Whether you've traveled before or not, living and working overseas can be challenging. Learn how best to prepare and make the most of your time internationally. This course will prepare you to work and live overseas. It explores the epidemiology of common morbidity and mortality among travelers and examines key prevention, safety, and travel medicine principles and services to contextualize risks and maintain wellness. The course reviews applicable interventions, appropriate vaccines, and personal protection methods to prepare you to respond to expected and unexpected situations and will challenge you to examine travel health and safety priorities through case studies and discussions. The Honors Lesson will assist you with personal preparations for travel through the creation of a country-specific profile.
Tales from the Field: Courtland Robinson
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International Travel Preparation, Safety, & Wellness
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Cultural Competence & Ethics
In this final module, we'll address matters of cultural competence and the ethics of travel. Travelers have responsibilities to the people who live and work in the countries they are visiting, and it is important to keep th
與講師見面
Anna KalbarczykResearch Associate
International Health
[MUSIC]
So I've done many years of work on the China-North Korea border looking
particularly at refugees from North Korea crossing into China, seeking food,
seeking shelter, seeking asylum, protection, long term or short term.
And I grew up in South Korea, my father was a medical doctor there.
So I knew about Korea, at least the on south side of the demilitarized zone.
I spoke some Korean, I'd studied Chinese, so
I had language and some knowledge of the area.
Although I had not worked directly on the China-North Korea border in
northeast China.
But it was very much unknown territory.
We were trying to negotiate space to allow some research to go on to
understand the famine and it's impacts on mortality on the North Korean
population by interviewing people who had crossed into China.
China, at that time,
and still remains, opposed to the idea that these are refugees.
They consider them migrants, illegal migrants, and subject to arrest,
detention, deportation.
So we had very limited space within which to operate.
There were no camps, there was no UN presence,
there was nothing in the way of sort of a humanitarian protection or aid regime.
And we were trying to set up a study as well as some interventions,
limited interventions, by an NGO who I am not able to name.
[LAUGH] And so we were trying to feel our way forward.
How do you make this happen?
How do you open this space up a little bit?
And one of the things that occurred to myself and a South Korean colleague,
who was kind of my co-conspirator in all this, was to entertain.
So we were interested in talking to a North Korean official, not about refugees.
He was not, fact, seeking asylum, he was on a sort of official junket.
And to get him with some Chinese counterparts, members of the Red Cross,
and other people who we thought maybe could open up a conversation,
at least about sort of health issues,
about food insecurity, about problems inside North Korea.
And as one would do in that culture, you host a party, a dinner event.
And so we found a restaurant, actually was a North Korea-China joint venture,
so it seemed like sort of safe ground for everybody.
And it was on the floor, as traditional Korean meals were.
And of course, lots of alcohol, this was part of the culture.
There's a great deals of sort of virtual drinking going on.
And I made the decision relatively early on that it was kind
of important to show understanding for those cultures.
The health of my liver notwithstanding, thought, okay,
this is something I can take on.
I don't enjoy drinking heavily, it's not something I would recommend to students.
But it was something that we understood at least might open a bit of a door.
And, as it sometimes does, also maybe loosen tongues to talk about
things that they might not otherwise be willing to talk about.
So, long story short, after a long night of eating and drinking,
I finally sort of put the question to this North Korean official.
And said, would you maybe have something to offer in the way of
comments on what we've heard to be a food problem in North Korea,
some possible rise in levels of disease, infectious disease and otherwise.
And maybe could talk about sort of ways in which we might help better understand
the problem and better respond.
I thought a fairly innocuous question and a reasonably pointed one, but again,
framed as politely as I can possibly imagine.
And this gentlemen who had been sort of lounging and relaxing
as the evening went on, stood up ramrod straight and
declaimed in very official North Korean, in the workers
paradise of the Democratic People's Republic of Korea, there is no disease.
We have defeated disease, we have defeated hunger.
And if there are problems, they are only those brought on by American imperialists.
And then he sat down.
And we though, well there goes the party, and there goes all our efforts.
And I'm just going to have a splitting headache, and
nothing else to show for all of this.
As it turned out, as the party was breaking up and we were all sort
of saying our farewells, this official took my South Korean colleague aside and
he basically said, I'm sorry that I had to say those things.
And he sort of pointed and
nodded in the direction of a gentleman we knew was a party handler.
Any North Korean official who travels abroad
of any rank basically is accompanied by someone who monitors what they do, and
who they meet, and what they say.
And he essentially said I had to say those things.
And the implication that we perfectly understood was that had he
said anything more open or honest about food and security,
famine, a rise in diseases, which was of course occurring,
he would have been in great trouble with the party and his family as well.
So that was kind of a lesson, is to understand context and
sometimes be careful about who you ask and when you ask,
and try to interpret the responses accordingly.
The other was, again, another comment that we heard later after the party,
the dinner party, from a Chinese official who, again talking
with my South Korean colleague, I did and do speak some Chinese and
limited Korean, but it was not sort of an appropriate comment for me to hear.
Anyway, he passed this along to my colleague and
he said, we think we can work with that American, he understands our culture.
And he drinks so heavily he can't be a missionary.
[LAUGH] Which was a concern, that people were coming in and trying to
promote conversion to, what, Christianity or what have you.
So I took that as not simply a compliment to my maybe cultural competency skills,
but as a sign that really we were being accepted.
And as it turns out we were,
and work continues to this day in many different manifestations.
There have been security concerns, there have been periodic
investigations of our study team and so forth.
And I'm happy to say that we don't drink all the time and
every time we go out there.
But I think it's just a kind of a point that students need to think about.
There's sort of the textbook issues, sort of know the maps, and know the lay of
the land, and know your contact points, and have some language on your team so
that if you're in a situation and somebody asks you a question in
a language you don't understand, somebody around you can maybe translate for you.
Because you have to have, as somebody once put it, in terms of some cultural
negotiations, tolerate a high level of ambiguity.
Meaning there's a lot of things you're just never going to know.
What did he say, what did she mean, what was that all about?
And you have to figure out fairly quickly
is that something that's just a matter of a well, I'll figure that out later,
I won't need to know, or is this putting me in harm's way?
Is there something being said or talked about, or am I doing something or
saying something that in some way is conveying insult,
conveying a problem that is going to rise to a level that is going to put us,
Martin and our people, our respondents, in some kind of harm's way.
And of course that's the first order of ethical conduct of research,
is do no harm.
So I think culture competency is about those many things.
It could be language, it could be what do you eat and when.
There were a lot of quote unquote delicacies, live octopus legs and
things that I chomped down just because it seemed like the thing to do.
It was a delicacy and being offered it and they're picking up the tab,
it's kind of an insult to say, really, I don't eat those sorts of things.
But you may draw the line, maybe dog meat is where you draw the line,
maybe meat of any kind.
And maybe you have to say, I'm sorry I don't drink, it's for
health reasons or my own sort of cultural practices.
And that's okay, too, but you have to figure, out even,
then how to say no appropriately, how to, of course, say yes appropriately,
and how to communicate that, sometimes verbally with language.
Or, of course now, non-verbal communication is a very important thing.
And all the issues of how close or
far away do you stand from somebody when you're talking.
Even a gesture as I'm dong now in a certain context might be acceptable.
But if I do the more Western, wide gestures and flailing of arms
just to make a point and be dramatic, and somehow we think communicative,
could be seen as really quite affront, or frightening.
Why is he so mad, why is he gesturing and waving at me in such an aggressive manner?
How do you greet people, do you shake hands, do you hug?
Do you, like in Thai cultures, I know, as I've lived there for many years,
do you give a wai or some namaste?
Those are things that matter, and those are things you can learn, and
of course pick up as you go, and sometimes it changes.
Maybe there's a group of people you're meeting who are more on
the handshake variety, and other people,
because they're more Western-oriented than others, who would really not accept that.
Of course, when you're dealing, not just across cultures,
but between genders, you have to be thoughtful of that.
So there may be a way a male greets a male that's appropriate, but
would be inappropriate for a male to greet a female.
The best thing I can say is observe before you do.
[LAUGH] Watch what other people are doing, and don't just come in and
assume you know what's happening, or how to behave, or
even because somebody told you before you went, this is what you do.
Probably better to check it out ahead of time.
And nothing wrong with standing back a little bit and
watching how people who are more versed in local culture do these sorts of greetings,
how they kind of distribute themselves in terms of sitting down at a meeting or
a dinner or some such.
Because all of these things could be conveying signals of different kinds,
some quite trivial.
But some, you never know, seemingly trivial, but ultimately making a,
possibly, very strong point of this is somebody who was reaching out, seeking
to understand us, seeking to work with us even though there may be differences.
Or somebody who is just going to kind of try to do it their own way,
bringing whatever their own norms and values and ideas and priorities.
And that's somebody who may be not as acceptable,
either in the immediate instance or over time.
Well, I think nowadays, of course, with millions,
literally millions of journal articles and publications at our fingertips,
we just press a button, Google it, and everything pops up.
So do read as much as you can, but
there's a point at which probably you're going to be over saturated.
And there's going to be conflicting information.
And what's current versus what was ten years ago maybe true, but not so true now.
Often at places where I work, a great deal was unsettled because of recent conflict,
disaster, and so forth.
So those things that might have been normative in the past are not
as clear in terms of how do you operate.
I think the main thing I would suggest is read up as much as you can,
know where you're going, look at the maps, and literally know where you're going,
and figure how you might get back.
Read up as best you can, figure out all the sort of demographics,
the geographics, the politics, the religion, the culture, and so forth.
And then, again, I think, observe before you speak and act.
I think there is a very important way in which sometimes, particularly in the West,
we sort of think if you get on the ground and you do things, you get going.
Because that's what we do, we want results, we want to intervene, and help,
and all that.
And those are all perfectly good motives, but
quite often the very best thing to do is just observe.
Pay attention, be patient, wait for somebody else who may be in
a position of greater authority to kind of signal to you,
okay, this is how we think it might be best.
Do ask questions, but be humble [LAUGH] in the face of what you don't know.
And be careful about, maybe, what sort of questions you might ask first.
What's that old sort of saying about you never talk politics or
religion at dinner parties.
It's just the kind of thing that really kind of gets
people going in some often very negative ways.
You may not come into a highly patriarchal society and
say hey, tell me about how you mistreat women around here.
Of course, that would not be responded to well.
But it doesn't mean you can't find a way to ask those questions.
And say, well, I understand that,
from what you've told me, this is how your families behave,
or how girls get married as soon as they menstruate.
This is an issue we have been dealing with, in child early forced marriage.
You have to find a way, I think, to somehow represent
what you may strongly believe to be a human-rights based
orientation to a problem that isn't matching up with what
might be sort of traditional cultural religious values.
But to do so in a way that, as much as you possibly can,
is thoughtful, polite, and open to dialogue.
Because then you have at least maximized your chances that there will be dialogue,
as opposed to just denial, or go away,
or, in fact, you're a threat [LAUGH] to us.
And that doesn't do anybody any good, particularly,
I would say, the people who you feel may be most vulnerable in this context.
And those may be minors, they may be girls, they may be women,
they may be minorities, they may be disabled, LGBTQ, all those populations
that we know in global context may be facing marginality and disadvantage.
Those are the people we want to represent.
But those are not often, typically, the people you first meet.
You meet the gatekeepers that are in the positions of power.
How do you negotiate your way through that gate without sort of storming
[LAUGH] through or accepting somehow no is the last word, or
we don't have that problem around here is the last word?
Obviously, we have to keep questioning, but to do so in a way that,
as much as we possibly can think of, is done in a culturally-appropriate manner.
