Working equally with international partners: Local solutions for global problems

“It’s usually the Western institutions that set the agenda,” says Hoffman. “Local partners often end up being the implementers, even though they know best what’s happening on the ground. That means inequality already exists before a project even begins.” Vermeiden adds: “The risk is that Western organisations propose solutions that don’t actually work in practice, because they don’t fit the local reality. That’s when things start to go wrong.”

• Tienke Vermeiden is a researcher at LUMC who has worked for many years in Ethiopia, Tanzania and Zimbabwe. She is now involved in AFRICARhE, a project that aims to improve care for pregnant women and newborns affected by Rhesus disease in Africa.
• Charlotte Hoffman is a physician and PhD candidate at LUMC, working on FRESHAIR4Life, an international project that focuses on protecting young people from diseases caused by tobacco use and air pollution.

Just sending a mosquito net doesn’t solve the problem

While working in Tanzania, Ethiopia and Zimbabwe, Vermeiden saw first-hand how solutions that worked in the West sometimes had little impact locally.

“Take mosquito nets, for example. We know they’re effective, but if people don’t use them—or use them incorrectly—the problem remains. Translating that to AFRICARhE: LUMC has extensive expertise on Rhesus disease, but our partners are the experts in their own health systems. It’s essential that the people facing the challenges take the lead.”

In FRESHAIR4Life, it’s the countries themselves that choose to participate. “It’s never imposed from the outside, and that immediately creates more equality,” says Hoffman. “Together with local partners, we develop approaches that match the realities on the ground. There’s no such thing as a one-size-fits-all solution. Each of the five participating countries—Greece, Romania, Kyrgyzstan, Pakistan and Uganda—faces its own unique challenges.”

The “white savior” mindset

When Western societies present themselves as the bringers of solutions, this is often referred to as the white savior mindset. “We tend to assume we know what’s best for others, but that’s often not the case,” Vermeiden explains. “Take the idea of planetary health: it’s currently a hot topic in Western institutions, but for the Māori in New Zealand, this isn’t new science at all—it’s the philosophy they’ve always lived by.”

For her, it’s a reminder that “our” version of the truth is just one perspective, not the truth. “There’s a lot we can learn from other ways of seeing and doing science. That requires humility.”

Hoffman sees similar challenges in her own work: “Karachi, in Pakistan, is one of the most polluted cities in the world. But many people there say, ‘We don’t even have food on the table tonight—how can we worry about a lung disease that might develop in thirty years?’”

What’s in it for us?

Global partnerships don’t just benefit local communities—they also benefit us. “AFRICARhE teaches us a great deal about Rhesus disease, which has become rare in the Netherlands,” says Vermeiden. “And by studying global issues like tobacco use and air pollution through FRESHAIR4Life, we can develop strategies that may also be effective here,” adds Hoffman.

Words carry history

Working across cultures isn’t always easy. It takes sensitivity to different ways of communicating. “What’s considered professional in one culture can come across as cold or impersonal in another,” says Vermeiden. “It’s a constant balancing act.”

Language also matters. Words can reinforce inequality or recall colonial history. “In older scientific texts, we sometimes encounter terms that are now seen as offensive or racist,” Vermeiden explains. “That raises the question: can you still use such sources, even if the knowledge is valuable? We discuss those dilemmas with our partners, and sometimes we decide to exclude certain studies altogether.”

“I thought I knew better”

Both researchers agree: equal collaboration is an ongoing process, with no finish line. Reflection—especially self-reflection—is key. “When I was seventeen, I did medical volunteer work in Zambia,” says Hoffman. “I went with the best intentions, but now I know that such programmes are often seen as a form of medical tourism. Some organisations even profit from it by charging volunteers large fees. That can actually undermine local healthcare systems. Looking back, I think: that wasn’t such a smart move—but it was an important lesson.”

Vermeiden had a similar experience during her PhD research in Ethiopia in 2013. “I’d lived in Tanzania and studied development studies, so I thought I knew what I was doing. But I soon realised that collaborating with Ethiopians is completely different from working with Tanzanians. I learned a lot from that.”

Hearing every voice

A key focus within both AFRICARhE and FRESHAIR4Life is ensuring that all voices are heard—not just the loudest ones. To support this, Vermeiden and her colleagues use deep democracy, a method developed in South Africa after apartheid. “In a democracy, the majority decides—but that can leave minorities feeling unheard. Those feelings can derail projects and even societies. Deep democracy helps ensure every voice is considered in the decision-making process,” she explains.

Bringing everyone to the table means including young researchers as well. “In the Netherlands, students and PhD candidates are used to having a lot of ownership,” says Hoffman. “In other countries, hierarchies are stronger, so younger researchers are less likely to speak up—even though they often know exactly what’s happening in their communities.”

Vermeiden agrees: “We work with three African and two Dutch partners. Even in our small team, you notice the hierarchy—the professor speaks, the PhD student listens. In the Netherlands, doctoral candidates take much more initiative. We try to encourage that same sense of ownership, but it’s a gradual process.”

“Are they even on the same page as us?”

How do partners in the Global South see issues like humility and the white savior mindset? “An Ethiopian colleague recently told me: ‘There’s a lot of talk from Northern partners about equal collaboration, but we often can’t even get a visa to attend conferences in Europe. That means unequal access to knowledge,’” says Vermeiden.

Others take a more pragmatic view. “Some are simply glad that funding comes from the North and that we can support them in applying for grants,” she continues. “We hear things like: ‘You have the capacity to do this. We don’t have pensions and need extra income alongside our jobs.’”

Accepting imperfection

True equality in collaboration is not a destination—it’s an ongoing process of learning, humility and honesty. “In the end, we all have to adjust to one another—to meet halfway,” says Vermeiden. Hoffman adds: “And we have to accept that we’ll make mistakes and that discomfort is part of the process.” Because ultimately, it’s these partnerships—built on mutual respect and a willingness to learn—that make genuine progress in global healthcare possible.

Learn more about LUMC’s international collaborations here.