Navigating the violent process of decolonisation in global health research: a guideline

Abstract

As part of the call to decolonise global health, there has been an emphasis on shifting different aspects of the global health system, including the role of donors1Ashuntantang G Luyckx V Naicker S Venkatapuram S Reform of research funding processes could pave the way for progress in global health.Lancet Glob Health. 2021; 9: e1053-e1054Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar and journals,2Olusanya BO Mallewa M Ogbo FA Beyond pledges: academic journals in high-income countries can do more to decolonise global health.BMJ Glob Health. 2021; 6e006200Crossref PubMed Scopus (7) Google Scholar addressing racism,3Besson EK Confronting whiteness and decolonising global health institutions.Lancet. 2021; 397: 2328-2329Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar decolonising the mind,4Naidu T Says who? Northern ventriloquism, or epistemic disobedience in global health scholarship.Lancet Glob Health. 2021; 9: e1332-e1335Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar and ensuring adequate working conditions for staff in low-income and middle-income countries.5Steinert JI Atika Nyarige D Jacobi M Kuhnt J Kaplan L A systematic review on ethical challenges of ‘field’ research in low-income and middle-income countries: respect, justice and beneficence for research staff?.BMJ Glob Health. 2021; 6e005380Crossref PubMed Scopus (3) Google Scholar Historically, decolonisation has always been a violent process6Khan T Decolonisation is a comfortable buzzword for the aid sector.https://www.opendemocracy.net/en/decolonisation-comfortable-buzzword-aid-sector/Date: 2021Date accessed: August 25, 2021Google Scholar and global health might experience the same. Disrupting and calling out neo-colonial practices requires courage to bear the cost that comes with doing so.7Abimbola S Asthana S Montenegro C et al.Addressing power asymmetries in global health: imperatives in the wake of the COVID-19 pandemic.PLoS Med. 2021; 18e1003604Crossref PubMed Scopus (18) Google Scholar I write this piece specifically in the context of academic research partnerships between high-income and low-income countries and what can be anticipated. In response to the movement, when researchers in low-income countries challenge the current systems to fight power asymmetries on their terms, the process of power transfer is going to be violent, taking different forms. Little has been written about how to deal with the complexity of the process, particularly the violence that comes with it, and how this violence manifests itself in research collaborations between high-income and low-income countries. Violent, marginalising behaviours can include continual questioning of the ability and technical skills of the staff from low-income countries. Other behaviours that undermine equitable collaboration include critical decisions being made about the study by high-income country researchers or travelling to the site without prior communication with the low-income country's principal investigator; publishing papers or deciding authorship without the knowledge of the low-income country's principal investigator; directly communicating with the field staff undermining the site principal investigator, and communicating unsubstantiated allegations against the principal investigator to the low-income country's university leadership as a means of coercive influence. I have come to understand the power dynamics that influence decision making from my position as a marginalised player in the system. Although the literature often situates power as a consequence of an inherent superiority of high-income countries universities, I argue that those power asymmetries are primarily influenced by the weaknesses of institutions in low-income countries. Global health research institutions in low-income countries give away power in exchange for resources, funding, recognition, and the chance to be published in high impact journals by affiliation. That situation is often perceived as more comfortable and risk aversive than addressing local systemic issues. Decolonisation can succeed only if the colonised are willing to move out of their comfort zone and seize the opportunity to take responsibility for their own destiny. In the appendix table, I have described how violence or facilitation could manifest for different actors, taking advantage of the power imbalance and also guidelines to deter, while also attempting to understand what drives the behaviour. I have tried to distil what I have seen, witnessed, experienced, or heard accounts of over the past 12 years into workable guidelines, for I have also seen that the extent of violence depends on the degree of power imbalance. The privilege of power as academics in global health comes from being male, white, based at a high-income country university, seniority (both in academic position and age), and working on an agenda that attracts funding, institutional value, and support. Striving to be accepted by the internal ruling group, for institutional support, is a very interesting occurence that I have found to be a strong driver of power in the workplace. The majority of individuals strive to be a so-called company person, quietly accepting organisational policies and conforming to the institutional vision that serves to maintain the status quo. There is, however, a minority who excel in their work and want to be respected for their personal achievements. When such individuals seek institutional support to navigate the process of decolonisation, they often expect people to join them in the goal of achieving improvement and change. By being creative, showing initiative, and refusing to conform, however, they often fail to gain the support of their leaders and peers. Creativity leads to vulnerability. Hence, the quest for growth, which requires a degree of autonomy, has to be carefully thought through and planned for. The change, if to be led by investigators in low-income countries, requires effort to reduce violence through the use of more constructive strategies, presenting an alternative narrative (panel).PanelGuidelines for investigators in low-income countries•Before you sign grant agreements, sit down with your grant administration team, including the legal department; read every part of the contract especially the clauses meant to protect you; ask questions; if you trust the grant admissions team enough, share your concerns and explore your vulnerability•Be very clear about accountability; who are you ultimately reporting to; is it a primary award or a sub-award; connected to this, clarify the decision-making process with the investigator, your organisation, and your funder; document the agreement with both the funder and your organisation•Make sure you are part of the communication with the funder even if you are not directly contracted; there might be deliberate efforts to keep you out, but politely request for yourself to be part of the communication as it impacts the work you do and is important for your professional growth•Make sure your team, especially in the field, are in agreement with you and approve of your strategy; at times the collaborators directly communicate with the field team without your knowledge; make clear guidelines, before the project begins, that you should be made aware of such communication and are always copied in on any such formal conversations•When you seek equitable partnership, anticipate complaints and escalations targeting your technical skills as a counter strategy; documentation is the key; maintain a decision log; file the evidence if it is via email; if a decision is made in a meeting, minute it and ensure acknowledgment from investigators•Build a profile; as far as possible within the terms of your contract take on responsibilities both within and outside your organisation, even if it means volunteering; take it as an opportunity to learn but also to have alternate voices vouching for your professionalism, ethics, and capability•Build your own circle; connect with people; use social media effectively; in a world where everyone speaks, be the one who listens; read the latest publications in your field, let the authors know what you like about it, write to them, and connect with them; people love to talk about their work, and many are willing to help you if you ask•Invest in yourself; there is no greater armour than the quality of your work; the standard has to be nothing less than excellent; when you are vulnerable, there is no other ground to stand on; find something that really excites you, be visible, take on the opportunity, and prove yourself•Read, read, read, and reflect; then write your reflections; publish if you can as a blog, an abstract, or even a Twitter thread; writing gives visibility•Find like-minded people; stand up for them, for the right principles; they are the ones who will stand up for you when you need them •Before you sign grant agreements, sit down with your grant administration team, including the legal department; read every part of the contract especially the clauses meant to protect you; ask questions; if you trust the grant admissions team enough, share your concerns and explore your vulnerability•Be very clear about accountability; who are you ultimately reporting to; is it a primary award or a sub-award; connected to this, clarify the decision-making process with the investigator, your organisation, and your funder; document the agreement with both the funder and your organisation•Make sure you are part of the communication with the funder even if you are not directly contracted; there might be deliberate efforts to keep you out, but politely request for yourself to be part of the communication as it impacts the work you do and is important for your professional growth•Make sure your team, especially in the field, are in agreement with you and approve of your strategy; at times the collaborators directly communicate with the field team without your knowledge; make clear guidelines, before the project begins, that you should be made aware of such communication and are always copied in on any such formal conversations•When you seek equitable partnership, anticipate complaints and escalations targeting your technical skills as a counter strategy; documentation is the key; maintain a decision log; file the evidence if it is via email; if a decision is made in a meeting, minute it and ensure acknowledgment from investigators•Build a profile; as far as possible within the terms of your contract take on responsibilities both within and outside your organisation, even if it means volunteering; take it as an opportunity to learn but also to have alternate voices vouching for your professionalism, ethics, and capability•Build your own circle; connect with people; use social media effectively; in a world where everyone speaks, be the one who listens; read the latest publications in your field, let the authors know what you like about it, write to them, and connect with them; people love to talk about their work, and many are willing to help you if you ask•Invest in yourself; there is no greater armour than the quality of your work; the standard has to be nothing less than excellent; when you are vulnerable, there is no other ground to stand on; find something that really excites you, be visible, take on the opportunity, and prove yourself•Read, read, read, and reflect; then write your reflections; publish if you can as a blog, an abstract, or even a Twitter thread; writing gives visibility•Find like-minded people; stand up for them, for the right principles; they are the ones who will stand up for you when you need them Lastly, I must admit that it has not been an easy piece to write, and I have delayed it for some time. I realised that silence is not an option. For those individuals who are not privileged to speak, but are passionate for the movement and change, silence is a disservice. Speaking up is also an opportunity to continue the virtuous cycle of compassion. People have been there for me in my dark hours; I hope I can be of some help to others through my honest reflections. My message to those in leadership roles anywhere and who can spend their privilege of being in powerful roles: We must take sides. Neutrality helps the oppressor not the victim. Silence encourages the tormentor not the tormented (Elie Wiesel). There are several people who I am grateful to for their support and might not be able to name all of them, but I do remember all of them in my prayers. I am thankful to Penny Holding for her advice that the battle for justice starts with speaking up, to Babar Hasan for helping me realise that being an investigator from a low-income country I was equally valuable as the research cannot be enabled without us, and to Uzma Memon for sharing a vision of staying true to the community and fighting for it. I have also been fortunate to find people on Twitter who can speak truth to power, who have connected, and have been a great support including Mishal Khan, Afifah Rahman-Shepherd, and Tammam Adoulat. Muneera A Rasheed is a member of Action to Decolonize Health, an activist, action-oriented collective of global health academics, practitioners, and students coming together to put forward ideas, arguments, and strategies to reconstruct the global health system. I declare no competing interests. MAR is no longer employed by The Aga Khan University. Download .pdf (.2 MB) Help with pdf files Supplementary appendix