria, the community health worker should take the lead role in making introductions and explaining purpose and intent.

Designing a project on paper is one thing but being on the ground to assess feasibility of design, data collection, assessment and where necessary redesign is very critical, especially at baseline level. Project design is also very essential to winning over a community and integrating health benefits of the proposed intervention with cultural humility. By considering cultural humility the CoRE project has now moved into implementation phase. As implementation of CoRE has begun in Southern province, I quickly learnt that I owe much of my success to the effort of those that walked the journey with me and taught me the real meaning of what cultural humility is and how best to integrate it into the programs and projects we plan and do. Keeping cultural humility at the core of our business leads and guards us on the path of project success and a more cooperative community that will gladly participate and cheer you on to positive research results.