Cross-cultural work and the complexities of packing
5 MINUTE READ
from Luke’s Journal 2021 | Fire in the Belly 2021 | Vol.26 No.1
I have been involved with overseas visits to a certain country since 2006: visiting the same orphanage, watching children grow up, performing health checks on the children, staff, affiliated church members and, time permitting, checking other local orphanage children.
I am also the team doctor, so I can be busy after hours, behind the scenes keeping the team well and functioning. One team member down with illness or injury has a flow on impact on the performance of our whole crew whose duties include running a holiday programme and teaching varying skills as well as having fun. Before we leave, information is required on any medical problems so that I can pack my supplies. A compact but comprehensive supply of medications is essential for the team. Gastroenteritis episodes are common with the change in water and diet.
I have learned much over the years about cross-cultural work and the complexities of packing my kit. In the early years, I worked in a thatched hut with no running water, but more recently in a concrete building, still with no running water. Two years ago, I once left my cake of soap on the nogging of the unlined wall to return the next morning to find gnaw marks all around the edges. Hence one very clean mouse gut!
It takes thirty minutes to set up on the first day. I have a small kit of essential equipment that I haven’t changed at all. Spare batteries are always required as occasionally children sneak in before lockdown and leave the auriscope on all night! I have a medical check sheet to complete for each child’s examination, with children requiring tests, follow up or hospital referrals marked in red pen and placed aside for discussion with the leaders.
Interpreters are essential and a good one is worth their weight in gold. In 2019, some children who spoke a different dialect had just arrived and two interpreters were required to relay information. This increased the time needed for each examination.
“Medication should not be high-powered for a local clinic situation.”
It is often amusing as children line up for their turn, knowing the ropes from staring through the open windows to observe the proceedings. By mid-afternoon, it is the adult session. I try to tailor the examination to adult specific mode but they insist on the same examination as the children, thinking that I am neglecting care if I do not examine
their ears, etc!
What I have come to learn is that medication should not be high-powered for a local clinic situation. Simple analgesics, antibiotics, gut medications, asthma medications and topical creams are the most common requirements. In some cultures folk feel ripped off if not given medications. Small plastic bags with a few tablets authenticate the consultation. Local knowledge is essential to know what is appropriate. Teaching sessions are essential at the end of every day, to ensure that medications are being used correctly, and as an opportunity to upgrade skills. If the locals cannot understand a spoken direction, it is important to write it down, as often accents cause difficulty. Body language helps so much. Acting out scenarios provides information and comic relief.
“World views are different, experiences are different, values are different.”
It is becoming increasingly difficult to bring medications into developing countries, so taking money and sourcing locally (mindful of the country of origin of medications) is sometimes easier. Taking a local to help with purchasing can be helpful as prices can soar for foreigners.
My first day’s question is, ‘What have you run out of and what are your most urgent needs?” Then a trip to the pharmacy that afternoon with a big list is most helpful. Betadine, ear drops, optic preparations and simple meds such as paracetamol can often be purchased much more cheaply locally compared with purchasing in Oz.
One great frustration occurred five years ago when a Pharmaceutical company’s charitable arm, under the guidance of their legal team introduced documentation requirements for procurement of medications. Suddenly, one had to supply the name of the local medical recipient for the transported medications. No, I could not supply a name as that would be dangerous for the local doctor. This was a military dictatorship!
Also, I could not guarantee storage between 4-24 degrees for the medications as the room was in a hut, in stinking hot conditions, where we worked at temperatures between a cool 34C up to 43C. I had to wipe the mouse urine off the stored medication bottles and retrieve the mouse nest from behind the plastic storage drawers, so no, clean conditions are certainly not guaranteed. I suggested the lawyers accompany us to realise that their world was vastly different from the one to which I was to work in. Different rules apply. This is one of the very important facts. Different rules do apply. These are parallel universes! World views are different, experiences are different, values are different.
Another important lesson is to listen to the locals and learn what works for them. New team members often want to impose their cultural values instead of adjusting to local values and seeking their wisdom. Saying that, sharing skills and empowering the tired local workers creates wonderful memories.
So, if you are a first timer, wondering how to pack, read about the culture, try to determine the needs if at all possible and ask for help from others who have walked before you. Learn each time you travel and, most importantly, don’t forget your mouse trap!
Dr Maria Haase Dr Maria Haase is a GP working part time in Private Practice. She and husband, David, relocated to Toowoomba, QLD in February 2019. She has made annual short-term visits to Myanmar since 2006 to work in an orphanage and to hone her clinical skills. (COVID-19 prevented this year’s trip.)