Mercy Nqandeka and Rachel Cummings reflect on their contrasting research cultures and the implications for inquiry in the medical/health humanities. This piece is part of a collection of posts from attendees at the 2024 Medical Humanities International Summer School for PhD researchers in Vadstena, Sweden, coordinated by the Centre for Medical Humanities and Bioethics at Linköping University, in collaboration with the Institute for Medical Humanities at Durham University.
This piece came about following a discussion we, the authors, had at the Durham / Linköping Medical Humanities Summer School in 2024. The theme of this event was interdisciplinarity and, as a group, we spoke about many kinds of cross-border dis/connections.
During one seminar, we discussed our relationship to our research subjects. Based in London, Rachel is a nurse researching clinicians who deliver end-of-life care. Based in South Africa, Mercy studies indigenous healers in her own community, the amaBomvana, a sub-group of amaXhosa from the Eastern Cape. We thus share an entanglement with our subjects. However, during our discussions, we talked about the different ways this plays out in our different positions and locations. We seek to explore this in the following dialogue.
Rachel: During our discussions at the Summer School, you talked about how you had to secure acceptance from your research subjects before you could do your fieldwork. Can you talk a bit about that?
Mercy: In my context, gaining entry into the community is an essential part of the research process. Before I can begin any fieldwork, I must first be formally introduced to the community chief. From there, I work with other local leaders to help identify potential participants. Once I meet with participants, I don’t simply start asking questions—they need to understand who I am. That means sharing my full introduction, including my clan name, surname, and even details about my parents and grandparents. This is how people assess my identity and decide whether I am someone they can engage with. It’s our way of ensuring trust and mutual recognition before any exchange of knowledge takes place. Does this sound familiar to your approach to ethnographic research?
Rachel: In some ways, yes, and in some ways, no. To access my research site, there was a similar process of introduction via senior figures and building rapport with participants. I also had to give them some sense of who I am and what I was trying to do. But, for the most part, this took place on a professional rather than a personal level. My research approval went through various formal committees and the access I was ultimately granted (to a hospice in-patient unit) was, in part, based on my previous professional experience. During the ethnography, I introduced myself as a nurse to the healthcare professionals I was researching. This was about creating common ground between us and communicating that I understood the various challenges they face.
Your experience of building trust on a personal rather than a professional basis reminds me of a point made by Lisa Stevenson in her 2013 ethnography of Inuit communities in northern Canada. She argues that the idea of anonymity and confidentiality as self-evidently “social goods is a culturally and historically specific idea” (85). Stevenson quotes Peter Kulchyski’s (2006, 160) earlier work in the same setting, which describes “the embodied sense that one’s great great great to the nth degree grandchildren will very likely be interacting with the great great great to the nth degree grandchildren of one’s neighbour.” Such a context clearly changes the role and significance of a researcher.
Mercy: The quote resonates deeply with me because I understand that the role of a researcher goes far beyond merely extracting information. In many communities, especially within the context of ongoing struggles in developing countries, people are continually seeking ways to improve their circumstances. As such, they inevitably ask how a researcher intends to contribute to their future. Research, therefore, should not be a one-sided transaction. It is through building genuine relationships with participants and their communities that a researcher fosters long-term connections—connections that may extend across generations. This approach promotes a sense of shared lineage and responsibility, where research becomes part of a broader commitment to mutual growth and enduring collaboration.
Rachel: The same should, of course, be true in clinical research. You want what you are doing to contribute to improved care for patients and for that to be a shared goal between researcher and subjects. Building those longer-term connections are, however, difficult in this context. Unlike you, after completing my research, I did not remain in the setting. The institutional context also makes it impossible to establish generational connections.
Perhaps, for those in my position, building the “mutual growth and enduring collaboration” to which you refer is partly about representing research well. Individual relationships may not last, but the impression of research might. Like you, I want my community—nurses—to have a positive experience of research and understand it as something that can contribute to addressing our ongoing struggles.
Mercy: This highlights, I think, a deeper principle: that meaningful research, regardless of setting, should be guided by care, reciprocity, and the potential to contribute constructively to the communities it engages.
Rachel: Yes, and it’s particularly interesting to think about this in relation to medical or health humanities because it is about how to care-fully research the doing of care.
Mercy: I agree. For me, at least, the sustainability of research hinges on how researchers position themselves—not as extractors of knowledge, but as co-journeyers in collective struggles and aspirations. This is an example of that recursivity—an ongoing process of being reshaped by and in turn reshaping the research. It is something I have learnt from my interlocutors, but which also speaks to the forms of relationality I would like to see in our health systems more broadly.
Rachel: Agreed!
About the authors
Mercy Nqandeka is a PhD candidate focusing on Indigenous Knowledge Systems at Stellenbosch University, Cape Town, South Africa.
Rachel Cummings is a PhD candidate working on end-of-life care at the University of Bath, UK.
Thank you for this. The principles discussed here are some that permeate all of health care. Research should be a reciprocal and shared process. In both research and clinical settings dialogue is important (essential) and often excluded because we don’t want to “contaminate” our “data” with subjective, relational information. If we don’t understand the context and culture of our subjects’ we don’t understand how they will interpret and participate in the research.
So much research presently is researcher motivated and driven and, sadly, aimed at furthering an academic career. The concept of knowing and being known by the people involved in the research requires approaching each other by “bracketing” our own assumptions and cultural practices and entering into the relationships as though we are entering a country in which we have no knowledge. It also involves opening ourselves to the scrutiny of the community of our “subjects” (interesting that we use this term while doing everything we can to objectify them in the interest of empiricism. It makes a lot of sense to me to explore the experience, beliefs, lived world etc of each other as we involve ourselves in research. I expect it would require dialogue, reflection and disclosure of the beliefs, motivations, assumptions of ourselves and others. How would this affect the questions, interpretations, outcomes of our research.
Of course all of this is true in our clinical settings where we provide inadequate care if we ignore or exclude the context, culture, illness experience, reflection about our relationship.