Things without roots and water without a source dry (Ethiopian aphorism).1^{(p. xiii)}

Critical global health and critical medical education research are growing areas of academic interest,1 with authors from many continents and regions gravitating towards work in this area.2–8 High-income country (HIC) scholars and theories continue to dominate in these spaces, with fewer low and middle-income country (LMIC) scholars or theories represented.8–13 One step towards global inclusivity is to actively encourage the use of theories, methodologies and other forms of knowledge from under-represented countries and regions.

There is growing recognition that colonial influences on our field must be addressed.14–18 Whether framed as postcolonial, decolonial or anticolonial, this important set of theoretical approaches has in common its framing as countering the ongoing global effects of European colonisation and imperialism that began in the fifteenth century. At the same time, as global health and medical education scholars build their understanding of the historical and continuing influences of colonisation, the absence of non-western forms of thought in medical education remains a challenge. There are exciting opportunities to learn from intellectual traditions that developed long before the era of colonisation, and which exist separate from European intellectual and theoretical approaches. However, these intellectual traditions remain largely absent in global conversations as scholars from non-dominant cultures contend with the power of western intellectual traditions that claim universality in global spaces. This results in epistemic injustice19 with global south scholars experiencing ‘cultural cringe’, a term described by A.A. Philips as an internalised sense of inferiority that leads to people considering their own culture as lesser than cultures elsewhere.20 21

In this analysis paper, we introduce Qiné, an Ethiopian intellectual tradition dating back many centuries (predating colonialism) that continues to exist and has the potential to expand scholarly inquiry in critical spaces. In bringing Qiné into global critical scholarly conversations, we suggest ways it might broaden notions of ontology and epistemology, while being cautious about inappropriately applying western notions of theory and methodology. So dominant is western thought in the critical canon that it can be daunting to bring other perspectives into this space in a non-tokenistic way.22 We recognise that this is not the first example of this work; various indigenous theories and methodologies are increasingly recognised, as is Ubuntu, a philosophical tradition present in multiple Sub-Saharan African cultures, and Japanese traditions informed by Confucianism and Buddhism.

We first outline key Qiné definitions and concepts. Next, we describe our positionality and reflexivity as authors (one from Ethiopia and one from North America), and the processes we followed to bring Qiné concepts into this global critical scholarly space. We provide a brief background on the collaborative partnership model between Ethiopian and Canadian faculty members that has enabled us to build respectful relationships and trust essential for shared thinking. We then review some of the literature about Qiné written in English. We provide a few examples of Qiné's potential contributions as a theory and methodology in global health and medical education scholarship. We conclude with some suggestions for next steps in incorporating Qiné and other ‘a-colonial’ approaches into the methodological and theoretical toolkit for global critical scholarship.

Qiné is an Ethiopian intellectual tradition and poetic practice that derives from and influences Ethiopian thought, culture and relationships. Qiné has developed over hundreds of years, evolving since the sixth century amidst Ethiopia’s turbulent history.1 The central tenet of Qiné is that all phenomena, subject matter, knowledge and truth, are incomplete and thus open for exploration and interpretation. Qiné starts with the process of interrogation and deconstruction of a preformed notion, thought or truth. It promotes exploration at multiple levels, eliminating the notion of unidirectional thought. It does not primarily seek to explain, but rather allows exploration both in breadth and/or depth to formulate ‘truth’ as a function of time and space. Fundamentally dynamic in nature, it opens up an educational space where certainty is temporary. Qiné encourages looking for additional layers of meaning in a non-competitive way. No one form of knowledge is dominant; Qiné centres the ‘realization of the contingency, opacity, insecurity, ambiguity and contradictions of meanings, social relations and practices, and of the emergence of suspicion and of skepticism regarding the reality of “reality” and of “appearance” of the claims of knowledge’.2 (p115) Qiné allows a way for people to raise questions that could help address contradictions, contingency, insecurity, and ambiguity. It is a collectively owned and incrementally derived critical theoretical approach that involves interpretation and meaning-making through explorations of appearance and reality. It promotes the individual scholar’s critical and creative capacity.

Composing a Qiné is an art that is practised through questioning. It starts with a period of meditation and reflection where the scholar/student of Qiné explores the subject matter through a variety of forms of questioning and analysis. Through this process, the scholar/student tries to capture what escapes the hegemonic understanding of the subject matter or what is excluded or distorted by the hegemonic understanding. The educational goal for the student is to find out how difficult it is to strike out a new direction. This is accompanied by a process of linguistic experimentation with the goal of figuring out the best way of expressing the insights gained through the critical questioning. This requires a thorough awareness of how variations of meaning are derived in different contexts as functions of the complex interactions of words, phrases and meanings. As the central tenet of the Qiné tradition is incompleteness, the purpose of Qiné composition is to continuously expand possibilities. Each Qine is open for the same applications of open-ended practice of creating through critical questioning, leading to a deeper understanding.

Qiné has a method that is commonly used to decentre, diverge, and explore its subject as a way to add deeper and more nuanced interpretations. It is a form of reflection, critique, deconstruction and reconstruction with the ultimate goal of innovating a new way of understanding and creating meaning. To do this, Qiné employs the nuances of language to unpack and explore multiple layers of meaning. The poetic qualities of Qiné are derived from this creative use of language while the actual practice remains critical and creative.

Given the complexities of introducing a canon of thought and practice such as Qiné into dominant western intellectual traditions, we have chosen to introduce it to the world of international medical education scholarship through two specific examples.

Theoretically, through the concepts of wax and gold, Qiné enables global health education researchers and scholars not only to identify fundamental complex problems and formulate ‘new ways to look at old and unfamiliar problems; it enables us to raise new questions and develop new concepts for understanding social practices’2 ^(p115) in all their complexities. The Qiné process reveals multiple layers of meaning, moving between surface realities and depth while considering issues, relations and events from various perspectives.1 Qiné gives the scholar the freedom to innovate and construct an ethics that is consistent with the prevailing social philosophy and linked to the needs of that society. Qiné forces the scholar to keep thinking and creating by releasing her from the bonds of the dogmatic commitment to a particular canon. This also illustrates the emancipatory potential of the Qiné Hermeneutic.

Educationally, Qiné is a pedagogical practice that involves questioning and employing dialogical or dialectical approaches to issues in non-dogmatic ways. In Qiné tradition, argument or debate is ‘a responsive engagement with and reciprocal attunement of the qiné’s participants to each other’s ideas and to the subject matter of the qiné’.^1(p103) While medical education practices have been criticised for operating within fairly linear models,34 we do have areas in which more nuanced approaches have been accepted as useful. The use of critical reflection is one of these, in that it encourages the questioning of assumptions and examination of power relations.35 Qiné is one such method of critical reflection. For example, the direct import of western ideas and thoughts to non-western spaces is continually being interrogated in anticolonial literatures both in medical education and critical global health.31 Qiné could be used both as a theoretical framework and methodology to resist the unopposed and unexamined adoption of western notions and assumptions in medical education in non-western educational spaces.

As the international critical global health and medical education communities strive to increase equity and inclusivity globally, we can benefit from theoretical and methodological approaches from diverse geographical and cultural settings. In this analysis, we introduce Qiné as an Ethiopian intellectual tradition that has relevance for healthcare and higher education.

Qiné has potential to provide alternate theoretical and methodological possibilities for moving forward, which do not omit or ignore the deep and ongoing effects of colonisation. Given the relative absence of non-European forms of thought in global health education today, looking across the globe to learn from colleagues with different non-European forms of knowledge in a non-competitive way is an important step. With Qiné, we can learn about and find ways to use an ancient Ethiopian intellectual tradition that is very much alive and changing today. Qiné is valuable unto itself, as a robust conceptual approach; it is also important as it stems from a tradition that lives outside of European thought or reactions against European colonialism. Qiné can join Ubuntu,36 Indigenous knowledges from lands now known as the Americas37 and East Asian traditions38—to name but a few—in building a more diverse armamentarium of methodologies and theories in our field. These ‘a-colonial’ approaches can and should exist alongside anticolonial efforts to render the field more inclusive. In advocating for ‘a-colonial’ approaches, we must pay attention to the risk of oversimplifying, and potentially rendering less meaningful, intellectual traditions that may not easily translate into English. It is also essential to avoid knowledge appropriation, so this work will require the leadership of people from whose cultures and traditions these knowledges derive. For scholars from non-dominant cultures, Qiné could provide one way to claim epistemic autonomy and a way to release oneself from the cultural cringe that stunts the development of context-specific intellectual traditions.

In bringing Qiné to international audiences, we also showcase the fact that powerful intellectual traditions exist in places that are now extremely economically disadvantaged. HIC educators and scholars who engage in collaborations with LMICs may assume that they not only bring their economic privilege (which has enabled the resourcing of research, innovations and biomedical advancements) but also ‘the best’ theoretical and methodological approaches. LMIC educators and scholars often have little choice but to accept the full package of what is provided, in ways that may erase diverse traditions to the impoverishment of us all. As an international community of critical global health and medical education scholars, we will be wise not to equate the benefits of economic privilege with the rigour of cultural and intellectual traditions.

There is more to learn about adapting and adopting between cultures. This applies to efforts to transpose European/North American theories, methodologies and educational practices to other contexts, and when bringing theories from other cultures into wider use. Knowledge has been shared across cultures for millennia, often being shaped into something rather different as it is taken up in another context. In the book Transforming Medical Education: Historical Case Studies of Teaching, Learning, and Belonging in Medicine, M.A. Kujeeb Khan describes two medieval examples of knowledge adaptation: the uptake of Chinese and Korean medical texts in Japan and the uptake of Greco-Roman medical texts in the Islamicate world.39 Khan notes that in each case, original medical texts were ‘appropriated’ and ‘reformulated and reworked texts’ were also incorporated into the newly emerging medical canons in those places.39 ^(p44) This led to a reorganisation of imported medical knowledge in both the Islamicate world and medieval Japan.39 As a global medical education community, studies of other efforts to export or import medical and medical education knowledge could advance understandings of these processes.

Comparison across intellectual traditions is another area of potential future work. What different opportunities, for example, do more collectivist traditions such as Ubuntu and Qiné offer compared with largely individualistic Euro-American traditions? What factors might medical educators consider as they choose one tradition or another? One also may wonder what Qine would offer that is distinct from other western pedagogical practices of dialogue?

In February 2025, Addis Ababa University launched the African Hub for Innovation and Critical Scholarship in Health Professions Education. The Hub provides a critical space and essential resources to support the building of a community of Ethiopian scholars to begin discussions of ways to use Qiné in research projects. Following Qiné principles of being collectively owned and incrementally derived, Hub participants are starting to consider pilot Qiné research projects. The Hub also creates opportunities for sharing of Qiné concepts with other scholars, both in Africa and beyond. For example, early discussions are underway with Indigenous scholars in Canada about comparative analyses of Qiné and Indigenous research methodologies.

‘A-colonial’ intellectual traditions may offer a way forward for fields such as ours that still contain many vestiges of colonial thinking. An effective way to decolonise global health and medical education could be to advance a-colonial theories and methodologies as educators to identify still-problematic areas of scholarship and practice. It is relatively easy to identify problems; creative solutions can be more elusive. Qiné offers us one new option to help critical global health and medical education scholars move towards the globally diverse and inclusive communities we aspire to be while also offering a way to deal with issues of epistemic injustice and cultural cringe.