Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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88 Surgery and Healing in the Developing World
• Educational background: highest educational level of patient and affect it
has on his healthcare; effectiveness of written materials, learning styles
(through story telling or demonstrations, auditory or visual learners), choice
of which language used for teaching (usually mother tongue most effective).
• Religious affiliation: affect of one’s religion on health or body image, special
rites or blessings, healing rituals, religious healers, role of religious
leaders (priests, imans, monks, elders, pastors), superstitions (not naming
the infant until the cord falls), icons, scarring.
• Cultural aspects of disease incidence: genetic or acquired conditions prevalent
(hypertension, sickle cell anemia, Tay-Sachs), increased resistance to
particular diseases (malaria in sickle cell).
• Biocultural variations: physical features, height, weight, supranumery digits
• Developmental considerations: care of babies and elderly, perception of
aging, assessing children’s growth, discipline (Andrews MM, Boyle JS:
Transcultural Concepts in Nursing Care, Second Edition. Philadelphia: JB
Lippincott, 1995).
The goal, in transcultural healthcare, is to preserve the positive or neutral cultural
behaviors affecting health and modify the behaviors negatively affecting wellness
in a manner that respects the heritage and preferences of the individual.
Professional Diversity in Transcultural Nursing
It has been my priviledge to participate in transcultural nursing, being ever mindful
of the mission that placed me in that setting. Often, the flight to “lands far away” to
provide healthcare in a Third World culture begins with the realization, during childhood
or young adulthood, that we as westerners have unlimited resources compared
to the majority of other populations of the world, promoting our desire to share the
knowledge and skills we possess. The richness we gain in friendships with those of
another culture, the insight into self, and gained appreciation for life far outweigh
inconviences or perceived sacrifices on our part. A driving force for me was the
compassion modeled by my parents during their interactions with less fortunate, as
well as stories and photos my parents’ peers related as they cared for others worldwide.
Travelogs, such as the adventures by Martin and Osa Johnson in Borneo and
Kenya, gave rise to my desire to become acquainted with people of other cultures,
and to assist them toward longer and more comfortable lives. Nursing seemed to be
the key to open this door. I have not been disappointed!
Nursing is a diverse profession, but when engaged in the tropics, the diversification
seems unlimited and vital. Roles of the nurse include that of practicioner (diagnosing
and treating), administrator, educator, midwife, public health nurse, mechanic,
parent, host or hostess, student, member of a greater society. Depending on the
remoteness of the clinic or hospital, these roles widen to fit the needs. The broad
scope of work needed is a reminder to stay focused on the productive aspects of
health promotion and disease prevention in a culturally sensitive approach.
Preparation for Nursing Experience
Nursing in Third World countries is often delivered in sites with few physicians,
if any, to consult. This necessitates thorough preparation in understanding the process
of diagnosing and treating diseases. Several years of nursing experience is helpful,
and becoming a Nurse Practicioner or completing courses in tropical medicine,
anesthesia or midwifery are recommended.