When working on any international venture, the impact of culture simply cannot be removed from the task; the two are embedded together, not two independent factors. This concept applies to my team’s Ukweli test trip project in Sierra Leone. Three examples of cultural issues that will affect the project and the mission of reducing the maternal mortality rate in Sierra Leone are the prevalence of “traditional” medicine, the conservative approach to masculinity that results in female restrictions in health settings and the stigma attached to survivors of major diseases like Ebola. The battle between scientific medical advances and traditional medicine is one foreign to me in America, and this increased competition will pose a viable threat to the success of our venture. Generally, men in America encourage female control of her health and will support a sick woman in seeking medical attention, but the same may not be necessarily true in Sierra Leone – especially if the doctor is male. And in America, we care for and cherish cancer survivors or stroke survivors or survivors of major car crashes or other tragedies – but in Sierra Leone, those who survived the Ebola epidemic are not treated well in society.
While these specific instances are rare in the United States, especially stigmatizing survivors of diseases, I have certainly seen instances in which women in a classroom setting are looked down upon or given microaggressions that attempt to diminish her intellect. And there are cases in which women may request a female physician – but men might do the same, so I’m not sure if there’s an adequate comparison there. Certainly differences exist in patient confidentiality standards and gender equity in the medical profession, as not only are there simply more doctors per patients but there are more female doctors as well. Some of these cultural issues are tough to compare to America, if I’m being honest. While I know there are segments of the population, especially Native Americans and Amish communities who prefer communal treatment and trust the strength of their community to heal over a doctor, I do not have personal connections to these groups and they are for the most part in the minority in terms of those specific beliefs.
It is hard to say which cultural practices can be leveraged, being that I am answering this question totally arbitrarily since I have never been to Sierra Leone. But from the outside looking inward, the cultural practices of a close family unit (many family members live together in one house) and of community members directly serving as health officials within those same villages can be leveraged to establish greater trust in our project. Greater trust means faster access to medical resources to save lives, which puts people back to their work to continue to earn money. Additionally, the deep roots of tradition, demonstrated in cultural dances and songs, can be leveraged for communication and educational purposes. Cooperating with community leaders well-versed in the nation’s African context will enhance our team’s mission as it relates to health and the local economy.
The African context is based in a much shorter-term economy, has larger gaps in quality of life, infrastructure and healthcare between rural and urban areas and has less accountability within the healthcare system when compared to the American context. These challenges will present themselves as the Ukweli team attempts to not only design a reliable product, but attempts to make it accessible and widely-used to maximize impact. A shorter-term economy could restrict a family or individual to choose between money and health. We will also likely see less access to hospitals and doctors in rural areas, or upon a doctoral referral, refusal by a rural individual to give up the time it takes to travel to such a far away city. And less accountability means les trust, less pay trickling down to CHWs and a lack of standards and procedures for medical training as well as drug testing.
The African context offers less advanced medical resources than in America. Finalizing the test strip itself will not work in Sierra Leone. The product must be made and workable prior to the fieldwork. However, Africa’s context offers different communication resources and opportunities. Radios and word of mouth are likely to be more powerful tools to leverage in Sierra Leone than they would be here in the United States. Close neighborhoods may listen together to popular radio stations and programs, and the Ukweli team can take advantage. And much easier, on-the-ground access to medical professionals will benefit our team in Sierra Leone, compared to the more elitist feel of medical professionals in the U.S. Since most villages have at least basic public health officials, our team will be able to get a feel for which communities are most in need and what resources such communities are lacking.