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Paper short abstract:

Community-engaged methods are often viewed as providing opportunities for “empowering” local communities and making research relationships more equitable. This paper explores the potential pitfalls of participatory methods and considers co-design as an ethical evolution of such approaches.

Paper long abstract:

Community-engaged, participatory methods can be essential in building stakeholder engagement in global health research and implementation, and they can facilitate community-led initiatives. They can also lead to re-entrenchment of unequal power dynamics and unearned privileges in global health while paying lip-service to equitable engagement. This paper explores the tension within applied medical anthropology in supporting social justice ideologies underpinning contemporary global health in counterbalance to ethical obligations to protect research collaborators, recognizing that the risks of research and global health implementation are not equally shared.

This paper shares experiences from long long-term ethnographic and community-engaged global health work in highland Guatemala. I describe methods undertaken to contribute to efforts of local organizations through community-engaged research, programming, and advocacy. I attempt to unpack how such textbook community-engaged, participatory action research went terribly wrong, tragically culminating in the targeted assassination of a study participant, colleague, and friend. In doing so, I will consider the prospects of moving beyond some of the pitfalls of traditional participatory methods through co design.

Co-design approaches are explored through concrete examples of perinatal care and water quality-testing projects in rural Guatemala built upon community-identified needs and priorities. Co-design has the potential to rebalance power dynamics in global health implementation and build equity in access to resources. The co-design approach can move beyond procedural ethics to position global health work within local moral worlds. However, challenges remain as to whether co-design can be replicated and scaled as a transformative methodological shift for medical anthropology in global health.