I think the biggest cultural issue that is going to affect the sickle cell anemia project is that people in Sierra Leone believe in spiritual healing. If the people truly believe that the magical services offered by community organizations can heal them they will not feel the need to go get tested. Going off this point, the sickle cell device we are trying to create will also test for sickle cell trait. People carrying the sickle cell trait do not experience the symptoms of the disease and therefore will not go get tested because they believe that they are healthy and maybe that they are healthy because of the magical services.
Another cultural issue that may affect the people of Sierra Leone from using our test strip is the countries main religion and the traditions around that religion, Islam. I am not completely sure that statements I am about to make about tradition based off religion is a cultural issue for Sierra Leone but from my time spent overseas in the Middle East, which are also predominantly Muslium countries, (which I will explain later) I am making this assumption. There is a tradition that is based off religion, that could be described as a cultural ‘norm’, that the man of the house is the person in charge. The man of the house would have to sign off on and give permission for his wife and children to travel, drive, receive medical care, exetra. If this type of tradition is present in Sierra Leone it might be difficult to get mothers and children tested for sickle cell anemia and the sickle cell trait.
A third cultural issue that may affect our ability to provide a successful device is stigma around the disease, sickle cell anemia. The people of Sierra Leone might not want to be tested because their might be an unwritten rule that if you have an incurable disease (no matter the disease or maybe specifically sickle cell anemia) you will be treated like an outcast. People might not want to risk being shunned from the community and in order to guarantee that they just won’t be tested.
Growing up in the Middle East I have been exposed to a culture that is based around religion (Islam) in many ways. One experience that pertains to a cultural issue that we might encounter in Sierra Leone, a predominantly Muslim country, is that the man of the house tends (not always true now a day) to have the power. When I turned 18 I went to the Road and Transportation Office in Dubai, UAE to register for a driver’s license. Before I could even submit any of the paperwork I had to present a permission slip signed by my father that I was allowed to drive. This may seem minor but in Saudi Arabia, the country neighboring the United Arab Emirates, there is a rule that women can not travel without a male family member. If these types of rules are implemented in Sierra Leone we might have some issues with people who want to get tested or want their children to get tested but can’t because of the religious culture.
At home I have known people who believe that their trust in God is the best medicine that will heal them instead of modern medicine. I have also observed Jehovah Witnesses deny medical treatment because of their beliefs. This can be compared to the magical healing services in Sierra Leone. Another cultural issue I have experienced that is similar to what we might experience in Sierra Leone is the stigma behind being sick. Generally when someone is sick even if it is a common cold people tend to keep their distance. This is because they don’t want to get sick themselves. There’s a stigma behind sick people that they are always contagious even if the contagious period has passed or if they don’t even have a contagious sickness.
In Sierra Leone we might encounter community and market problems because of the cultural norms. In order to gain the communities trust and support around the test strip we should bring in doctors, who are generally well respected figures, to explain why they should get tested. In order to insure getting tested does not disrupt their day-to-day lives we need to figure out a way to bring the device to each specific community. If people have to change their social/cultural ways of life people will be less likely to go out of their way to get tested. Finally, having the organizations that run the spiritual services (that also offer other religious services) advertise the sickle cell test strip will encourage people to go get tested because the information is coming from a trusted source.
Implementing our sickle cell test strips in Sierra Leone will be difficult because as we discussed at the retreat processes tend to move slower there. If we want our devices to be delivered somewhere it might take twice as long as it would in the US because people don’t feel the need to get stuff done as quickly. In summary, work is completed at a different pace compared to the US.
Another challenge that we might face is getting our device delivered to rural places after it has been manufactured. The roads might not be suitable for trucks (which would be necessary if we needed to keep our device at a certain temperature) to travel on. Looking at the bigger picture it might be difficult getting our device into the country from the place of manufacturing. Sierra Leone is a developing country and does not have the resources to produce the device therefore we would need to find a place that could manufacture the devices and import them into the country, which would be another challenge.
On the other hand, getting our device out on the market after it works and we have the research behind it should be much easier than in the US. The FDA in the US is extremely strict, if our device was approved by the FDA it would have to go through clinical trials which could take years. There is a different system in Sierra Leone which should speed up the process of getting the device out onto the market.
Finally, in Sierra Leone we will also have the opportunity to talk to the people who would be administering the device and get their advice on how to improve it. In the US it would very difficult to access the people who would be providing and administering the device and could take a very long time to set up those meetings. Apart from the professionals, we will also have the chance to ask the local people about the test strips. By getting the locals opinions we will have the chance to figure out the best way to market our device.