Table 1
Faculty Mentor Observations about Benefits and Unintended Consequences of Student STEGH for In-Country Institutions.
| Benefits | Unintended Consequences |
|---|---|
| Help get the work done, increase capacity Become future staff members | Time away from mentoring local (in-country) staff |
| Provide inspirational enthusiasm. It is fun to re-experience things we know well through the eyes of students experiencing them for the first time. | When a trainee is not a good fit, they can be quite draining in terms of mentorship time and emotional energy to the team. One person’s struggle (which pales in comparison to the struggles of many local staff members) can overpower the greater team needs, and in worst case scenarios can break trust and have implications for broader partnership work and potential for future students. |
| Are more sensitive and aware clinicians | |
| Enable greater cross-cultural exchange | |
| Open door for more collaboration and networking | |
| Raise institution’s profile/social capital |
Table 2
Faculty Mentor Recommendations Regarding Themes for Discussion During Mentoring and Training.
| Theme | Comments |
|---|---|
| Context and local culture | Expand their world view |
| Have them respect the culture and local beliefs, even if they disagree | |
| [Our goal is] that they leave our program with a MUCH better contextual approach to global healthcare and clinical practice generally that will make them much more effective at (and motivated to do) future global service work and better clinical practitioners in their home careers | |
| Make students aware of the global burden of unnecessary suffering | |
| Setting and managing expectations | Realistic expectations (about how much progress can be made in short time period) |
| Defining success (learning about others cultures and building trust with a team are huge successes that are undervalued) | |
| Understanding impact of STEGH | Not all global health work is effective and some is destructive and counterproductive |
| There has been lots of efforts wasted in global health | |
| They need to understand why failures occur in this field | |
| Understand impact (and in some cases, burden) that they impose on their hosts | |
| Getting them to understand our mantra of 3C’s in global health – co-creation, collaboration, and capacity-building — is a great first step | |
| Local priorities and collaboration | Need to let work be informed by local knowledge and priorities |
| Understand that all project development that happens in the classroom (which can be an important intellectual exercise) needs to be revisited honestly in the field with the local team that has a much deeper understanding of the work and ultimately will drive and continue the work moving forward | |
| Foster understanding of importance of collaborating with local partners |
Table 3
Themes and Student and Faculty Mentor quotes regarding STE GHs (extracted from focus group discussions and open-response survey questions).
| Theme | Students’ Illustrations | Faculty Mentors’ Illustrations |
|---|---|---|
| Global health work requires key personal attributes that include humility, cultural sensitivity openness, flexibility | “I don’t think there’s a globally competent person […] when you go abroad to any country whether it’s in Africa or South Asia or South America, I don’t think you can be actually competent in any culture. But I think you can bring with you a knowledge about that culture and humility and openness to 1earn about the culture.” “I would say not that a person has to have incredibly deep knowledge of a million different cultures, but that they are open and willing to listen and understand other cultures.” “…realizing that when we do go to other people’s houses, their countries, their institutions, as much as we’re coming from a place of great resources with great healthcare capacity there’s a way that we have to conduct to ourselves that allows us to achieve the right aims and that you have to do it respectfully and it takes time.” “Someone who simultaneously can acknowledge incredible difference but also the same humanity and that the people that you’re working with are real people and are equal to you in what they deserve and how they deserve to be treated but at the same time may have totally different backgrounds and approaches to problems, which I feel is a hard balance to strike.” | “[Global health professionalism involves a] deep appreciation of BOTH the values, attitudes, beliefs, and resources of other social groups and communities AND the boundaries and potential impact (both positive and negative) of one’s own values, attitudes, beliefs, and resources.” Not easy to appreciate [cultural differences] by simple “book learning.” When they [students] travel to a new country for a global health experience, very rarely do I hear them ask questions about local beliefs, values, desires (rather than give their advice). |
| Interpersonal networks and collaboration at home and abroad are necessary at all stages of a global health experience (prior to departure, while in country, and upon return) | “I think the students who have been to the place before are definitely a big resource for people going for the first time, or even for the second time.” “But I think a way of doing it might be to actually do visit a country find colleagues that are working on something that you’re interested in, and see what skill set they are lacking and how you can sort of plug in or divert funding to achieving that aim. And isn’t that what global health is about? We’re sort of partnering with people abroad and plugging in holes that they can’t fill versus sort of setting the priorities for research or for intervention that might not be the same priorities your colleagues and your partner institutions have.” “But if there was something set up so that those of us returning from certain areas could kind of meet to talk about it and then even think about ways to continue the sustainability of our various projects and just brainstorm about that, because we all kind of came back and school started and life got busy and I personally thought it would have been really nice to have some sort of support group, maybe student-centered, to continue those thoughts and those efforts that we had spent so long working on” “I think the message that we should be sharing is how do we work together as global citizens.” | “Most students need significant framing of their experience and where they fit in a much longer story (i.e., the work doesn’t start when you arrive, or end when you leave) — so relates to managing expectations reframing how you define success, and working to build trust and relationships as the basis for any good work. Which takes patient listening – a skill that is not a natural common one among many American students.” |
| One major pitfall in global health work is a lack of appreciation of power dynamics (e.g., assigning priority to a student’s project over local needs and priorities) | “And I think one of the issues is that global health aims to be different from international health and from colonial medicine, and yet we’re entering a place where there’s such incredible power dynamics in terms of money and who has the skill set and the research and the wherewithal to go through certain projects.” | “Getting them [students] to embrace the reality that they will make little contribution in regards to impact through short duration student projects is important in managing expectations. Ideas that they will ‘change the world’ should be tampered with pragmatism.” [Students have] “myopic thinking.” “They’re [students] always expecting that they can solve health care issues in other countries because they’re smart and passionate.” |
| “Oftentimes, people came to a place and sort of bull dozed over people that have lived there all their lives and really knew the problems that were there. They didn’t take the time to shake people’s hands and really put themselves in a position where they are a visitor and are being allowed to do work in a certain place.” | “No amount of academic prep can truly prepare you for field work.” “They don’t realize how much administrative work and human resource management is required for making a difference.” “They are not aware of the dangers of global health work.” Lack of recognition that initial global health experiences are mostly about education for the student and less about impact for the patient population. “Marrying the health care needs of individuals and populations in resource-limited countries with the most evidence-based methods of meeting those needs should be at the heart of all global health endeavors. Unfortunately, this is not always the case currently or historically. Global health endeavors should always be undertaken with the yardstick of how well a particular effort meets this standard and must always be delivered with cultural sensitivity, gaining a true understanding of the challenges of providing healthcare in challenging global settings, and the real ways that” | |
| Bias exists everywhere and in multiple forms; students need to know their biases and be aware of others’ biases and address them whenever possible | “You start to stereotype…make judgments…start to say, ‘Oh, I know a little bit so that will then enable me to bridge the divide that pre-exists within the situation,’ You can always ask a question rather than jumping to a conclusion.” “So you see providers treating people differently and then people don’t want to go to these clinics and… just like within different groups, like I didn’t expect there to be so much mistrust, so much fear, so much racism because I haven’t been that way before.” “I did the semester abroad in XXX and guess ignorantly, I was thinking East Africa might be similar, like the places I would stay might look the same. The water access might look the same. Sanitation might look the same. So I was kind of expecting to really be grungy and rough-it, and then I get there and the apartment’s like nicer than my apartment here. There’s like great sanitation. Everything is very clean and very nice. That, to me, was a big slap in the face. I shouldn’t have just assumed that one country in Africa is very much like the other. And I was very happily surprised.” “Someone will assume that everyone in the room either feels the same way about something or thinks [everyone] has the same opinion about something or sees it the same way.” | “If students have not lived or worked in a low-income setting they usually are not well prepared to work there.” “[Students] do not understand how fragile settings are. Do not understand how our ‘exceptionalism’ is at times woven into our DNA – causing others to look at us with wary eyes and, causing us to behave in ways that are arrogant and clumsy.” “Students usually have a certain vision for what they think should happen, or perhaps what is best for another person” |
| Reverse culture shock and guilt about inequities can be pervasive | “You go to a developing world and see how people live their daily life with no expectation and then you come to a place like XXX, where people, for the most part mostly privileged compared to the rest of the world, and then you begin to see little things that we think are important. And I think for the first three months, I was like, ‘This is not important.’” “It’s really a drastic transition. You feel like you have to deprive yourself of many things to feel like an okay human being…” | |
| “And never, ever felt prepared for the reverse culture shock…you spend so much time getting used to one standard of living and then find yourself like overwhelmed and disgusted and confused about the way the people live here…part of the reverse culture shock is then also how easily you go back to your normal life…what just happened, how did that experience just slide through my consciousness…I just feel like I never myself take time enough to reflect and kind of process what happens.” “I had situations where I felt conflicted not eating what everyone else was eating… I find that we in that setting just complain a lot about the food that people eat on a daily basis…” “I certainly had zero tolerance for a lot of things that people complain about here. And I would get mad about things just like you couldn’t tolerate. | ||
| Ethical challenges are prevalent | “When is it human rights and when is it just culture, and when is it your place to question it.” “It never hurts to put yourself in someone else’s shoes. Like flip the situation on its head.” “…they used the language barrier between themselves and the patients as like an opportunity to talk freely in front of the patients without knowing that they couldn’t understand even in the context of as they were translating for a doctor, just like making jokes and kind of like, you know, judging what the patient would say as they were translating. That was a big part of it. That really bothered me. And the other part was knowing that there was no other healthcare in the area, kind of using it as a learning opportunity for themselves… ‘Oh, I can try pulling teeth because there’s no regulations out here’.” So using it more as an experience for themselves rather than the best care possible for the people that we were seeing…” “I actually got a really bad reaction when I would ask people for a signature, for a thumbprint or even for like a verbal okay, because in the area that I was in, a lot of people had been coming around and asking them for signatures to relocate that village and so I was… actually, someone screamed at me, yelling at me, telling me that… because they thought that I was part of that and they thought that I was taking advantage of them by getting a signature for like whatever with my motives. And so, it was just a very, very delicate way to get consent without making them feel like I was taking advantage of them.” “… the ethics of identifying problems kind of like forming relationships with the community and what your responsibility is as far as continuity with that is. Especially with identifying problems. Like seeing things that you’re not able to solve, but you could solve potentially but… I don’t know. It’s just a hard situation. I would have liked to … have an action plan like how to address some of the things that came up when I was there.” “I think communication is extremely important… People underestimate how important and how challenging it is, and I think a huge part of that is language, and culture also. But I think that for whatever reason, when you can’t speak someone else’s language, there’s a tendency to forget how to communicate, and I think that maybe the rules of polite conversation don’t necessarily apply because you can’t speak the same words as them.” | |
Figure 1
Word Cloud Depiction of Student and Faculty Open-Ended Responses.