Guiding Cross-Cultural Principles from Public Health

Muslim women's health

I work in public health. As opposed to being a nurse in an emergency room or intensive care unit where care is focused on an individual patient, as a public health nurse I look at whole populations and health projects that will ideally make entire communities healthier.

Before moving to Kurdistan, I had the privilege of working on a women’s health project in the foreign-born Muslim community in Massachusetts. It was a merging of worlds as I watched God uniquely use my background in my job. We were generously welcomed into the community during a time when people could rightly be suspicious and concerned. Women and men willingly met with us, answering often difficult questions about health care and prevention.

I could speak and write for hours about this project, but recently as I was thinking about why the work went so well, I realized that the principles behind it are relevant to cross-cultural work around the world.

I wanted to share the principles that we used as we developed and implemented the project with the hope of beginning a conversation about working in and with  communities around the world.

  • At every level, involve the community.  Attempts to reach a population group without first knowing the group are often inappropriately designed and poorly received.  This principle is especially important when working with populations that represent a variety of different ethnic and linguistic backgrounds, each with varying belief systems and barriers, among other situational, historical, social, and economic differences.  An effective outreach program will need to consider those characteristics unique to each group and tailor its design accordingly, incorporating participation from representatives of the population in all phases of the program.  A good question to ask a community is: “Is this a prioritized need of your group, or is it a perceived need by outsiders?”
  • In every encounter, use diverse community partners.  Outreach programs that attempt to reach diverse groups can face obstacles such as not having sufficient knowledge, experience, or access to reaching and serving the community. Another mistake outsiders make is meeting with only one group and applying broad strokes from that group to the rest of the community. A culturally competent approach to outreach must include innovative and creative community partnerships in order to educate and serve the community.  Effective partners can be organizations, individual community leaders, educational institutions, media outlets – virtually any accepted and trusted avenue through which people can be reached and served.
  • With every message, educate whole families.  Because three quarters of the world relies on and adheres to a family system of support, decision-making, and problem-solving, educating people as individuals in isolation from their families may deter long–term, health-seeking behaviors and result in wasted time.  Accurate messages must be targeted to whole families, as well as to the entire population group, to facilitate an environment in which diverse groups can seek health care without barriers or fears. Outreach messages and strategies cannot and should not ignore the context of people’s lives.
  • Plan with, not for, the community. While this may seem simple, it’s not. If you really analyze some of the work that any of us do, we may realize that we plan for communities all the time. “Let’s do this!” we excitedly say! “This will make a huge impact!” And then we are desperately disappointed when our projects fail. Planning with a community means doing their project, their way. That’s hard, especially when we come as experts in our respective fields. Planning with instead of for means listening and asking questions, clarifying and rephrasing, all toward getting a better sense of how the project is perceived by the group we are working alongside.
  • As a guiding perspective, look to the long–term.  It takes a lot of time to do cross-cultural projects well. Our project took twice as much time as we thought it would. Building relationships, drinking tea, testing programs, asking for advice, drinking tea, getting feedback, revising, taking a step back when you want to take five steps forward, drinking tea….did I mention drinking tea? Relationship-building is a huge part of effective public health projects. Outreach programs should incorporate a long–term perspective with a willingness to invest time and resources in developing a positive and mutually trusting relationship with those groups over time.

Those principles served us well in the project I described at the beginning. As I have moved on to work in Kurdistan, I have needed to look back at them. I want things to move quickly. I want to work for change. I want. I want. I want. And then I take a step back and I think about the meaningful conversations that I get to have every single day. I think about the laughter and conversations I’ve shared as I’ve sat in the homes of Kurdish friends and colleagues. I think of the things I’m learning, the humility that is inherently a part of being an outsider in a new culture and being like a small child in everything from learning the language to learning how to shop. I think about the ways God has uniquely prepared me for such a time as this.

I stop and I think about the privilege of working cross-culturally, the privilege of learning from people who don’t think as I think or live as I live. I don’t want to squander the privilege by being culturally arrogant and thinking my way is better. Instead I want to breathe, slow down, learn, and drink tea. 

What about you? Have you used these principles in your work? How have you worked alongside communities instead of in front of them? I’d love to hear through the comments. 

Note on the photo – we had the opportunity to do an amazing photo shoot for this project. This is one of the photos that the focus groups then chose to go into a community curriculum. It is of me with one of the project participants.

 *Author’s note: Some of the material from this piece was adapted from Communicating Across Boundaries Cultural Competency Curriculum developed by NAWHO and adapted by Marilyn Gardner and Cathy Romeo. 

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An adult third culture kid, Marilyn grew up in Pakistan and then raised her own 5 third culture kids in Pakistan and Egypt. After finally learning how to live in the United States, she finds herself unexpectedly living in the Kurdish Region of Iraq working at a university. She is the author of Between Worlds: Essays on Culture and Belonging and Worlds Apart - A Third Culture Kid's Journey. Her writing appears in Plough Magazine, Fathom Magazine, and a few other places around the web. You can find her blogging at Communicating Across Boundaries: Communicating Across the Boundaries of Faith & Culture.

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