Cultural issues are some of the hardest to understand when starting an international venture. The project of creating low cost UTI test strips for people in Sierra Leone has run into a couple of these problems. First of all, there is a large stigma against people with urinary tract infections in country. This makes it tough to educate people about them. It also means that it is hard to market the test strips when people are stigmatized for buying them. Another cultural problem is the reliance on traditional or alternative medicine. Many people will go to these kinds of doctors and not receive the proper treatment. The reliance on these types of alternative health practitioners is driving some people away from the real health clinics. The third cultural problem in Sierra Leone is the privacy that comes in the health clinics set up in the rural areas. In America, there are HIPAA laws that prevent any medical information being shared without your permission, but in Sierra Leone there are not these kinds of laws. This problem further affects the stigmatization of people with UTIs because even if people are brave enough to go to a clinic and get checked out, they do not always have the privacy they want.

I have not experienced most of these problems in America but while staying in India with family I observed some similar cultural issues. In India there is a large stigma against people with UTIs and I have seen people shamed for going to see the doctor for something like this. In some villages there is also a large reliance on alternative methods for curing diseases. I remember seeing just a hut that the town “doctor” worked in and the treatments that he gave out were a little questionable. One of the largest cultural issues in India is the caste system. Although it was outlawed, it is still very prevalent in society today, and it can affect the treatment you are given. If you are at the top then you can receive the best, but at the bottom, no one will treat you.

A cultural factor that could be used to market the UTI test strip is that most people using them do not have a high level education so we made the strip simple to use and read. Most of the people administering the tests are Community Health Workers (CHWs). Most of the time CHWs have not received more than a middle school education, so by making test strips simpler we can market to them more effectively than other strips. There is also a cultural practice in Sierra Leone that when you miss work to attend a class or something similar food or retribution will be provided. We could use this by partnering with a project also here at Lehigh that is working on making a low cost nutritional meal for malnourished children. Since most people who are going to attending these classes will be woman, and since culturally the women cook and feed the children, we could give out food and the nutritional meals to the mothers. By combining the cultural practice of giving food and women cooking we could get more people to come to our classes and learn about UTIs.

In Sierra Leone, the structure of the health care system is much different than here in America. Usually we have medical practices filled with doctors and nurses, but in Sierra Leone there are about 136 doctors for 6 million people. This has caused a rise in what is known has Community Health Officers (CHOs) and Community Health Workers (CHWs). These are less trained people who can screen and refer people but cannot diagnose diseases. It will also be different because nurses have variable training depending on how close they are to the urban areas. The farther out you go, the less training they usually have. This is much different from America where most nurses have the same amount of training in an area. The largest problem the African context presents is the language barrier. Thankfully we will have a translator when we are in country, but there are certain things that just can not be exactly translated.

There is also a large disparity between the resources available in America compared to the resources available in Sierra Leone. In America, electricity is easily accessible almost everywhere, but in Sierra Leone it is much harder to find in the more rural areas. Some people in Sierra Leone make money by charging others to charge their phone. Transportation is also a lot different in Sierra Leone. Less people have cars and there is not as much public transportation. This makes it much harder for people to make it to health clinics and information sessions. The clinics in more rural areas also do not have the same resources that a clinic in America would. Usually they only have the basic necessities.