Although important information gaps were identified, the data draw attention to critical public health interventions required in poor health districts, and to motivate for pro-equity policies.

Global institutional collaborations are typically focused on research, education, or training. These collaborations provide opportunities for the exchange of information and academic practices across countries and hemispheres. However, in addition to academic purposes, one of the ultimate goals of collaboration should be that local communities benefit from their involvement. These motivating factors came together in 2016 when the "Secret History" adaptation project was funded by the Pan Institution Network for Global Health (PINGH). The primary aim of the project was to culturally adapt and test a novel training-the "Secret History" method-that supports empathy and self-care skills for health workers. This chapter describes the project, but also illustrates how this project benefitted from a true global collaboration. The project team included researchers from University of Cape Town, South Africa, where the method was developed; Pennsylvania State University, USA; and the target institution, University of Freiburg Medical Center, Germany. The team brought together extensive knowledge of the intervention, implementation, evaluation, clinical expertise, access to the relevant participants, and international project management.

BackgroundMaternal mental health conditions are prevalent across the world. For women, the perinatal period is associated with increased rates of depression and anxiety. At the same time, there is widespread documentation of disrespectful care for women by maternity health staff. Improving the empathic engagement skills of maternity healthcare workers may enable them to respond to the mental health needs of their clients more effectively. In South Africa, a participatory empathic training method, the “Secret History” has been used as part of a national Department of Health training program with maternity staff and has showed promising results. For this paper, we aimed to describe an adaptation of the Secret History empathic training method from the South African to the German setting and to evaluate the adapted training.MethodsThe pilot study occurred in an academic medical center in Germany. A focus group (n = 8) was used to adapt the training by describing the local context and changing the materials to be relevant to Germany. After adapting the materials, the pilot training was conducted with a mixed group of professionals (n = 15), many of whom were trainers themselves. A pre-post survey assessed the participants’ empathy levels and attitudes towards the training method.ResultsIn adapting the materials, the focus group discussion generated several experiences that were considered to be typical interpersonal and structural challenges facing healthcare workers in maternal care in Germany. These experiences were crafted into case scenarios that then formed the basis of the activities used in the Secret History empathic training pilot. Evaluation of the pilot training showed that although the participants had high levels of empathy in the pre-phase (100% estimated their empathic ability as high or very high), 69% became more aware of their own emotional experiences with patients and the need for self-care after the training. A majority, or 85%, indicated that the training was relevant to their work as clinicians and trainers, that it reflected the German situation, and that it may be useful ultimately to address emotional distress in mothers in the perinatal phase.ConclusionsOur study suggests that it is possible to adapt an empathic training method developed in a South African setting and apply it to a German setting, and that it is well received by participants who may be involved in healthcare worker training. More research is needed to assess adaptations with other groups of healthcare workers in different settings and to assess empathic skill outcomes for participants and women in the perinatal period.

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