Sorry, the title is to catch your attention. If this is the way you think about solving a public health issue in a hard-to-reach community, you have already lost the battle. Approaching any community that is not your own requires humility, respect, and a lot of listening. Having worked in many different cross-cultural environments as an outsider, allow me to share with you a few points essential for effective collaboration in all cross-cultural settings. Please forgive me the indiscretion of colloquially painting Haredi communities all with one brush in this article; I am aware the differences are great.
- You must be invited in. This first bridge may be the hardest. To be invited into a community to help solve a problem means the community already recognizes the problem, feels it cannot be solved internally, and has a trusting relationship with someone outside of it who they feel can help. The problems that they are trying to solve (eg. Loss of work, need for consistent schooling) are usually different than the ones we are trying to solve (eg. non-adherence to isolation, mass gatherings). That is workable. We need give them the respect of centering their issues as primary when crafting solutions, and create strategies which address both concerns. Luckily, there are representatives of the community with relationships outside of it, and the trust within between them is heart of the intervention.
- The solutions must come from within. The model of working with “Community Health Workers” mobilizes and empowers people from within the community to respond to the public health issue. This is a well-known and well-studies approach in which community members – even without much education or no professional training – come forward as the quiet leaders of the health intervention. Community health workers are uniquely positioned with a wealth of knowledge that outsiders could never master. They speak the language, they know the culture inside out, they are familiar and so trusted, and they are aligned both with the concerns of the community and of the external assistance. They are the face of the intervention: eyes and ears within the community, and the mouth which can deliver a message. Without their alliance, we are deaf, blind, and mute to the needs and thoughts within, and so cannot assist.
- Health of the country is determined by health at home. One of the most impressive health interventions I have ever witnessed was an effort by local medical trainees who were working with a remote community in Guatemala. One large wall of the health outpost was covered with a map of the area in which every home was marked, numbered, and assessed for who was living there, what work they do, what resources they have, what the environment around them was like, who had been vaccinated, what health issues they struggle with, etc. This microlevel survey allowed them to target health campaigns and intervene quickly with those at risk when new information came up. COVID poses different challenges for different people – whether it be the elderly who fear isolation, workers who fear loss of income, parents struggling with the children all home, those who cannot read or have no access to technology, etc, they have different motivations and reasons for acting as they do. Until they have the chance to speak with a trusted source about their issue, it is unlikely they will drastically change their behavior. And until we create the framework to understand the drivers of their actions, we are unlikely to create interventions which work.