This week I have chosen to take a more critical reflection on the concept of ‘culture.’ In the little time I have been here in Mongu I have heard several times that certain behaviors and practices that I witness are ‘cultural.’ For example, women are to make little noise during childbirth and if they do cry out they may be reprimanded for making such noise. Also, pain management is not the same priority as it is in the western world, and both of these practices (not allowing a women to show pain in child birth and little pharmaceutical pain management) are often explained to me as a result of the strength and ‘culture’ of the people here. At first I just accepted these realities as ‘cultural’ and neglected to think more critically; however, as I dig deeper I am pushed to question if these experiences for the people in Mongu are in fact ‘cultural’ traditions OR if this is more related to the inequities that the people here have to live with due to the resource challenges present in Zambia’s Western Province?
My colleague has been coming to Mongu since 2008, and she (Jessica) continues to witness significant improvements each year at the Lewanika hospital, as the healthcare providers and community seek quality health care; however the need for improvement in relation to the quality and delivery of healthcare remains. At this hospital Jessica and I attend the morning report. This is a meeting that is attended by all of the heads of the departments as well as the administrative staff. The aim of the meeting is to pass over the night shift report and address any issues or concerns. Due to a language barrier, and the soft-spoken nature of most people in Mongu, I often struggle to understand the report. And yet one morning I heard a man speak very passionately at this meeting about his frustration in regards to the care that was provided for a particular patient. He repeated this statement “we should treat every patient like our brother or sister.” His point was clear- the people deserve quality care.
BUT how does one deliver quality care on a maternity ward where 10 plus babies are delivered within 6 hours with only two nurses/midwives on staff? Or how does one deliver quality care at an anti retroviral clinic that sees over 500 hundred patients per day with similar staffing realities?
The concept of culture remains challenging to define. Many definitions of culture tend to define culture as something that is static; focused primarily on shared values, traditions, beliefs and customs. This narrow view of culture sees certain characteristics of various ethno-cultural groups as ‘cultural traits’ without considering the complex socio-political and economic factors that shape people’s lives. Most people and have been socialized and raised to understand culture primarily through a ‘culturalist lens,’ which can be problematic when it leads to stereotypical thinking in which one assumes that certain behaviors are ‘cultural’ because that is what they have been told, while missing the wider socio-political and economic factors that shape people’s life circumstances. Poverty in this spot of the world is rampant. Children spend their day outside of a grocery store doing any task considerable for 1 Kwacha (1 US dollar is approximately the equivalent of 6 Kwacha). They will wash your car, assist you with groceries- anything! Many men work 2 or more jobs to try and support their family, and the women are working equally as hard. The outcome of colonization is prevalent; however at this point of time I feel the need to look much deeper into the history.
So are these behaviors of healthcare providers that we see ‘cultural’ – women being slapped during childbirth for making noise because they should stay quiet, or little pain management post invasive procedures because the people are strong and taking pain medications is viewed as a weakness to the illness – OR – are these behaviors much more complicated? Is healthcare, and the delivery of healthcare more so shaped by the socio-economic, political and historical factors and less about the ‘culture’ of the people here? As usual I’m left with more questions and less answers…