Medical humanitarianism: anthropologists speak out on policy and practice

Public discourse narratives: from 'Secret Aid Worker' discontent to shifting power in humanitarian systems

Public discourse is rich in meaning, reflecting consensus, dissent, and change. Yet, very little public discourse on the humanitarian sector has been authored by aid workers themselves. We conducted a thematic analysis of the 'Secret Aid Worker' (SAW) series, published in The Guardian newspaper between 2015 and 2018, the only corpus of data on humanitarian life experiences publicly accessible through mainstream media. Our research questions were twofold: how did authors frame their work and appraise humanitarian structures?; and how did they reflect and amplify humanitarian issues of the time? The main themes included: personal challenges of humanitarian life; characterisation of stakeholders; and systemic issues within the humanitarian sector. The SAW narratives reveal a powerful discourse of discontent. They planted seeds of change regarding shifting power, coloniality and racism, sexual abuse, and duty of care. We argue that such public discourse has symbolic power, calling for greater accountability, equity, and justice in remaking the future of the humanitarian sector.

Global Health Education and Mediatization of Care in Costa Rica

Costa Rica has become a destination for global health education courses, while funding for global health has increased dramatically over the past thirty years. An examination of one Costa Rican group's efforts to market humanitarian discourses, focusing on website design, provides a window into the workings of global health education and details the sometimes-uncomfortable position of non-US health professionals in educational programming. This contributes to theorizations of the intersection of mediatization and care, and suggests links between the legitimation of global health as a discipline, on the one hand, and the reproduction of inequities, on the other.

Global Mental Health: Five Areas for Value-Driven Training Innovation

OBJECTIVE

In the field of global mental health, there is a need for identifying core values and competencies to guide training programs in professional practice as well as in academia. This paper presents the results of interdisciplinary discussions fostered during an annual meeting of the Society for the Study of Psychiatry and Culture to develop recommendations for value-driven innovation in global mental health training.

METHODS

Participants (n = 48), who registered for a dedicated workshop on global mental health training advertised in conference proceedings, included both established faculty and current students engaged in learning, practice, and research. They proffered recommendations in five areas of training curriculum: values, competencies, training experiences, resources, and evaluation.

RESULTS

Priority values included humility, ethical awareness of power differentials, collaborative action, and "deep accountability" when working in low-resource settings in low- and middle-income countries and high-income countries. Competencies included flexibility and tolerating ambiguity when working across diverse settings, the ability to systematically evaluate personal biases, historical and linguistic proficiency, and evaluation skills across a range of stakeholders. Training experiences included didactics, language training, self-awareness, and supervision in immersive activities related to professional or academic work. Resources included connections with diverse faculty such as social scientists and mentors in addition to medical practitioners, institutional commitment through protected time and funding, and sustainable collaborations with partners in low resource settings. Finally, evaluation skills built upon community-based participatory methods, 360-degree feedback from partners in low-resource settings, and observed structured clinical evaluations (OSCEs) with people of different cultural backgrounds.

CONCLUSIONS

Global mental health training, as envisioned in this workshop, exemplifies an ethos of working through power differentials across clinical, professional, and social contexts in order to form longstanding collaborations. If incorporated into the ACGME/ABPN Psychiatry Milestone Project, such recommendations will improve training gained through international experiences as well as the everyday training of mental health professionals, global health practitioners, and social scientists.