Troubling Objectivity: The Promises and Pitfalls of Training Haitian Clinicians in Qualitative Research Methods

Abstract

Building research capacity is a central component of many contemporary global health programs and partnerships. While medical anthropologists have been conducting qualitative research in resource-poor settings for decades, they are increasingly called on to train "local" clinicians, researchers, and students in qualitative research methods. In this article, I describe the process of teaching introductory courses in qualitative research methods to Haitian clinicians, hospital staff, and medical students, who rarely encounter qualitative research in their training or practice. These trainings allow participants to identify and begin to address challenges related to health services delivery, quality of care, and provider-patient relations. However, they also run the risk of perpetuating colonial legacies of objectification and reinforcing hierarchies of knowledge and knowledge production. As these trainings increase in number and scope, they offer the opportunity to reflect critically on new forms of transnational interventions that aim to reduce health disparities.

Health research capacity building of health workers in fragile and conflict-affected settings: a scoping review of challenges, strengths, and recommendations

“…Secondary: To strengthen longitudinal partnerships with institutions in low-resource settings. Residency HSPs (3) Partnerships, local research context, human resources, technology, attitude, evaluation approach Local collaborations, mentorship component Training of trainers, equity in partnership involvement Minn, 2015 [ 46 ] North; North-South Qualitative RM To introduce participants to qualitative methods, to present examples of qualitative research that had been conducted in Haiti Workshop HSPs (not specified) Partnerships, duration, attitude Context-specific design, local collaborations Duration, equity in partnership involvement Elharram, 2017 [ 47 ] North; North-South Mixed Methods RM; HE To develop medical knowledge and skills via anatomy dissections, surgical simulations, clinical pathology shadowing, and interactive sessions in research methodology and medical education. Workshops Academics (24) Duration Practical exercises, interactive learning, mentorship component, mutually beneficial Preparation via needs assessment Kaseje, 2018 [ 48 ] North; North-South Mixed Methods GS To establish a paediatric surgical rotation.…”

“…In addition, health workers were often reported to be overwhelmed with other responsibilities such that they perceived health research as being additional and unnecessary work duties. Furthermore, the development and maintenance of regional and local partnerships was a common challenge, seeing that most studies were driven by north-south partnerships that lacked nationally led initiatives [ 41 – 43 , 45 , 46 , 53 ]. This is problematic because such initiatives lacked adequate contextualization to address locally relevant health issues.…”

“…Studies reported that HRCB programmes were largely driven by funding from the Global North given the limited resources within FCASs, yet following implementation of HRCB, this scarcity in local funding led to limitations in follow-up and long-term support [ 40 , 41 , 44 , 49 , 52 , 53 , 57 ]. In addition, time allocated to conduct HRCB intervention was often less than adequate [ 41 , 44 , 46 , 47 , 49 , 51 , 53 ]; one particular study highlighted the risk of having week- or month-long programmes fall under “helicopter ethnography” and “voluntourism” [ 46 ], where HIC researchers engage in rapid, temporary, and often self-serving activities in LMICs without planning for or building long-term relationships in LMICs. Additionally, the use of technology such as tablets to expand access to HRCB initiatives was problematic without adequate training [ 45 , 49 , 51 , 53 ].…”

“…The theme of personnel challenges highlighted problems relating to the individual participants of HRCB interventions. Studies revealed that local researchers and personnel in institutional leadership roles displayed different levels of acceptability towards the HRCB interventions [ 39 , 40 , 45 , 46 , 53 , 58 ]. The lack of support towards HRCB programmes was reported to delay implementation of the programme as well as hinder/discourage learning by participants.…”

“…Locally driven initiatives demonstrated significant strengths, in that they were designed to meet specific needs relevant to the context in which they were implemented, as informed by local needs assessments [ 41 – 44 , 46 , 48 , 51 , 54 , 56 ]. These initiatives were also driven by local collaborations and were implemented by local actors [ 40 , 45 , 46 , 53 , 56 – 58 ]. Having them driven and implemented by local actors allowed for knowledge sharing between partner institutions prior to the delivery of the HRCB initiatives and subsequent utilization of local examples and issues of interest throughout the HRCB material provided to learners [ 39 , 40 , 52 , 55 , 57 ].…”