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 current role as project manager, I have learned 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 my work, cultural humility 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 achieving 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 trial in Southern Province, Zambia. Coming into my fellowship, I was very excited to make a difference and to quickly get the ball rolling on our 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 that the community would not be as excited as we were that a new drug to treat malaria would be available at no cost. The new drug, Dihydroartemisinin Piperaquine (DHAp), is safe and more effective than the current drug being used in the community, Artemether lumefantrine (Coartem). DHAp is also longer lasting, so we figured the community would be keen to switch. However, the communities we were working in have used Coartem for a long time and were hesitant to switch.
We quickly learned 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. Without first sensitizing the community on why our trial was being done, people in the community assumed that they were 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 to influence their communities and ask them to consider participating in our project.
I realized that one needs to be humble enough to understand that communities know themselves best and that outsider researchers and program implementers may know little to nothing at all about what is best for the community in which they’re working. A person who does not live in a village could be perplexed as to why a traditional leader should be a key stakeholder in preparing the grounds for implementation. In many African cultures, traditional leaders are prominent figures of society and their voices count in most social matters — including those affecting community members’ health. Traditional leaders can be thought of as a ladder that a project team needs 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 respond to a case of malaria, the community health worker should take the lead role in making introductions and explaining the 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 even 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 learned 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 cultural humility and how best to integrate it into the programs and projects we plan and do. Keeping cultural humility at the core of our business keeps us on the path to project success and a more cooperative community that will gladly participate and cheer you on to positive research results.
