TABLE 2

Framework for the Assessment of GCH Intentions

IntentionFramework
Discernment of selfBefore every engagement in GCH, reflect on the impetus to participate and explicitly clarify goals to self and GCH partners. Consider goals of altruism, adventure, compassion, proselytizing, guilt, learning, professional advancement, research, or other personal gain.
Expressed need by receiving patient populationAllow the space, time, and commitment to engage the community in an assessment of needs and project planning. Acknowledge that people know their own needs. The role of the US GCH practitioner is not to presume needs but to help meet the needs identified by the community.
Cultural humility and linguistic competencyLanguage and cultural humility, including through use of language and cultural interpreters, is an essential expectation when working with vulnerable populations. US GCH practitioners bear the responsibility of acquiring such skills or identifying interpreter services that would not further burden the resource-limited global health partner.
Benefit to host communityEnsure that GCH efforts are of benefit to the community by examining the long-term impacts of interventions on patients, the existing health system, and future programs. Working in conjunction with existing health systems can allow for sustainable contributions to medical education and health system strengthening.
Benefit to selfIdentify resources and support for preparation, reflection, and debriefing to maximize the benefits of working in a different health setting.
Ethically acceptable material benefitsDonations of medical equipment, technology, and educational materials must be done in conjunction with the expressed needs of the global health partner. Expired medications, nonformulary medications, and equipment that requires expensive maintenance or is not desired by the receiving health center can result in a negative clinical and ethical impact. The receiving GCH partner should be engaged in the determination of utility of donated materials and identification of needed resources.
Ethical relationshipGlobal health relationships must have a foundation of mutual respect and shared goals. Such relationships may require time to develop. Engaging with partners in program development, ensuring follow-up, evaluating outcomes, and sustaining communication are important to the short-term and long-term goals of GCH collaborations.