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“To Do No Harm” Spiritual Care and Ethnomedical Competence 163

“Accept existing mixed practices (e.g., local and Westernized) where
appropriate” (IASC, 2007, p. 108).
4. Even when allopathic health services are available, local populations
may prefer to turn to local and traditional help for mental and physical
health issues. Such help may be cheaper, more accessible, more socially
acceptable and less stigmatizing and, in some cases, may be potentially
effective. (IASC, 2007, Action Sheet 6.4)
5. Before supporting or collaborating with traditional cleansing or heal-
ing practices, it is essential to determine what those practices involve
and whether they are potentially beneficial, harmful, or neutral. (IASC,
2007, Action Sheet 6.4)
When attempting to offer sustainable disaster work in South Asia, I have
learned the power of engaging experienced nongovernmental organizations
(international iNGOs or national NGOs) in mediating collaborations:

1. They often have the trust of the people because the staff has taken the
time to learn local realities.
2. They form a cadre of barefoot counselors providing psychosocial first
aid and making referrals.
3. They provide feedback on the merits and demerits of outsiders provid-
ing services.

Indeed, with regard to No. 3 above—feedback that [we] outsiders are
ethically called upon to solicit—there have been several NGO communi-
cations (Jayawickrama, 2006; Shah, 2006) about wrong-headed interven-
tions brought from the West. Such feedback has also been reported by
WHO officials (Summerfield, 2005; van Ommeren et al., 2005).
In order to regulate well-intentioned, but inappropriate, interventions
from iNGOs and NGOs, governments can play significant protective roles.
For example, when tsunami relief efforts by iNGOs and NGOs appeared
to be lopsided in favor of donor stakeholders versus practical needs on the
ground, the government of India took steps that “mandated consulting the
affected people in relief efforts, refusing any measures to be permitted that are
donor-driven and disturb the way of life of the people” (Prashantham, 2008,
p. 201). A proactive stance for outsiders is to recognize that some degree of
“pushback” is inherent to aid relationships (Shah, 2007a) and that pushback
can be magnified in cross-cultural encounters. Furthermore, beyond simply
anticipating pushback, mechanisms of communication and feedback must
be put in place to solicit dissatisfaction from the field to repair and adapt
operations so that a program evolves with real-time, real-life concerns.