Medical Culture Shock (part 1)

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Looking back, I think I may have experienced just a little bit of culture shock during my 3 weeks in Burkina Faso in 2006. It’s hard to say. On the one hand, I don’t remember much in the way of anxiety, fear, feeling homesick, a desire to withdraw, or judgment of the host culture. On the other hand, we had a deck of cards out in the Lyele villages and we played A LOT of Gin Rummy. I mean, like 200+ games. I’m not sure if it was really a form of escapism or just a way to fill the 14½ free hours each day, but it was certainly a coping mechanism. I have definitely experienced reverse culture shock, and this is one I’m pretty embarrassed about. After that trip I came back to the States and had to take a few Summer classes at Bossier Parish Community College. After registering as a student and paying tuition at the business office, I walked outside to explore the campus a bit, when nature began to call. Remember, I had been in the bush for the 2½ weeks prior to this. Without thinking, I walked up and stood facing the outside wall of the administration building, and… realized what I was about to do just in time, and quickly walked inside to find a restroom!

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Those bushes weren’t there yet in 2006

Here in Yei, I only seem to be experiencing culture shock in the hospital setting. Healthcare in much of the developing world tends to be quite paternalistic (not that we are exempt from this in the U.S!). In my practice, if I’m treating a patient for a bacterial infection I will explain the condition, what I think caused it, the treatment I am recommending and some of the major side effects, and other medical and home remedies or supportive measures the patient might find helpful while the antibiotics are treating the infection. I’ll pause for questions multiple times and assess whether the patient and I are on the same page and whether they are likely to be adherent to the treatment regimen. This process isn’t as arduous as it sounds, but even if it was I’ve been taught that this is the best way to communicate with my patients. The process here is more straightforward: “Take these pills for 1 week.” Or, if you are feeling particularly smarmy, “You are sick. Take these pills for 1 week.”

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My clinic team, at the end of a long day

I’m not quite there. It’s always hard to find the line between ethnocentrism and “now I will show you a more excellent way,” but for now I’m going to continue to try to model intentional patient communication for the CO’s and nurses. The patients don’t quite know how to handle it. They laugh when I introduce myself, and especially when I ask if they have any questions at the end of the visit. The most confusing part for everybody is the anticipatory guidance. When I explain the warning signs and symptoms the patient should look out for, including reasons to come back to the hospital, the interpreters nod at me and say ‘ok’. When I further explain that I want them to now tell that to the patient, there’s an awkward pause. They are probably just figuring out the best way to explain what I said, but I secretly wonder if they are actually waiting to see if I am joking.

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Finally got a picture of the labor ward

Medical privacy is another area I’ve had to adapt to. Generally I sit down next to my patients when talking with them; it helps people feel heard, less hesitant to ask questions, and softens the perceived power differential. Last week on rounds on maternity, sitting across from my patient meant I was actually sitting on the next patient’s bed. We’ve had surreal moments where we are trying to convince someone that a medication or intervention is necessary; when she is hesitant, other patients and visitors in the ward are likely to chime in to convince her to listen to us (or I assume that’s what they are saying). It’s the same in clinic. This week I’ve been on antepartum clinic, and because of Yei’s size it’s not unusual to see 60 or more patient’s in a day. After they are assessed by the midwives, they are called in 4 or 5 at a time and sit in a row next to my desk. After I have seen one, she leaves and they all move to the next chair in line. This is a great system for efficiency, and necessary to take care of so many women who are in such need of good quality prenatal care; but it still feels pretty awkward to talk with my patient while my next 4 patients watch and listen from a foot away. Fortunately, as best I can tell I am the only one that feels at all uncomfortable with this.

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Antepartum clinic. I’ve still seen worse (ahem, Denver Health)

I’ll share more tomorrow. In the meantime, please pray that the God who commanded us to go into all nations would also give us wisdom once we get there, and that He would show me both what to teach and what to learn from the way things are done here.

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