Toward an Ethics of Community–Academic Partnership
Community–academic partnerships, which often form unexpectedly, can be time consuming, tedious, and sometimes awkward alliances, yet they arise out of perceived needs and can be fruitful. Putting aside hierarchy to explore such partnerships as communities themselves that seek to capitalize on the strengths, knowledge, and life experiences of each stakeholder can offer a fresh perspective for thinking about the ethics of community-academic partnerships. This commentary explores the partnerships detailed in the symposia through the lens of ethnography.
Community Engagement, Patient-Centered Research, Community, based Research, Partnership, Collaboration, Ethics
See. This is why I keep thinking anthropology really is the master discipline. Each of the narratives in this collection is unique, yet each tells the same story: that we should all be ethnographers now. If we’re serious about making a difference in U.S. health care, that is, we all need to look with the eyes of ethnographers and speak with the voices of interpreters. These narratives try to do that; they try to say what life feels like “in the field,” “on the ground”:
“We assumed we had the ‘research’ skills and they had the ‘community’ skills.”
“ . . . thinking that you are humble and grateful is not the same as being humble and grateful.”
“ . . . always fearful of breaking the trust of the systems they are studying and/or the trust of the communities they are part of . . .”
“Is acknowledgment or greeting someone crossing a line?”
“I had felt the day–to–day tension of keeping a secret, being cautious but still wanting to connect, the constraints of not being genuine.”
In tone the narratives are sometimes confessional, sometimes expository; they focus sometimes on quotidian practicalities, sometimes on matters of theory or protocol.
In substance they embody familiar themes: respect, autonomy, justice, compassion, empowerment. [End Page 51]
Many quietly signal the sense that it is bad form to be discomfited or frustrated—with the manner or depth or consistency of engagement by community partners; the time sink and tedium that is research in the community; the tension of perceiving goals differently from partners. The general untidiness of the undertaking.
Allow me a conceit in thinking further about this collection, however. Let me imagine the narratives are field notes compiled by some participant–observer bent on studying the community of community–academic partnerships. Stories told by informants, through which the community defines and understands itself.
Seen through this lens, these narratives show us that “communities of partnership,” let’s call them, are local and particular—inhabiting “a primarily rural southern coastal county with several small towns” or “situated on the western shore of Lake Michigan and in the southeast corner of the state,” for example.
This collection offers origin stories, tales about how communities of partnership come into being:
“There was a moment of terror as both students wondered where they went wrong and how they did not convey that this was only an exercise. Dr. Barry clarified, ‘we know this was only a proposed project, but we really think it is meaningful, and we’re willing to do whatever we can to support you in carrying it out’.”[Ward, Mazul, Barry & Harley]
“There are two primary reasons why I opted to adopt a CBPR approach for my dissertation. First, tribal radio is a truly emic medium, and can only be understood to a meaningful degree with involvement from the local community, particularly those involved in its production. Second, making every effort to create equitable partnerships with the communities I work with is a matter of ethics, especially since I am an outsider to these communities.”[Wilbricht]
“Following a period of intense grief, I became determined to use the remainder of my career to help those who are ill or dying and their families to live the remainder of their life receiving the care that they, their families and communities wanted.”[Elk]
The collection also offers stories about how communities of partnership are “peopled,” if you will, who lives there, what they do, how they’re connected one to another:
“[N]inety percent of the women interviewed indicated that they were reliant on a male relative for transportation, coordination of appointments, and, more tellingly, as decision makers for women’s health screening decisions. Our partnership was with the community, not only the women, and a variety of outreach programs to men—primarily focusing on general health and the link between women’s health and the health of the community—were initiated.”[Shirazi]
“Our understanding was the agency would hire an additional interpreter or personnel. The community partner, like most nonprofits, wanted to use the grant money as an additional resource to support the organization.”[Saksena & McMorrow]
“My colleague reported that the patient left before completing his appointment and appeared to be distressed, uttering a statement that was construed as a threat of self–harm. The patient’s name and medical record number was provided, which led to the discovery this patient is an academic colleague, collaborator, and a personal friend . . .”[Raynor & Penkin]
Other stories describe conflict in community life . . . :
“When there is one person who can bring half of the group together, their absence can bring work to a standstill.”[Pallai]
“We have a lot of skills. We can work on diabetes prevention, reproductive health, domestic violence; you name it. Just tell us already! What do you want us to do in this project?”[Bravo, Gutierrez & Young]
. . . and overcoming conflict:
“Well, we were hoping you’d decide what your project would be. It’s your project. You get to decide.” “Oh.”[Bravo, Gutierrez & Young]
“Two specific practices we use to break down divisive assumptions and stereotypes. . . . The first practice is to start each . . . meeting with an opening question that everyone at the meeting answers. . . . the second . . . is using five minutes of meeting time for guest researchers to explain their personal motivation for their research.”[Thomas, Kaiser & Svabek] [End Page 52]
Continuing our conceit then, if “[t]he central aim of ethnography is to provide rich, holistic insights into people’s views and actions” (Reeves, Kuper, and Hodges, 2008), said what would our participant–observer make of communities of partnership on the basis of the stories these members have told?
Not surprisingly, as a social form, communities of partnership are very much intentional—even when serendipity has some hand in bringing them into being. They are instrumental and vigorously goal–oriented, coming to exist as a response to perceived need. That need may be professional, such as fulfilling the requirements of a program of study, or directed toward broad challenges of promoting social justice, access to care, equitable health outcomes. Communities of partnership are also meant to be reflective about process and dynamics. And their members are meant to be virtuous, cleaving to ideals of character and practice.
Further, our participant observer would tell us that the commitment to “partnership” that defines the community’s understanding of itself is fraught. Exigencies both within and outside the community—third–party funding and the expectations it imposes, disjunction between the responsibilities built into the partner relationship and the responsibilities of partners as individuals owe to multiple communities, for example—ultimately allow for at best ephemeral relationships, however intense those relationships may be for the duration.
Running beneath the community’s stories as told in these narratives is the reality that communities of partnership are instrumental in a second way as well: to achieve their goals partners must use one another. This isn’t necessarily as bad as it might sound. Each side, after all, gets to use the other. I’m reminded of once–upon–a–time when I was a graduate anthropology student. Colleagues recently returned from the field regaled the not–yet–gone–into–the–field with a skit, their interpretation of how informants viewed them, titled “Trips to the Grocery Store: How Often Can We Ask?” What the narratives hint at is that this reality is a source of discomfort; that it doesn’t jibe with the equality and empowerment held out as the ideal in communities of partnership.
Our participant–observer might note as well that these stories reveal the obligation to resist or unmake hierarchical relationships within communities of partnership to be cross cut by the decidedly hierarchical (if largely tacit) expectation that researchers or public health professionals are the partners responsible for seeing that the whole thing goes well. Community partners can be challenged by circumstances, but only “professional” partners can truly fail:
“We’ve also learned that while The Personal is powerful, it needs to be used thoughtfully. Some opening questions can unintentionally derail the group with negative energy, making it harder to get on a productive track.”[Thomas, Kaiser & Svabek]
“Trust was previously mentioned in this essay and that concept is key not only to the personal use of healthcare but also to the creation of research that evaluates that care. Fostering that trust as a professional while calling for healthcare accountability measures is a tightrope that . . . TGNC healthcare researchers walk with trepidation, . . .”[Raynor & Penkin]
Finally, these stories speak of the value placed on lessons learned:
“Another key lesson learned was that prior to commencing the project, we needed to better communicate with the partner to identify one designated and committed staff person to be in charge of the project, to be our main point of contact, and responsible for all aspects of execution of the project.”[Saksena & McMorrow]
“This project, by definition had to have a level of flexibility, which can be difficult when working with academic publishing timelines and grant reporting. We found the project to be a long–term process requiring patience and flexibility.”[Shirazi]
“The most important lesson the students learned from this work was to include a community partner from the very beginning. . . . YWCA leadership appreciated the ability to help shape the study design and questions, and believed the research was much more meaningful because of the value placed on the agency’s experience with the community.”[Ward, Mazul, Barry & Harley]
“We’ve also learned some interesting things about the stereotypes and assumptions that [End Page 53] researchers make about “hard to reach” people, the assumptions that lay people make about researchers, and how to overcome prejudices that make it hard to connect with each other.”[Thomas, Kaiser & Svabek]
In one way or another, then, these stories assert that in communities of partnership it’s important to get it “right.”
So, stories told by and for communities of partnership show us a good deal about their inner workings. And they articulate community–defining values and expectations.
In the end, though, they may leave us with more questions than they answer, some of them fairly foundational:
Just what “it” do community–academic partnerships need to get right? Should they be held responsible to produce strategies for effective transactions across social divides or clear options for public policy?
Of the kinds of work community–academic partnerships do in the world, should some count for more than others? Does training students to work effectively across community boundaries matter less than, as much as, or more than helping communities themselves learn how to understand one another? Are community–academic partnerships meant to change the world, or make it more transparent? Are they exercises in capacity building, (Israel et al., 2010) and if so, whose capacity is it they seek to build?
What kinds of “community” count for this work? Communities can be defined not only by culture—ethnicity—heritage, but by geography, common identity, illness, a common cause (Horowitz, Robinson, and Seifer, 2009). Might there be value in creating partnerships across constituent communities within academic institutions? One thinks of the emerging emphasis on collaborative training for health care professionals.
What should an explicit ethics of community–academic partnership encompass? As distinct from ethics in such partnerships.
There are no doubt other questions behind these stories that I’m not seeing yet. And that’s probably as it should be.
To return to our conceit one last time, looking with the eyes of an ethnographer and speaking with the voice of an interpreter isn’t an academic exercise. It isn’t about belonging to a particular community or bringing a particular body of knowledge or expertise “to the table.” It’s about how we live in, experience, and do our jobs in the world when our jobs intentionally seek to make life, if not outright better, at least less challenging across our communities.
Conflicts of Interest. The author reports no conflicts of interest.