When I talk about culture, I refer to both overt and covert
cultural tenets. There are those cultural values that everyone is
aware of and feel free to talk about. These are not much of a
challenge to address when they come in conflict with global health initiatives. Through education and open discussion, there
can be a positive change. The hidden cultural tenets are the ones
that pose a great challenge when they cross paths with global health initiatives.Hidden cultural tenets result in "passive aggression" from the natives. They do not oppose the health initiatives but at the same time they do not support them.
Having worked in Southern Africa from
1995 to 1998 on HIV/AIDS prevention programs where I was born, I experienced
challenges faced by health workers as they deal with issues that go
against "cultural grain." I struggled with presenting sex education
lessons. I was uncomfortable and my audience was uncomfortable too. In Southern
Africa, the subject of sex is not openly discussed among people of
opposite sex and different age groups. Since most values
are passed down through oral tradition, this makes it difficult to
provide sex education to children. The word “sex” is regarded
as dirty and can never be used in a family or formal setting. Sex organs are
never referred by names because it is a taboo.Children do not discuss sex education with their parents. In school, sex is barely talked about in biology during a lesson on reproductive system.
Such cultural beliefs/tenets make it difficult for a health worker to engage the
community in sex education to avoid contracting HIV/AIDS. For most people, HIV/AIDS does not exist. For some, it does but it is just like flu or Malaria. One year, the then president of South Africa, Thabo Mbeki made headlines when he said HIV/AIDS does not exist. This is an example when culture and global health are at odds.
Most groups of people have certain
cultural values that go contrary to global health initiatives. This is more prevalent in developing countries. It may be an issue of women's rights in Middle Eastern countries or women circumcision in Africa. The
challenge is how global health workers address those subjects that
are “no go areas.” Failure to handle these topics in a
culturally sensitive may may result in poor global health outcomes.
It is imperative for global health workers to be cognizant of host
country cultural tenets that may be hot spots and deal with them with
respect and candor.
Onias, I think you've hit a very good point. Regardless of where you are from, you are automatically born into a culture and there is this innate sense of pride that you have to defend. I think former South African president Mbeki wanted to defend his country from HIV/AIDS because his country had a tough history with outsiders coming in. The Dutch colonists instituted apartheid, where whites, a minority, had not only the power but were thriving financially, so I cannot blame him for being defensive. After all, as public health workers, we are outsiders too, trying to promote better practices towards better health/living. With your mention of oral traditions, I can understand the point of view of those who are reluctant to change because after all, traditions have been passed on all these years and they worked before, so why would they not be applicable now? What is unfortunate though is that younger generations are attracted by modern everything, so these oral traditions are becoming extinct.
ReplyDeleteThanks Aurelie for bringing up those great insights. I did not look at it from that perspective.
ReplyDeletegreat discussion, Onias and Aurelie. Indeed our individual cultures are points of pride and identification. Culture is a meaning making process and we make them ourselves. So, what meaning does HIV/AIDS have to people in southern Africa? What connotations does sex have for them? What did HIV/AIDs mean from Mbeki? As global health workers we must understand that local meanings and knowledge are important and need to be engaged in when mounting prevention, intervention programs. Almost always our education, training, epidemiological knowledge and understanding informs our actions and what we think is right. And communities (natives) resist us. But of course, I would resist you if you tried these in my family without engaging us in what you are doing and without appreciation of the meaning making processes/ communicative practices we live in (our culture). Aurelie , you are so right..we are all outsiders to the community. Again critical here is the realization and reflection that how we as outsiders engage in healthy behavior change in far flung global communities....
ReplyDeleteAttempts to address the HIV/AIDS pandemic in Thailand by Mr Condom were successful because Mr Condom was regarded by the natives a local person. He had lived in this area since the 1970s. It is also important to note that most attempts to educate people in Southern Africa about HIV/AIDS did not use the existing systems (respected birth mothers). Most of the health workers were young people who did not have a social standing in the society.
DeleteOnias, I really enjoyed reading this post. I feel that throughout the course of my MPH degree this is something that has been brought up in each and every one of my courses, in one way, or another. Something that we always talk about when we discuss program planning is that there has to be involvement of the community members in order for any program to succeed. I feel that it could be beneficial if the members of the community came together and devised a plan that they think would be cohesive with their community and the issues that they face. Whenever we discuss culture there are always going to be barriers that have to be crossed before anything can be achieved. I am currently teaching Human Health and Sexuality and I have students from many cultures, it is always interesting and educational to hear their perspectives on topics that we discuss in class. I find it fascinating that there are many misconceptions, and myths about certain topics that are consistent across cultures. For example, a student shared in our lecture that women in her culture are less likely to visit an OB-GYN for annual Pap exams because the men of their culture feel that it isn't necessary and that their women's anatomy should be for their eyes only. Like I mentioned before, whenever we face issues, culture adds additional barriers that have to be crossed.
ReplyDeleteThanks Grace. Great thoughts. I think it is imperative that, before we try to educate people of a different culture from ours on a certain health topic, we need to do an assessment;
Delete1. What are the barriers (real and perceived)?
2. What are the non-negotiables?
3. How can we start a dicusssion on certain issues that may be deemed non-negotiable?
Grace...good points on the community involvement. One the cultural one, think of the following questions. Can we ever address cultural issues by considering it as a barrier? And why should a community's cultural beliefs be labeled as a 'misconception'. Are we educated folks the only carriers of knowledge? is all local cultural knowledge harmful and detrimental? Then how has human kind identified with their cultures across time? So what if some cultures believe that their women's anatomy is for their husband's only. Is that wrong? What other points of engagement with these thoughts can we create?
ReplyDeleteThanks Prof for posing those critical questions. When we label culture as a barrier, we have lost the people of that culture. I believe that for any health intervention program to be effective, it has to be first informed and schooled by the culture of the people it intends to reach. It has to go through the filters and lenses of that culture and pass the Litmus test that;
Delete1. It will not offend the natives
2. It will be effective in getting the intended outcomes
3. The solution/intervention will be mutually agreed upon between the natives and the health workers (create a win/win outcome).
I agree that some cultural tenets may make it difficult to make some necessary health changes. But lets all look back when western medicine started. They used to do some procedures that used to actually kill patients. Western medicine has evolved over many centuries. What is needed is patience as groups of people change after seeing the light.
Wow! Hot discussion! I was very impressed by all of your thoughts! I am always interested in culture and health issues because of my personal experience in China and the US, just the same as you, Onias, It was really a good example to discuss the effects of cultural beliefs in HIV/AIDS prevention program in Southern Africa. Indeed, it is a challenge to implement a program which is conflict with the culture norms of the target. So, going back the question that Lala raised, can we address cultural issues by viewing it as a barrier? In my opinion, there is no right or wrong cultural knowledge in some extent. I think every cultural value has the original meaning for the population who live within the cultural context. As researchers, we might need to focus on exploring the reasons why the cultural norm makes sense for the target audience, and how we can develop a culturally tailored program which is consistent with the cultural beliefs, even in the global health.
ReplyDeleteCulture is neither good nor bad. It is what it is. There may be some cultural tenets that do not promote good health, but that does not mean that culture in itself is bad. From a sociological perspective, culture are the beliefs, way of life, art, and customs that are shared and accepted by people in a particular society. Customs can never to labeled good or bad. They are what they are. The view that culture is a barrier is ethnocentric. It says that my culture is good and yours is bad. As health workers, we need to look at culture from the perspective of the people who share and accept it.
ReplyDeleteFrom an anthropological perspective, culture is the learned patterns of behavior and thought that help a group adapt to it's surroundings. This means that "there is a reason things are done this way around here." Its not by accident. in that regard, culture cannot be viewed as a barrier. It is what it is - culture, learned patterns that help people to adapt to their environment.
ReplyDeleteCulture does impact health outcomes. Whether we look at the culture of a small group within a major cultural group or major cultural groups (such as American culture or Indian culture), cullture has a way to impact the way health services are perceived or accessed. The impact (positive or negative) is even greater when we look at culture across country and continental lines. Campbell and Guiao (2004) explored the implications of the Muslim culture on female self-immolation (burning). They burned themselves as a way to protest injustices towards women. Myers (2010) also studied culture, stress, and recovery but focusing on Schizophrenia patients. They concluded that culture has a great impact on recovery from mental health.
ReplyDeleteAs stated several times in this class, culture is neither good nor bad. It is what it is. Culture is an important aspect when dealing with global health. Because of that, it should be seen as a useful tool to help global health workers.
References
Campbell, E. A., & Guiao, I. Z. (2004). Muslim culture and women self-immolation: Implications for global women's health research and practice. Health care for Women International, 25(6), 782-793. doi: 10.1080/07399330490503159
Myers. N. L. (2010). Culture, stress, and recovery from Schizophrenia: Lessons from the field for global mental health. Culture, Medicine and Psychiatry, 34(6), 500-528.
doi: 10.1007/s11013-010-9186-7