The road to hell is paved with good intentions. (Bernard of Clairvaux, French Abbot, 1090-1153) Many of us in the helping professions are motivated to do good and give back in some way, perhaps because of our lucky lives. For those of us who do global health work in low or middle income countries, we are acutely aware of the abundant gifts we have as US citizens, especially if we have grown up in the middle or upper-middle class. I am reminded to appreciate what I take for granted: the ease of turning on a faucet for drinkable water, readily available internet access, and a standard of cleanliness and upkeep that is comforting. However, despite the inconveniences of living and working internationally, I receive more than I give. There is a richness to walking in another’s world. I am free of the worries and detritus of home and enamored with the differences: Sounds and smells. Delicious food. A different rhythm to the day—a siesta makes sense during the heat of the day when you can’t disappear into air conditioning. Physical poverty does not mean spiritual poverty. I fly back home, feeling nourished in a way I am not at home. How could this result in bad outcomes or feelings for those I want to help?

In Toxic Charity, Lupton talks about the receiving side of a volunteer visit: hearing the volunteers judge you for your poverty and need of assistance. He reminds us that we are not better despite the fact that we may have more money and more options. Rather we need to respect the world the other walks in and be curious. Differences demand cultural humility. This is different from cultural competence or sensitivity and the diversity training many organizations mandate these days.

Cultural humility is an ongoing process, a life-long process, the continuous interacting, reflecting, and learning as we encounter the other. Culture is more than ethnic or racial groups. Culture includes age, income, education, faiths and sexual orientation. We bring our own experiences and perspectives as we encounter others who are different whether at home or time zones away. It is useful at home as we encounter the other, whether immigrants or individuals who reside somewhere else on the political spectrum. Respect is critical to cultural humility. Respect means we are on equal footing. Power differences exist, they are recognized and then minimized, because I respect you.

When I was involved in domestic violence training in Russia and the Former Soviet Union in the late 1990s, my Minnesota colleagues and I encountered several challenges: How do you approach domestic violence in a patriarchal society? How can you order the perpetrator out of the home when property is not owned, but communal? What services were available for the perpetrator? These were not questions we were asking in the US at the time. Because responding to domestic violence in the US came out of the women’s movement, our efforts were focused on the female victim/survivor and her kids. Being curious about these different perspectives involved conversations, deriving different solutions and required mental gymnastics. It demanded acknowledging biases. We were flexible and gained valuable perspectives on our own culture as we brainstormed possible solutions with our Russian and FSU colleagues.

More recently, I’ve been writing a residency training curriculum with faculty in a Family Medicine Department in Palestine. In reviewing the adolescent portion of their Pediatric curriculum, there was no mention of separating the adolescent from their parent to have what I call the sex-drugs-rock-and-roll talk, a discussion about what a teen is or isn’t doing related to risk taking behaviors (alcohol, sex, drugs, smoking) that they don’t want to share with their parents. “We don’t do that here,” the family physician informed me. “The parents are always involved with the children.” This presented another opportunity for me to examine my own cultural biases: individual vs. family orientation and the pros and cons of both. Of course, that is another blogpost.

Suffice it to say being curious and owning my biases is not a painless process. Practicing cultural humility requires intention and attention. It is a continuous process, a life-long learning endeavor. The curiosity of humility moves us away from sterotypes, forces to examine nuances. This is a perspective that might help us in today’s politically charged world.