Surgery and Healing in the Developing World - Dartmouth-Hitchcock

2
8 Surgery and Healing in the Developing World
or the efficacy of the modes of practice, but they should acknowledge and respect
them. Respect for local methods of treatment and their practitioners is important.
Nationals often consider Western medicine to be ineffective against a wide range of
physical illnesses, and especially useless in dealing with psychosomatic problems
ranging from heartbreak to witchcraft. For many people in the developing world
today the only available treatment is dependent on traditional medicine in curing,
not only in the back bush but also in the economically deprived areas in cities.
A specific example of cultural differences in the practice of medicine overseas is
the insistence in many Islamic countries that women be seen and treated only by
female physicians or caregivers.
Communication
The inability to communicate freely with national patients and caregivers may
be very frustrating. Not only are there concerns with verbal communication, but
expatriate physicians should be aware that gestures which have one meaning to them
may have an entirely different meaning in a different culture and on occasion may
even be rude or offensive.
Understanding the importance of good translation and real comprehension on
the parts of patients and national personnel, many organizations take special pains
to insure the best possible translation. But there are many instances when this is not
the case. A visiting surgeon needs to determine the degree of real understanding of
the interpreter as well as of the patient, and it may be necessary to repeat oneself over
and over again or to state the same thing in several different ways to be sure that
what one is seeking to say is understood. Please remember also that speaking more
loudly doesn’t mean that we are speaking more understandably. A smile and an
appropriate touch, though they are not substitutes for clear understanding, may
help to transcend language barriers. Learning even a few phrases in the local language
or dialect may be very helpful in establishing rapport.
Treating the Whole Patient
When communication is less than ideal and with marked cultural differences, it
is easy to think in terms of the present illness or the presenting problem rather than
in terms of the individual human being. To listen to the patient is every bit as important
in the Third World as in the U.S. where polls indicate that patients’ greatest
frustrations are failure of their physicians to listen. A listening attitude is very helpful
even when comprehension is presumed to be complete. A smile, eye contact, and
even touching (within the cultural context) may increase the patient’s confidence.
The patient-physician relationship is further enhanced when interest is shown in
other than strictly physical, for example family and work concerns.
In other words, patients the world over appreciate the same consideration extended
to our patients nearer home. Unfortunately, in some situations the number
of patients is so overwhelming that there is not the luxury of time to practice optimally.
Even in such circumstances, however, empathy can be demonstrated and is
thoroughly appreciated.