01/31/2020: Noah S. Weaver

Cultural Issues

A basic example of how cultural issues will affect the Ukweli project is the issue of privacy. Although it is commonly accepted to have a healthcare provider or employee be in the presence of someone during typically intrusive (as in lack of privacy) procedures, protecting a woman’s privacy is crucial. This poses as a basic (yet important) barrier to women seeking out the test strips due to this fear: however, the women are free to do these tests in the comfort of their own home, and sending this message will be critical to our group’s success.

Another cultural issue includes the practice of female genital mutilation (FGM), which is responsible for a whole slew of female health-related issues, included some instances of maternal death. This is performed during a type of ceremony when women are transitioning from childhood into adulthood, but it is incredibly dangerous nonetheless. Thus, this contributes to a greater number of maternal deaths. This practice might cause women to be afraid to seek medical attention by those who are qualified when they are in great need, perhaps for the fear of embarrassment regarding their condition. This delay in care also contributes to UTIs and preeclampsia, the same things we are testing for with the test strips. If they are afraid to seek us out, then more mothers will continue to die.

 

The final example is the practice of “giving the child back to God” when a child is born disabled. Although this is incredibly sad, I can certainly understand why they do it. For instance, the people of Sierra Leone are already among the poorest in the world, and they literally cannot afford to have one weak link if they expect to survive. This doesn’t mean I agree with the practice, but I can at least understand to the extent possible what lens they view this issue through. With that said, the delay in care (often accompanied by a UTI and preeclampsia) can often cause those same birth defects. The people there still often believe that these defects are acts of God, when that is not the case. If the people still believe that there is no hope for their child to be saved from these circumstances, they will not view the test strips as necessary. Using our preexisting connections with some of the people from the country will also be crucial in maintaining the trust of the communities we are actively involved in. Without this type of community networking, the Ukweli project will also fail.

Social Issues at Home

I have not experienced the last two of these situations at home, but some examples would include the concern for privacy when a female undergoes a gynecological exam. Considering how many physicians have improperly used their position to inappropriately and unnecessarily touch a female during these exams, the concern of privacy is understandable, but protection is also required on the healthcare provider’s part (e.g. having someone of the opposite sex in the room at all times). I realize this is not the best correlation as many women in the US aren’t as afraid to be examined (as it is medically necessary), but this is the closest parallel I can think of in relation to the first example from earlier.

 

Another social barrier to health care in general within the US is the lack of affordability. Many people are simply unable to afford health insurance, which is a type of commonality they have with the people of Sierra Leone. However, the difference is that hospitals in the US are required to treat every patient with an emergent need, regardless of their ability to pay. This is a political, financial, and social barrier in the sense that this type of problem could be solved in the US (although not perfectly) under a Medicare for all model. I am not agreeing or disagreeing with the model: no model is perfect. What I am simply pointing out is that all people would be covered, and the barrier of affordability would be greatly reduced since it would be a collective pool of those insured.

 

The last situation to a social barrier in relation to healthcare is the lack of education. This is absolutely similar to that of Sierra Leone (although it is much worse in Sierra Leone), but most people do not understand why and how their healthcare process works. For example, if a physician orders a lipid or metabolic panel, the patient will (usually) not be able to interpret what their results mean. Of course, it would be pretty difficult for the average person to understand things that require a decade’s (or more) of education and training, but this is similar to the lack of education that the people of Sierra Leone experience in such a way that they might not have been taught the process of why and how certain conditions like UTIs can and will complicate a woman’s pregnancy to a degree.

Leveraging Cultural Practices

A cultural practice that could be leveraged is through early pregnancy screening. It is often common for women to wait until they are “showing” at around the three month mark before they seek medical attention. Perhaps an advertising campaign method of letting women know that it is okay to get screened as soon as you suspect that you are pregnant would be effective if we tout the improved outcomes with early preventative care and the convenience of our test strips along the way.

 

Another leverageable practice would include a traveling vehicle for our test strips. The practice of walking to a local clinic would be eliminated if we could provide transportation to CHWs and bring our test strips to the consumer. Of course, the authorization to do so would require that a physician or pharmacist be present in order to legally prescribe the strips (or other essential medications: they need to stay profitable). Perhaps a traveling pharmacy is a good solution to making the healthcare with screening as accessible as possible. Obviously, this would be an entire project within the Ukweli test strip project.

 

A final practice that might benefit the sale of our test strips is marketing them to traditional birth attendant (TBAs). Of course, we cannot sell our strips to them directly, but gaining the trust of TBAs could prove crucial to making our strips as well marketed and accessible to all women to the extent that is possible. The TBAs are seen as essential in most districts of Sierra Leone, and although they cannot help someone give birth alone, incorporating them alongside qualified health providers within healthcare facilities would be a great way to discourage the illegal practice of giving birth in one’s home.

 

Related article: https://www.healthynewbornnetwork.org/hnn-content/uploads/hpp2.pdf