Intercultural Competencies Learning Module
Pre-departure Workshop for Students in Global Health Contexts
Learning Module
- Creator(s):
Objectives of the Learning Module:
Target Audiences:
This learning module is designed to provide a resource to pre-departure workshop facilitators at the University of Michigan (U-M) Global Education who have students taking part in global health related programs.
This module was specifically designed to meet the needs of University of Michigan School of Nursing (UMSN) students, who regularly participate in global health related short-term programs. Most of these programs are UMSN or U-M aiffiliated programs that are cultural immersion/health delivery systems observations focused. In these programs, students will typically find opportunities to study at another institution, and observe health delivery systems by visiting hospitals, community centers, cliniques, and shadowing health care professionals in that community. UMSN currently administers 1 undergraduate and 2 graduate programs in Thailand, 1 undergraduate and 1 graduate program in Uganda, 1 undergraduate program in India, and 1 undergraduate/graduate combined program in midwifery in Denmark. UMSN also administers various custom internship/project based programs for all nursing students.
Each year, around 75 nursing students travel abroad for various global education opportunities. These students are required to attend a mandatory pre-departure workshop oranized by the Office of Global Affairs in the U-M School of Nursing and the U-M Global Engagement Team, under the Provost's Office.
The students are both undergraduate and graduate level students. One major distinction between a student being undergrad or grad student is their professional certification status. Undergraduate nursing students are not yet certified nurses, even though they get certified for a different level of scope each year during their studies. Graduate students are professional certified nurses. Their scope is substantially different that the undergraduate students.
Predeparture orientations currently do not have different content for grad vs. undergrad students, however, facilitators will adjust the content as much as they can based on the needs of the students. One major challenge with this is that there is no standard of education, each group will be offered different content, sometimes to the expense of letting go of some of the most fundamental learning opportunities. With this module, facilitators will be able to see the overall picture, and curate the necessary learning experiences for their students within feasible timeframes, and realistic and personalized reflection requirements.
Another challenge is time. Nursing students have rigid academic and clinical schedules, and it is nearly impossible to find time that works for the whole group travelling abroad. If we can find time, it is not more than 2 hours, and as you can see in this module, there is no possible way to cover the contents in this module in 2 hours in a meaningful way. Most students leave without being able to reflect on the content, and they typically do not refer to their folders to go back and review the resources we pointed out to them. Once the mandatory workshop is complete, a checkbox has been fulfilled, and the students are off to their immediate travel arrangements and needs. With this module, the facilitator can assign necessary sections and commentary based on the student needs, and require the students to cover the content prior to the in-person workshop. This way, at the in-person workshop, everyone has had a chance to cover the content and engage with the content so that higher level student needs can be identified, assessed and addressed.
Finally, in response to the previous two challenges, we currently divide out our pre-departure workshops into 3 groups (1 grad, 2 undergrad sections) and there is no cross-learning opportunity between these sessions. With this module, students will also get a chance to learn from one another's reflections. This is potentially very helpful in developing students' own inter-personal skills, as well as communication skills which are essential to developing inter-cultural competencies. Similarly, if the project is completed based on each student's program/destination, and a minimum of 2 peer reviews are required for each student to complete, every student will get a chance to learn more about the applications of these inter-cultural competency concepts in potentially 3 different cultures.
There are 6 learning parts to this module. The first three sections are geared toward more basic, common UMSN travelers. Typically, undergraduate students may or may not have traveled abroad before, and even those who traveled abroad have done so more in touristic fashion rather than study/work abroad. The sections on this module are designed to include a wide scope of prior inter-cultural experiences by adding subsections that contain information targeting more in-depth understanding of the concepts. These categories are indicated to the instructors under categories Basic and Advanced. Instructors may select the sections to be completed by their learners based on their learners' needs. Most sections also have a number of commentary questions, and instructors may also curate the required commentary questions based on the needs of their groups, or let learners choose a minimum number of commentary in which they wish to engage. These commentary sections are a good way to collect student reflections, and determine what further resources may be needed prior to the pre-separture workshop. Commentary sections can also be used to allow students to learn from their peers' responses by reflecting on various perspectives and advancing their understanding of the concepts through application.
One recommended learning model is to implement a peer reviewed project at the end of the module. The recommended project is to take 4-5 concepts students have learned in this module, and apply it to their destinations/contexts as much as they can know about it before they travel. By doing this, students will get a chance to advance their understanding of the concepts by applying them to a context. At the same time, they will be encouraged to learn more about the context in which they are about to immerse themselves. This project could also push them to question some of their own biases, or internal/external stressors that would be helpful to address before they travel. One other obvious benefit of the peer reviewed project is that the students would be able to learn from their peers, and see the various contexts the concepts may exist.
Study abroad, intern abroad, pre-departure workshop, inter-cultural competency, global health, voluntourism, community engagement.
This module is developed to maximize your learning while allowing you to go through the content at your own pace, on your own terms. You are responsible to cover all of the sections assigned to you, and you are responsible to attend an in-person pre-departure workshop after completing this module. You are highly encouraged to reflect on each of the questions posed in the module, but your instructor will give you directions on what your specific requirements are. Every nursing student traveling abroad for a health related program is required to complete the Part VI. Global Patient Safety section of this module, and submit their certificate to their global health advisor before they can travel. Make sure to receive specific instructions on how to complete this module from your pre-departure workshop instructor.
Part I - Knowledge
Objectives:
Duration: 1 hour (Ask your instructor what commentary questions you must participate in.)
Part II - Skills
Objectives:
Duration: 1 hour (Ask your instructor what commentary questions you must participate in.)
Part III - Attitudes
Objectives:
Duration: 1 hour (Ask your instructor what commentary questions you must participate in.)
Part IV - Community Engagement
Objectives:
Duration: 24 hours over 6 weeks (Ask your instructor what workbook assignments you are required to submit.)
Part V - Volunteering vs. Voluntourism
Duration: 1 hour (Ask your instructor what commentary questions you must participate in.)
Part VI - Global Patient Safety
Duration: 1 hour (Ask your instructor if you need to complete the commentary question, and make sure to submit your GAPS certificate to your global health advisor in order to travel. This is also required for you to complete the globa health minor or concentration if you are pursuing these programs.)
Objectives of this module:
Audiences:
There are 6 learning parts to this module. The first three sections are geared toward more basic, common UMSN travelers. Typically, undergraduate students who may or may not have traveled abroad before, who have not studied abroad/worked abroad before. These sections include subsections that may contain information targeting more in-depth understanding of the concepts. These categories are indicated below under levels Basic and Advanced. You may select the sections to be completed by your learners based on their needs. Each section also has commentary, and you may also curate the required commentary based on the needs of your groups, or let your learners choose a minimum number of commentary in which they wish to engage.
Part I - Knowledge (Basic)
Objectives:
Duration: 1 hour (recommended with 4 commentary discussion questions)
Part II - Skills (All levels: Basic, Advanced)
Objectives:
Duration: 1 hour (Recommended with 3-4 commentary discussion questions)
Part III - Attitudes
Objectives:
Duration: 1 hour (Recommended with 2 commentary discussion questions)
Part IV - Community Engagement (Advanced)
If the student is attending a short-term program note that this section may not be relevant. If the student is engaged in a long-term project, and/or if the student will be engaging with communities to implement collaborative projects, this is a perfect training module for them to complete. They will not need to complete any of the other sections, they can simply complete this and the Global Patient Safety Module.
Objectives:
Duration: 24 hours, recommended to complete in 6 weeks
Workbook for possible commentary requirement can be found here:
Part V - Volunteering vs. Voluntourism (Basic and Advanced - if the student is attending a U-M program, they can skip this section. If the student is attending an unfamiliar program that has short-term volunteering aspects, this section should be mandatory.)
Duration: 1 hour (Recommended commentary: 1)
Part VI - Global Patient Safety (Basic and Advanced - Required for all global health related travel and global health minor and concentration pursuing students.)
Duration: 1 1/2 hours (Recommended commentary: 1)
“The sum of a way of life, including expected behaviour, beliefs, values, language and living practices shared by members of a society. It consists of both explicit and implicit rules through which experience is interpreted.” Geert Hofstede, 2001.
Geert Hofstede, a pioneering researcher on the concept of culture, also notes that it is “programming of the mind.”
When interacting in another culture, there are often “unseen” factors that can affect an experience or interaction. There are many aspects of a culture that are visible, such as art, popular music, or food, but the vast majority of cultural understanding is implicit, or things we can’t see.
When we encounter these “implicit” rules in a culture that is different from our own, that’s when we have the potential to face a misunderstanding or label things as “odd” because we don’t understand it.
As you think about your upcoming experience abroad, remind yourself how much is happening under the surface and how much of that culture you have yet to see or understand. When something happens that makes you uncomfortable or strikes you as “strange” think of this image, take a step back, and make the conscious effort to recognize and understand that you may be looking at an “invisible” or “implicit” cultural norm.
This image helps us to think about the process of leaving our home culture, entering another, and then coming back to our home environment. Keep in mind that we all experience culture shock and cultural adjustment differently, so your path may not look exactly like this, but it may share some similarities. It is important for us to think about this image, because if you or someone else you are traveling with experiences culture shock you can step back and think about what might be happening in the context of this timeline. This can help you to deal with it more effectively.
(1) First, when we enter a different culture, we tend to enter the “honeymoon” phase, where everything is new and exciting. The food is amazing, the climate is exactly what you wanted, there’s so many fun things to do and explore. There is a lot of buzz and excitement, and you are looking forward to experiencing everyday life where you are.
(2) Then, as time goes on, and it can be a few hours, days, weeks, or months, you start to realize that you don’t actually like the food. Why is everything so spicy anyway? And that the sun is so HOT everyday, and it’s difficult to get around on public transportation (after all you don’t speak fluent French, or Spanish, or Swahili). All of the things that once felt exciting and like an opportunity to explore, now make you frustrated or irritated. You just want to be able to eat a salad, or take a bus without waiting for 3 hours.
(3) After this, you may become homesick. You may begin wishing that everything was the way it was at home and you didn’t have to “struggle” with all of the new things you do abroad. You might miss your friends, or your favorite food, or being on campus. You might feel like there is nothing you can do to change this situation, and it can be a bit lonely. You might question why you decided to go abroad in the first place.
Reflection and support are highly important during this phase because it can be isolating to feel homesick. Once we understand more about the process of culture shock, you can challenge yourself to assess where you are in this image. Sometimes naming your stage can help you realize that this isn’t the end--the process will most likely progress on the upswing and get better. In order to work through it, reflection and sharing your experience with others is a key element to keep going.
(4) The next stage is adaptation. You begin to realize that the place you are now, is not like your home, but that’s not a bad thing. You start to recognize that the climate, and transportation, and food in your host country aren’t going to change anytime soon, and you begin to accept the situation and adapt. You may even start liking it again.
(5) At this stage, you have spent time adjusting to the culture, forming relationships, and you can now navigate public transportation yourself. You can cook your favorite local dish and have built strong bonds with friends or a homestay family. You now start to see your host country as your new home.
(6) You know that you will be heading home soon, and you are really excited to be back in your home culture, but may also have mixed feelings about leaving. After all, you went through this process to adjust and now feel comfortable here. So you may feel split between being in your host country and being in your home country.
(7) You are back at home and trying to slip back into your old routine, but may find that it’s not fitting as well as it used to. You just had a transformational experience living in another culture and find that your friends and family don’t really understand what you experienced. They expect you to be the same “you” that you were before, not understanding or realizing the ways you have changed and how your perspective may have shifted. This can be a challenging time in a similar way that stage 3 was while you were abroad.
Even though your friends and family may not understand exactly what you have been through, it is important to keep your support systems in place. If you can, find a group of students on campus who have been abroad before and share your experiences with them. If you traveled in a group, make time to get together again stateside.
(8-9) In these final stages of re-entry, you begin to readjust to your life at home and integrate what you learned during your experience abroad into your new life stateside. These two stages can often take a longer time to happen, because a lot of times, we don’t realize the challenges that can come with readjustment and integration into our “home” culture. Oftentimes, the expectation is that you should be able to re-adjust immediately since it is your home, but this isn’t always the case.
The purpose of sharing this image is so that you have an understanding about what might be ahead for you. So that you know if you are stuck in stage 3 or 7, that this is all part of the process of adjusting. There is nothing wrong with you, you aren’t the first person this has happened to, and cultural adjustment is about the process.
If you are experiencing things that seem to fall outside of this, or you can’t seem to get past one stage, it’s also important to know what your resources are. Talk to your travel companions, talk to an on-the-ground support/organizer, contact your education abroad office or trip leader. Even though you may be able to isolate where you are on this image, it doesn’t mean you have to experience it alone.
Sarah's Story: Culture Shock
Before travelling to the Marshall Islands, Sarah felt unprepared for her journey. The first months living abroad were the hardest of her life. She was overwhelmed by the heat, the poverty, and her living conditions. She also felt constantly "exposed," missing the anonymity on the street that she enjoyed in America. Over time, she came to stop wanting to change things that she could not and to recognize and appreciate the relationships that became to be an essential part of her experience there.
Now, visit resilient traveller website, and learn about the skills Sarah relied on, in order to adjust to her new context.
Social identities are our affiliations with various groups based on physical, social, and mental characteristics. Sometimes these identities are self-proclaimed by ourselves, but other times they can be ascribed by others. For example, for those of you who do not know me, I identify as Turkish American. When people hear me speak they may identify me as a non-native speaker. Based on this social identity, they may make assumptions about my immigration status, socio-economic status, and what job I do here.
Sometimes when we are abroad, there are certain aspects of our identity that come to the forefront more so than they would at home. For example, for many Americans, their identity as an American, when in the US, is something they almost never think about. Yet, when they travel abroad, this part of their social identity may become one of the first markers people identify them by.
Social identities often shift depending on who we are with and what cultural environment we are in. As you interact abroad, keep in mind that people may make assumptions about you based on your social identities and you may inadvertently do the same. Negotiating these aspects of our identities is one of the challenges of experiencing life in another culture. Yet, it can also be a great learning opportunity as well.
As an example, people may have assumptions about what it means to be American, and you can help share your insights on that and dispel some stereotypes. The same holds true for the location you will be traveling to, as well. Keep an open mind and avoid making assumptions about the culture and social identity of others.
At the same time, keep in mind that while you may not feel like you speak for everyone in a particular identity group, the people you interact with might make that assumption. If you are the first American [or another identity] that an individual has met, they may perceive your voice as the voice for all people in that group. It can help to make the clarification that you are not necessarily an authoritative voice for an entire identity.
1- Manage logistics: For example, booking flights, getting a visa, accommodation, transportation, communication with home while abroad, etc.
2- Research the host culture: For example, using library resources, online sources, and news articles to ensure you have a general sense of the laws, culture, and customs of your host country, etc.
3- Preserve health and safety: For exapple, complete the Travel Health and Wellbeing Abroad mandatory pre-departure workshop, visit UHS or another medical practitioner for required medications and immunizations, ensure medications are legal in your host country, etc.
1. Choose at least four of the questions below and comment in the discussion section: (You can comment on as many as you would like)
2. Engage with at least 2 of your peers' comments in a respectful manner. Make sure to add the @ sign in front of your peer's name when commenting.
For this activity, you can either require each student to comment on all or a minimum number of questions posed to the throughout the section. Comments can be shared with the group to generate discussion during the in person session. Alternatively, if you are working with seasoned travelers, you may skip this activity.
At the in person workshop, you may use the talking points below to help students understand what culture means, bearing in mind that it is also important to avoid generalizations.
Geert Hofstede, a pioneering researcher on the concept of culture, describes the term as [read quote from slide]. He also notes that it is “programming of the mind.”
○Avoiding walking on the M in the diag
○Michigan time
○Crossing the street even when the walk sign says not to
○It took you time to learn these things and to acclimate to life here on campus
○When you travel abroad, you may experience a similar adjustment, though it could be more pronounced given that you will be in an environment you are completely unfamiliar with
○Facing the wall in an elevator
○Greeting every person you meet on the street
○Eating with your hands or sharing food from one large pot●Why would you think these things are “weird,” or “strange?”
○Because it is different from the behavior we are used to in our culture--when we are faced with a situation that challenges our cultural paradigm (that we might not even realize we have) it feels strange and we can be tempted to label it as “weird” or “strange” or “odd”
○But to the people living in that country or community, it is totally normal, and they might even interpret some of the things you are doing as odd
○When you are immersed in another culture, along with learning about the new community you are in, you may also begin to realize things about your own culture that you didn’t realize beforehand
Have you ever experienced anything either at home or abroad that felt uncomfortable because it seemed to be different than the culture you are used to? What happened? How did you handle it?Encourage discussion here and break students into smaller groups if needed.
When we experience something different from our own culture or label things we don’t understand as “weird” or “odd,” we run the risk of making some unnecessary judgments that can have an influence on an overseas experience.
More resources are available on Peace Corps World Wide Schools Learning Module.
The Culture Iceberg: Encourage learners to look at the image and discuss what they think it means in the comments.
During the in-person workshop, use the following questions to help generate discussion:
Encourage students to comment in the comment section to discuss if they have experienced culture shock or shock upon re-entry, and ask the students to share experiences if they are willing.
Encourage students to discuss the following questions they can reflect on while watching the video:
After watching the video, use the following questions to generate discussion:
During the in person workshop, share out with the group if there are good examples from the responses, and discuss the skillss from the resilient travel website students could have managed their adjustment period.
If students have responded to this activity, share some examples during the in-person workshop for discussion.
Depending on the depth you wish to go during the in-person workshop, additional instructions and exercises for facilitating the Social Identity Wheelyou can be found here: LSA Inclusive Teaching Website.
Encourage students to use the following discussion questions to help students unpack the content:
For this activity, during the in-person workshop the discussion can be modified by asking students what they learned from the video and how they might apply these lessons to their own pre-departure preparation process. You may also share some responses students may have added in the comments before, and summarize what they have said.
Experiencing challenges is a normal and expected part of an experience abroad. As was mentioned during the knowledge section of this module, most people experience at least some level of culture shock while traveling abroad. In addition, there are other challenges that can arise including health issues or potential conflicts within the group with which you’re traveling.
Resilience, is defined as “the ability to adapt or rebound quickly from change, illness, stress, adversity or bad fortune.” Learning about and developing skills related to resilience can make all the difference when you’re faced with a tough situation.
The Resilient Travel Project was created to provide members of the U-M community with a resources for learning about methods for developing resilience.
The five factors below on Resilient Traveling Website help foster resiliency.
These factors complement and reinforce each other, and can be developed by practicing the skills in the skills section.
Take a moment to write down a quick sentence about what is happening in this photo.
DAE Framework
D = Describe
A = Analyze the event/object/photo several ways
E = Evaluate your results
Now take a close look at your response and determine:
Is your sentence objectively describing what is happening in the photo?
Or is your sentence conveying how you feel about what is happening in the photo?
For many, the initial response to being presented an unfamiliar situation is to evaluate it subjectively, based on how we feel about it.
This section is for graduate students who will be involved in patient care abroad:
Read the case studies below from actual U-M School of Nursing Faculty and Students, and reflect:
Case Study #1:
In Liberia a few of our Midwifery students wanted to resuscitate an infant after a difficult delivery but the Liberian healthcare providers refused to help. Their reasoning was that the child had already been deprived of oxygen and would be extremely likely to have deficits. There are no social services to assist the family or child with the potential deficits so "saving the infant" may cause more harm than good. This is obviously not what would be done in the United States. Our students still tried to resuscitate the infant but were unsuccessful. Afterwards there were tears, a debriefing with US colleagues, and a conversation with Liberian colleagues.
Now reflect on your own:
1- How would you have handled this situation?
2- What steps would you take after the event?
3- How would you support yourself? A colleague who experienced this?
Case Study #2:
While collecting data in Liberia, a teenager mother who had been raising her infant on her own while her husband was off working in the mines came rushing into the clinic with a very limp, pale, and thin baby (about 12 months old). She had missed a number of check-ups and vaccinations because it was difficult for her to get to the clinic by herself. A quick assessment revealed a thready and low pulse. We were finishing data collection and agreed to drive the woman and baby to the hospital (near where we were staying). The infant ultimately died related to malaria and anemia. The woman did not have enough money to pay for the burial or to get herself back to her community. We pooled some funds to pay to get the infant buried and to get her home. She literally had to leave her infant that evening and take a taxi home and never saw her baby again.
Now reflect on your own:
1- In general, the faculty have a policy not to transport people to the clinic/hospital. Why do you think this is?
2- What steps would you take after the event?
3- How would you support yourself? A colleague who experienced this?
Case studies provided by Dr. Michelle Munroe-Kramer, U-M School of Nursing.
Throughout your experience abroad, you will undoubtedly be confronted with new experiences, viewpoints and challenges. As you have such experiences, it can be useful to note what you’re going through and what it means to you.
You might choose to use a private journal or blog for family and friends back home. If you’re new to blogging and/or aren’t sure what topics to blog about, you can find blog prompts online that will guide you to reflect on various aspects of your experience abroad and your host community’s culture.
We would encourage you to make practice reflection regularly, and add it to your daily or even weekly routine! What might seem tedious or time-consuming now will undoubtedly be a really interesting way for you to gauge the growth and development you experienced while abroad.
The displayed quote from John Dewey sums it up nicely, “We do not learn from experience … we learn from reflecting on experience.”
1. Choose at least four of the questions below and comment in the discussion section: (You can comment on as many as you would like)
2. Engage with at least 2 of your peers' comments in a respectful manner. Make sure to add the @ sign in front of your peer's name when commenting.
During the in-person workshop:
Additional Activity (Optional, dependent on time): Road Map Activity
More resources for the facilitator to refer to:
Background Information:
This exercise is intended to help students recognize that subjective responses to new situations are often automatic, and to teach students a framework that encourages one to suspend their judgement when encountering a new viewpoints or situations. This exercise is sometimes referred to as DIE (Describe-Interpret-Evaluate). In this presentation we are using the DAE (Describe-Analyze-Evaluate) framework, which has a more positive and clearer acronym. For more information about the DAE, including the source of the included photo and framework description, please see:
During the in-person workshop, go over student responses, and have them reflect on their own responses.
Students will hopefully share that this framework is important, as they will soon be traveling abroad, experiencing a culture with which they may not be familiar. Inherent to the experience of traveling abroad is experiencing new ideas and situations, some of which we might not agree with. The DAE model encourages folks to suspend initial judgement, and instead take time to learn different perspectives.
In the case study section, address any questions students may have, and offer resources to develop skills to process these extremely difficult situations.
During the in-person workshop, introduce students to various ways they can practice reflection. If they are required to write a journal, give specific information regarding how they should be journaling. If you require them to write a blog, or other document to reflect on their experiences abroad, give them information on how they may be able to reflect.
Here are some ways UMSN students can share their reflections with their community:
Make a poster about their experiences (Only U-M access)
Write a blog for the Michigan Nurses Abroad Page (Only U-M access)
Now, close your eyes, and magine the following:
You are hanging out in your room, watching Netflix. All of sudden, a stranger walks into your room and starts rearranging your shelves, and your closet!
Now open your eyes and think about the following:
How does it feel to think about someone you don’t know coming into your space and making changes?
Cultural Humility
The “ability to maintain an interpersonal stance that is other-oriented (or open to the other) in relation to aspects of cultural identity that are most important to the [person]” Hook, Davis, Owen, Worthington and Utsey (2013)
“Cultural humility is a humble and respectful attitude toward individuals of other cultures that pushes one to challenge their own cultural biases, realize they cannot possibly know everything about other cultures, and approach learning about other cultures as a lifelong goal and process.” Karin Gonzalez (2018)
You know where you want the stuff in your room.
The people in your host community know where they want their stuff in their “room.” This ties back to the concept of cultural humility.
Step back into the dorm room example. How would you want someone to engage with you in that context? What expectations do you have of newcomers into your space?
As we discussed, the attitude of Cultural Humility will be especially critical to keep in mind as you build relationships with members of your host community.
While it’s important to get to know any peers with whom you might be traveling, getting to know members of your host community is beneficial for so many reasons.
Getting to know members of the host community can ease your cultural transition and provide you with a support system while away from home. Building these relationships will also help you understand your host culture at a deeper level and you may even develop a lifelong friendships.
Although it can be tempting to spend time exclusively with your peers, we would encourage you to break out of your comfort zone and make an effort to build relationships in your host community. Here are some tips for doing so:
Source: https://www.diversityabroad.com/study-abroad/articles/build-relationships-host-community
Operating in your host country with cultural humility, and using that as a framework to build relationships, can have an influence on the experiences you have and the stories you tell about those experiences.
When you spend time in a country or culture outside of your own, whether at home or abroad, the stories you tell when you come back matter. Those stories and descriptions can have the ability to shape the way others see the place or culture you visited--for better or for worse. How you describe and navigate that culture can also encourage, or discourage, stereotypes. Additionally, the way you operate and behave while in that context can influence the communities and individuals you are interacting with.
Let's understand the differences between the top two pictures vs. the bottom two:
The top two images appear to show local community members in a position of agency--they are actively teaching, or sharing their knowledge, both with other community members and “outsiders” or those who appear to be visitors. They are portrayed as taking a lead role in the activity that’s happening--they appear to be teaching and sharing their knowledge. They are situated as experts and as change-agents--they appear to have knowledge that they are leveraging to effect some sort of change or positive influence on their environments. The visitors (or outsiders) are either not pictured, or are shown in a learning position.
In contrast, the bottom two images position the “outsider” as the focal point of the story. Even though there are clearly doctors in the image on the left, the outsider/visitor instead becomes the focal point. She is photographing a child that is in a vulnerable position, without asking permission, and also not providing context to the rest of the scene. If someone sees this image in isolation, they may make negative assumptions about medical care in the country she’s in and conflate her role to that of a doctor, or “savior,” which is false. The image on the right also implies that an outsider is necessary to come in and “save” the lives of children in her host country.
The bottom two images are problematic, not because there is a foreigner engaging in “helpful” work, but because they are shown in isolation and don’t capture the context the above images do--that in nearly any place you go, there are local people fighting for change and doing work to better their own communities.
Although we can never be sure what is actually happening in the images because we weren’t present, we are making a set of assumptions about these images because of how the photographer chose to show them. Without context, images may be perceived in a way that is unintended.
When we visit communities that are outside of our own, we can sometimes, on purpose, or accidentally, tell a story in which we position ourselves as the hero. We might be proud of the work we are going to do, and that’s okay, but we must think deeply about the narrative we are creating.
Let’s watch this short video to see if we can unpack this a bit further.
This video might have been a bit hard to watch but it’s important for us to recognize that we should be careful about the images and stories we tell about our international or volunteer experiences. How we portray the place we are visiting has the possibility to reinforce negative stereotypes and also the opportunity to challenge them. Carefully considering our place in this work, and in these stories, does not have to negate the work itself, but can rather serve to tell a more balanced narrative.
Engaging in experiences outside of our own is a great thing, if done so in an ethical way. The way we engage with communities outside of our own and the stories we tell about these experiences can be very impactful--keep that in mind as you navigate life in your host country.
As we think about this savior complex and the images and stories we share about international experiences, here is a quote to help us dive a bit deeper:
"These [...] show the aid recipients as very passive, almost like they are objects, people unable or unwilling to do something about their own life. So they need you as a 'white savior,' to donate," says Riseth, who is taking a break from studying human rights at college. "You, as the donor of aid, are portrayed as the hero of the story and the only one who can create the change."
Although this quote refers to the “white savior,” this concept applies to anyone entering and engaging with a community outside of their own. Discuss with a partner:
PRINCIPLE 1: PROMOTE DIGNITY
Promoting dignity is often ignored once you set foot in another country, particularly developing countries. This often comes from sweeping generalizations of entire people groups, cultures, and countries. Avoid using words that demoralize or further propagate stereotypes. You have the responsibility and power to make sure that what you write and post does not deprive the dignity of the people you interact with. Always keep in mind that people are not tourist attractions.
PRINCIPLE 2: GAIN INFORMED CONSENT
Informed consent is a key element in responsible portrayal of others on social media. Respect other people’s privacy and ask for permission if you want to take photos and share them on social media or elsewhere. Avoid taking pictures of people in vulnerable or degrading positions, including hospitals and other health care facilities. Specific care is needed when taking and sharing photographs of and with children, involving the consent of their parents, caretakers or guardians, while also listening to and respecting the child’s voice and right to be heard.
PRINCIPLE 3: QUESTION YOUR INTENTIONS
Why do you travel and volunteer? Is it for yourself or do you really want to make a difference? Your intentions might affect how you present your experiences and surroundings on social media, for instance by representing the context you are in as more “exotic” and foreign than it might be. Ask yourself why you are sharing what you are sharing. Are you the most relevant person in this setting? Good intentions, such as raising awareness of the issues you are seeing, or raising funds for the organization you are volunteering with, is no excuse to disregard people’s privacy or dignity.
PRINCIPLE 4: USE YOUR CHANCE - BRING DOWN STEREOTYPES
When you travel you have two choices: 1. Tell your friends and family a stereotypical story, confirming their assumptions instead of challenging them. 2. Give them nuanced information, talk about complexities, or tell something different than the one-sided story about poverty and pity. Use your chance to tell your friends and stalkers on social media the stories that are yet to be told. Portray people in ways that can enhance the feeling of solidarity and connection. A good way forward is to ask the local experts what kind of stories from their life, hometown, or country they would like to share with the world.
Source: https://www.radiaid.com/social-media-guide
1. Choose at least one of the questions below and comment in the discussion section: (You can comment on as many as you would like)
2. Engage with at least 1 of your peers' comments in a respectful manner. Make sure to add the @ sign in front of your peer's name when commenting.
This section may be skipped by students who are more experienced, and/or who will be completing the Community Engagement Module.
During the in-person workshop, bring some of the examples from the student reflections, and discuss.
Below are some questions you can use to facilitate further conversation during the in-person workshop:
1- How does it feel to think about someone you don’t know coming into your space and making changes?
2- How do you think this relates to going abroad?
3- Step back into the dorm room example. How would you want someone to engage with you in that context? What expectations do you have of newcomers into your space?
As an example, for the dorm room example students might say, “I would want someone to take off their shoes.” As a facilitator, you could unpack this further and ask what that gesture represents. This can be tied back to thinks like being humble and respectful.
For additional discussion around the topic of cultural humility, see U-M Ginsberg Center resource:
Ethical Story Telling
Please note, this can be a sensitive topic for some students and there may be a variety of reactions to the video. You may want to unpack with your own reflection to this video.
Topics that may come up: cultural appropriation/appreciation, taking selfies
During the in-person workshop you may bring up some of the student reactions, and spark discussion:
How would you define the savior complex?
How can you avoid acting as the “savior” during your international experience?
What are your reactions to the video about the "savior complex"?
Have you ever seen social media posts similar to the ones in the video before? How do you react to them?
More resources:
●http://www.rustyradiator.com/social-media-guide/
●https://www.instagram.com/barbiesavior/?hl=en
During the in-person workshop, introduce students to various ways they can be involved in ethical story telling. After discussing good examples of inspiring stories encourage them to use the UMSN handle on social media posts, so we can re-post and share with the community.
Here are some ways UMSN students can share their reflections with their community:
Give them the link to share their photos/quotes
Give them the link to make a poster about their experiences (Only U-M access)
Give them the link to write a blog for the Michigan Nurses Abroad Page (Only U-M access)
Description
Now more than ever, people are seeking ways to affect change in their communities — both locally and around the world. This course is for anyone — from novices to experienced practitioners — who wants to work more effectively with community members and organizations, including through, but not limited to:
community-academic partnerships
social change projects
community service and learning
education and work abroad
traditional and community-based participatory research
non-profit internships
public scholarship
civic performance
Prepare in advance or take this course simultaneously to get the most out of your experience by engaging with communities ethically, respectfully, and sustainably.
Developed by a highly interdisciplinary team of U-M content experts and faculty, this course is designed to be both engaging and challenging, offering an accessible entry into foundational topics as well as a jumping off point to pursue work and further learning in effective community engagement. It is also a toolkit and a roadmap that offers concrete takeaways and resources for working effectively with communities.
Throughout the course, you’ll learn from experienced U-M students, faculty, and staff and local community partners, and you’ll have many opportunities to try out and apply the principles and concepts you’re learning.
No prior community engagement experience necessary.
Subjects: Arts & Culture, Social Sciences
Language: English
Duration: 6 weeks, or 24 hours total, 2-4 hours per week.
This course is composed of seven different module/topic areas, including an introduction and a closing section. While this course is listed as six weeks, the modules do not directly correlate with that number. If you decide to complete this course in its entirety, you should expect to spend roughly 24 hours (or roughly 2-4 hours per week) across all the modules, including videos, readings, assignments.
Module 1: Introduction to Community Engagement
Module 2: Community Context and Ethical Engagement
Module 3: Social Identities, Power, and Privilege
Module 4: Collaborative Leadership
Module 5: Reflections & Transitions
Module 6: Community-Engaged Project Management
Module 7: Conclusion
Instructor: Community Engagement Course Team
If the student is attending a short-term program note that this section may not be relevant. If the student is engaged in a long-term project, and/or if the student will be engaging with communities to implement collaborative projects, this is a perfect training module for them to complete. They will not need to complete any of the other sections, they can simply complete this and the Global Patient Safety Module.
Objectives:
Duration: 24 hours, recommended to complete in 6 weeks
Michigan community can access the course for free here
Course Syllabus & Learner Effort
This course is composed of seven different module/topic areas, including an introduction and a closing section. While this course is listed as six weeks, the modules do not directly correlate with that number. If you decide to complete this course in its entirety, you should expect to spend roughly 24 hours (or roughly 2-4 hours per week) across all the modules, including videos, readings, assignments.
Module 1: Introduction to Community Engagement
Module 2: Community Context and Ethical Engagement
Module 3: Social Identities, Power, and Privilege
Module 4: Collaborative Leadership
Module 5: Reflections & Transitions
Module 6: Community-Engaged Project Management
Module 7: Conclusion
Grading Policy
Course materials and assignments are available for self-paced learning. Learners must earn an overall grade of 80% across all module knowledge checks in order to pass the course. There are no prerequisites for this course.
Honor Code & Discussion Forum Etiquette
All of the assignments in this course should be completed by each learner on their own. Learning from each other through the Discussion forum is encouraged, but no collaboration between learners is expected. Submitted assignments, therefore, should be your own independent work, and not that conducted collaboratively with others. While we ultimately cannot monitor everything, edX and the course team will monitor forums and assignments for any activity that violates obvious codes of scholarly conduct.
Contact with the Instructor Team
Please do not contact the Teaching Assistant/instructor(s) directly with questions. While we value and appreciate the time and effort you put into the course, responding to individual questions is virtually impossible. Instead, please direct your questions to the forum, where the Teaching Assistant will respond when meaningful and appropriate.
Course Assignments:
Each module concludes with an assessment, so you (and perhaps your instructor) can gauge your level of understanding. There is also a workbook full of activities that will help you practice the skills and capacities covered in the course. The workbook is designed to help you individually — if you are taking this online course as part of a formal course or pre-departure workshop at an institution, your instructor might want to collect some or all of the workbook activities, so keep that in mind.
Not every student will need to complete this course. You can determine your group's needs, and assign the necessary work required based on the based on the workbook below:
Volunteering Abroad
Volunteering abroad is an opportunity to strengthen your cross cultural understanding and global competence. Being exposed to a new place and new people affords you the opportunity to a first hand exploration into the nuance and complexity of working and living across cultures. The exposure to new ideas and lifestyles will not only help you grow personally, but will also make you a more creative problem solver and a more effective communicator.
As you choose how you plan to volunteer abroad, we hope you consider the consequences of your presence on the community and incorporate the concepts of Fair Trade Learning. Review the suggestions below:
Retrieved from: https://ipe.engin.umich.edu/volunteer-abroad/
"Check Yourself" Community Engagement Checklist
Voluntourism
In her book, Hoping to Help: The Promises and Pitfalls of Global Health Volunteering (Cornell U. Press, 2016) Judith Lasker examines the impact on host communities and on volunteers of short-term international service programs in public health and medical care. She interviewed over one hundred people involved in such programs as organizers, volunteers, and host country staff and surveyed almost two hundred organizations that sponsor volunteers. Her book draws upon research to recommend nine ways in which such volunteer trips can be more valuable for all involved. Below is an excerpt from her book where she provides context for the term "voluntourism":
|
A “Tsunami” of Volunteers Medical missions.
Health brigades. Flying surgeons. Hundreds of thousands of people from the wealthier countries of the world travel annually to poorer countries for brief service trips as volunteers in programs sponsored by a growing number of community churches and national religious organizations, nonprofits large and small, colleges and schools of medicine and public health, hospitals, major corporations, and tourist agencies promoting “volunteer vacations.” Nearly every time I mention my research, someone has a personal experience to recount or tells me about a family member or close friend who has volunteered. That was not the case only a decade ago.... (pp. 1-18) |
The Guardian Article "The business of voluntourism: do western do-gooders actually do harm?" is also helpful to understand the problems with voluntourism.
If you are participating in a volunteer/internship based experience, make sure to attend one of the workshops on "Breaking the Barriers of Voluntourism: Engaging in Sustainable Cultural Humility Practices Abroad" by U-M Student Organization The Quito Project.
You can find more information and register for a workshop here.
The 5 times why method:
Ask yourself why you are participating in the program you chose 5 times:
Why did you chose to participate in this program?
Why?
Why?
Why?
But why?
Hopefully, at the end of this exercise you will be able to determine your root motivations and this will help you find and carry out a more meaningful global experience.
1- If you are attending a non-U-M affiliated short-term mission program, reflect on how your program compares based on what you learned in this module by commenting in the discussion section below:
2. Engage with at least 1 of your peers' comments in a respectful manner. Make sure to add the @ sign in front of your peer's name when commenting.
Volunteering vs. Voluntourism
(Basic and Advanced - if the student is attending a U-M program, they can skip this section. If the student is attending an unfamiliar program that has short-term volunteering aspects, this section should be mandatory.)
Resources: Highly encourage, or require your student to participate in the workshop by The Quito Project on Voluntourism. As a facilitator, you may also recommend students to read Judith Lasker's book "Hoping to Help: The Promises and Pitfalls of Global Health Volunteering." Another great resource for further learning on this topic is the article Fair Trade Learning: Ethical standards for community-engaged international volunteer tourism
Duration: 1 hour (Recommended commentary 1)
Possible number of commentary: 2
1- The 5 times why method: Ask yourself why you are participating in the program you chose 5 times:
Why did you chose to participate in this program? Ask 5 more times why.
2- If you are attending a non-U-M affiliated short-term mission program, reflect on how your program compares based on what you learned in this module.
FIRST DO NO HARM
"The myth is that, you can show up in a random rural community, and hand out antibiotics and actually have an impact on patients... If the best way to provide health care to low-income communities was through short-term trips, then you and I would be going on short-term trips to get out health care. Clearly not the best way to do it." Matt MacGregor, Timmy Global Health.
At the UMSN, we encourage you to participate in short-term global health projects realizing that for many of you long-term projects are not possible due to financial constraints, and other life-obligations. There are many highly regarded players in the global health arena that organize community driven, meaningful and impactful projects. As a U-M nursing student, your participation in these projects will not only add value to the project by bringing in highly qualified health care providers, but will also help you gain invaluable perspective in how your profession is connected to the world-wide health care systems, while allowing you to develop your inter-cultural skills. In this section, we aim at giving you the necessary tools to be able to understand the differentiate between helpful short-term health projects and not so helpful ones.
Below are two sections from Judith Lasker's book, Hoping to help, The promises and Pitfalls of Global Health Volunteering (2016, 159):
Main Characteristics of not-so-helpful short-term global health projects
|
Harming the communities they aim to help? In his book on short-term volunteering, "When Healthcare Hurts", Greg Seager lists the following five ways volunteers might harm the very communities they are trying to help because they lack understanding (2012, 252): 1- Without Understanding how to maintain patient safety on short-term global health projects, there is great potential for causing actual physical harm to patients. 2- Without knowledge, short-term global health projects often diminish confidence in the local healthcare system and its providers. 3- Without knowledge, short-term global health projects are often paternalistic in nature, offering relief where the only applicable intervention is development. 4- Without knowledge, short-term global health projects often cause economic harm to providers and health systems. 5- Without understanding, short-term global health projects are often more about the volunteers than the recipients of care. |
Main Characteristics of Impactful Short-Term Global Health Projects:
|
1- Foster mutuality between sponsor organizations and host-country partners at every stage. 2- Maintain continuity of programming. 3- Conduct substantive needs assessment, with host community involvement. 4- Evaluate process and outcomes and incorporate the results into improvements. 5- Focus on prevention. 6- Integrate diverse types of health services. 7- Build local capacity. 8- Strengthen volunteer preparation. 9- Have volunteers stay longer. |
GLOBAL AMBASSADORS FOR PATIENT SAFETY ONLINE WORKSHOP (GAPS)
"If you can't do it here, you shouldn't do it there."
The Global Ambassadors for Patient Safety online module is one of the major tools in this toolkit. It is a convenient, free, online workshop for students, to learn about the ethical challenges they may face when participating in health-related activities abroad. Upon completion of the GAPS module, students take the GAPS Oath to indicate their understanding of appropriate behavior abroad.
NOTE: This certificate is required for all UMSN students travelling on health related programs, as well as all students pursuing the global health minor or the global health concentration. Once you complete the workshop, you will be able to download a certificate. You can email that certificate to your global health program advisor, or bring the print out to the in-person pre-departure orientation.
1- If you are attending a non-U-M affiliated short-term health related mission program, reflect on how your program compares based on what you learned in this module by commenting in the discussion section below:
2. Engage with at least 1 of your peers' comments in a respectful manner. Make sure to add the @ sign in front of your peer's name when commenting.
During the in-person workshop, bring up the various kinds of programs students will attend, and if students compared their program in the commentary section, this could be a great way to guide the student on how to choose a program, as well as their responsibilities as a nurse, and as a U-M student. Remind them of their professional scope (particularly the undergraduate students), certification obligations, and liability insurance requirements. This could be a good way to keep record of the various kinds of programs students participate. When they return, invite them back to learn more about the program they attended, debrief, and decide if the program should be added to the list of programs we promote to our students.
Following discussion points can be useful to spark conversation, particularly with undergaduate students:
Ethical Issues to Address with Student Global Health Volunteers:
McCall, D. & Iltis, A. S. (2014). Health care voluntourism: Addressing ethical concerns of undergraduate student participation in global health volunteer work. HEC Forum, 26(4), 285-297.
All students participating in a health related program MUST complete the GAPS Oath. Below is more information on this:
What is the GAPS Toolkit?
If you work with pre-health students, either as an advisor, faculty, study abroad provider, host, or some other role, then these tools have been designed to help you. This website provides you with the tools you need to educate students and assure that everyone working with your students can provide a safe and ethical experience.
About the Tool Kit:
"As you use this toolkit, we welcome and encourage feedback. This was designed by staff at the Health Careers Center at the University of Minnesota, but what makes the tool useful is input from people like you who use this information in your day to day work.
To provide input regarding the toolkit, fill out this form. All input, questions, suggestions, and feedback are welcome. For example, if you would like us to link to additional resources, feel free to share those with us."
The GAPS workshop takes about a half hour to complete. When students complete this workshop, they will receive a certificate they can download at the end. Make sure to collect that certificate from all students, either prior to the workshop via email, or at the workshop. Note that all students pursuing the global health minor, or the global health concentration are required to complete this certification.
More resources for educators can be found here:
Take a minimum of 5 concepts of interest to you from this module and apply them to your destination specific context. (For example, if you are traveling to Denmark or Uganda, you need to apply one of the 5 concepts of your choosing in the personal and/or professional ways listed below.) In no more than 1000 words, explain how these concepts may be helpful to you in the following ways:
Feel free to include any other area you think these concepts will be helpful to you.
Make sure to follow the rubric* below:
*Rubric re-adjusted from LDL course rubric - UIUC, HRD 572, Fall 2019
Two levels of pop-up assessments in the form of pop up tests may be implemented in the future: For basic and advanced level needs.
A learning experience survey will be developed and implemented here to measure the effectiveness of this learning module and to receive feedback on how it may be enhanced.
AFS Intercultural Programs (2010). Retrieved from: https://www.afsusa.org/educators/lesson-plans/hidden-ways-culture-differs/
Barbie Savior. Retrieved from: https://www.instagram.com/barbiesavior/?hl=en
Definition of Cultural Humility. Retrieved from https://study.com/academy/lesson/cultural-humility-definition-example.html
Global ambassadors for patient safety Online Workshop (GAPS). Retrieved from: www.healthcareers.umn.edu/courses-and-events/online-workshops/global-ambassadors-patient-safety
Gonzalez, Karin (2018). Cultural Humility: Definition & Example. Retrieved from: https://study.com/academy/lesson/cultural-humility-definition-example.html
Hartman, E., Paris, C. M., & Blache-Cohen, B. (2014). Fair Trade Learning: Ethical standards for community-engaged international volunteer tourism. Tourism and Hospitality Research, 14(1–2), 108–116. https://doi.org/10.1177/1467358414529443
H, L. (2016, March 25). The reality of Studying Abroad. Retreived from: https://insights.missouri.edu/the-reality-of-studying-abroad/
Hook, J. N., Davis, D. E., Owen, J., Worthington Jr., E. L., & Utsey, S. O. (2013). Cultural humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology®. doi:10.1037/a0032595
Lasker, J. (2016). Hoping to Help: The Promises and Pitfalls of Global Health Volunteering. Ithaca; London: Cornell University Press.
LDL Work 2B (learning Module) Review Criteria, Fall 2019. Retrieved from: https://drive.google.com/drive/u/2/folders/1nqngRImH4nmhh3DwnhSOxxN4ExMB2xQL
McCall, D. & Iltis, A. S. (2014). Health care voluntourism: Addressing ethical concerns of undergraduate student participation in global health volunteer work. HEC Forum, 26(4), 285-297.
Raid Aid, Africa for Norway. Social Media Guide. Retrieved from: https://www.radiaid.com/social-media-guide
Rosenberg, T (2018, 13 September). The business of voluntourism: do western do-gooders actually do harm? Retrieved from: www.theguardian.com/news/2018/sep/13/the-business-of-voluntourism-do-western-do-gooders-actually-do-harm
Seager, G. (2012). When Healthcare Hurts: An Evidence Based Guide For Best Practices In Global Health Initiatives. Bloomington; Indiana: Authorhouse.
University of Michigan (2015). Culture Shock. Retrieved from https://vimeo.com/136250312
University of Michigan (2015). Know before you go. Retrieved from: https://youtu.be/RBXD-NA6yqc
University of Michigan, Michigan Online. Community Engagement and Collaborating for a Change Online Course. Retrieved from: https://online.umich.edu/courses/community-engagement-collaborating-for-change/?
University of Michigan, Ginsberg Center. Check Your Self Community Engagement Check List. Retrieved from: https://ginsberg.umich.edu/checkyourself
University of Michigan, Global Engagement Team. Preparing Students to go Abroad Resources for U-M Faculty & Staff. Retreived from: https://global.umich.edu/about/global-engagement-team/
University of Michigan, Resilient Traveling. Retrieved from: https://resilient-traveling.umich.edu/
University of Michigan, The Quito Project, Breaking the Barriers of Voluntourism: Engaging in Sustainable Cultural Humility Practices Abroad. Retrieved from: maizepages.umich.edu/event/3145234