How to Communicate as a Health Volunteer ∗

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How to Communicate as a Health
Volunteer
∗
The Cain Project in Engineering and Professional Communication
This work is produced by The Connexions Project and licensed under the
Creative Commons Attribution License
†
Abstract
Mr. Daniel Erchick of Rice University's Department of Bioengineering wrote this module. It prepares
students to communicate during their internships in developing countries as health volunteers in clinical
settings.
Contents: Reading, Assignments, Health-Career Student Commentary
1 Reading
1.1 Introduction to Working in a Clinical Setting as a Student
The health facility you choose to work in is likely to be located in a rural and underdeveloped part of the
world. Getting started in this clinical setting may feel like a daunting task. Once you set foot there, it may
seem to you as if the health facility has insurmountable problems. Conversely, it may seem as if everything
is already running in its own way. Both situations leave you with the question: where do we t in? How can
we help? As students, you will most likely have only a few weeks to volunteer your services. Therefore, you
must make the most of your time. Planning and research are best begun before you leave for your trip. Do
your best to acquire information on the health needs of the community that surrounds the health facility.
Remember, health care is not practiced solely at the clinic or hospital; it is practiced all throughout the
community: at home, at school, and at work. Health problems arise outside the clinical setting; and many
can be resolved outside the clinical setting. Your general goals should be as follows:
•
First, delve deep into the health challenges the community faces to ascertain the root cause of these
problems.
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Second, collaborate with the community to identify a health problem that your team desires to address
and a feasible and manageable solution.
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Finally, endeavor to implement this solution utilizing the resources of the community.
As a volunteer, you may participate in many health care areas. Perhaps you will work as a medical volunteer
in a traditional hospital setting, say cleaning instruments for surgery. Maybe you will act in a more public
health capacity, distributing mosquito nets. Or you could act primarily as an educator, teaching children
about nutrition and hygiene.
Most likely, your projects will fall in more than one discipline.
health care solutions are rarely discovered through a singular route.
∗ Version 1.2: May 29, 2008 4:01 pm -0500
† http://creativecommons.org/licenses/by/2.0/
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Eective
Instead, it will be wise to adopt a
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multidisciplinary approach. Throughout this module, I will oer suggestions for both working within a health
facility and for working in a health care role outside the health facility. Remain cognizant of whether projects
are focused within a health facility, outside the health facility, or span both realms. Understanding when
each focus is appropriate will help you form the most eective health solutions for the specic community
you are working with.
Keep in mind that good intentions can sometimes produce harmful results.
antibiotics to a community for tuberculosis treatment might seem benecial.
For example, providing
However, without proper
instructions, supervision, and follow-up, tuberculosis courses are often administered improperly. Improper
medication administration results in the emergence of antibiotic resistant strains of the bacterium, which
can become increasingly deadly and dicult to treat.
Also, being undergraduate students, your medical
knowledge and experience is limited. Hence, as a general rule, do not do anything that you are not comfortable
with or are not qualied to do at home. This is not meant to discourage but to motivate you to seek respectful,
eective, and sustainable health solutions. In many situations, it may be valuable to view yourselves simply as
observers, attempting to learn more about international health. However, with careful planning, knowledge
of your limits, and an intercultural approach you can contribute to health solutions.
During every step of your project, sustainability should be one of your primary goals. Simply providing
care while you are present in the community is not likely to have a signicant or long-term impact. Your
challenge is to nd manageable projects that will produce positive and sustainable results. Ideally, you will
begin projects by collaborating with community members and complete projects by relinquishing your role
to a community that is prepared to maintain the results or even progress forward.
Establishing a long-term relationship with a specic community will help ensure sustainability. Even if
this is your team's rst trip, nding even one contact person who can track down information will prove
valuable.
This can be accomplished by phone or email.
Sources for contacts include local and foreign
non-governmental organizations (NGO), leaders in the community you seek to visit, and leaders within
your own university and community. Information acquired before departure will be valuable in many ways;
for example, with prior knowledge you may be able to bring medical supplies that the health facility is
lacking.
While conducting your project on the ground, build relationships and be cognizant of potential
health projects for later years (assuming you are part of a health-related outreach organization). To learn
more about establishing these types of relationships, read the module titled How to Introduce Yourself in
Advance or in Person.
1.2 Assessing a Clinic's Reach
Often student volunteers' and community members' beliefs about health care do not match. To resolve these
dierences, you should speak with community members to learn about their most signicant health concerns
and to discuss possible solutions. If community members are reluctant to discuss health issues, rely upon
health facility administrators, doctors, and community leaders, until you can devise more suitable ways to
discreetly and respectfully obtain information.
Both group and individual meetings are suitable options.
Do what is necessary to obtain opinions from dierent groups with the community. For example, separate
meetings for women and men might be needed to get full and unrestrained answers. For more assistance in
gathering information from the community, familiarize yourself with the rapid assessment techniques found
in How to Detect Cultural Dierences and the Key Informant Discussion and Focus Group Discussion in
How to Conduct a Participatory Rural Appraisal for an Engineering Project. The aim of this assessment
is to develop an overall understanding of the community's health issues and nd a health problem and a
solution that your team could work towards. The following two assessments are best begun at home but will
denitely need to be continued once you reach your destination.
1.2.1 Surveying the community
Seeking answers to health care questions may teach you things about the community you could not have
previously imagined. For example, one student group was curious as to why certain days at the hospital
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were overly crowded. After speaking with several nurses, students learned that the most crowded days in the
hospital coincided with the village's rotating market day. On a market day, villagers traveled to the village's
center to sell their wares and to stock up on food and other supplies. Many villagers lived miles from the
hospital and had to walk the distance. Speaking with patients revealed that many could not aord to take
time away from work or family to travel to the hospital on a normal day. Instead, they chose to wait until
they were traveling to the center of the village for a market day and then visit the hospital, which is nearly
across the street. Here are some questions concerning community health that you might keep in mind:
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Are the existing health facilities sucient for the size of the community?
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·
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How many people fall under jurisdiction of these facilities?
What geographic area do these health facilities serve?
What other health remedies do community members seek out?
At what time between rst symptoms and near death do community members seek help?
To what extent do community members seek preventive health care?
How have education and other factors attracted or repelled community members to/from their health
facility?
•
•
•
How do nutrition and clean water t into health problems?
What social, cultural, political, economic factors play into health care?
And most importantly: What health needs do community members nd most pressing?
For information specic to health-related engineering projects, read the module How to Approach the
Planning of a Participatory Health-Related Engineering Project.
1.2.2 Surveying the health facility
After your team is satised with their understanding of the community's health issues, shift your attention
towards learning the strengths and weaknesses of the clinic or hospital where you plan to volunteer. Speak
with administrators, doctors, nurses and patients. If possible, initiate discussions about the hospital's capabilities and limitations. Use discussion rather than questioning or surveying; this style is less intimidating and
more likely to elicit a friendly response. Here is a list of questions to keep in mind during your discussions:
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What illnesses can the health facility treat?
What illnesses does the health facility see most frequently?
Which segments of the community utilize the health facilities?
Where can patients go for treatments that this health facility does not provide?
What needs do doctors and patients nd most pressing?
What solutions do they think are most likely to succeed?
What medical equipment or personnel is lacking or absent?
Closely tied to these issues are those questions associated with health care aordability:
•
•
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How aordable are certain treatments versus patient income?
Is health insurance available through employment or purchase?
How aordable and comprehensive is this health insurance?
Health care problems are more complex than they seem at rst glance.
political factors lie tangled beneath the surface.
several of these factors.
Cultural, social, economic and
To reach an eective solution, you may need to address
Do not bite o more than you can chew.
Keep the big picture in mind, but
try to develop projects that are manageable but still large enough to signicantly improve the health care
of the community.
For example, one team of students, while volunteering in a rural Ghanaian hospital,
decided to address the community's general propensity to avoid taking HIV tests. The obstacles to getting
tested were many and included the cost and patients' fear of the disease. Students collaborated with hospital
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administrators and doctors; together they decided that the most feasible course of action was for the students
to help the hospital host a free HIV education and testing day.
This plan t within the students' limits
and was a sustainable approach to the problem. By providing funds for the HIV tests and running the rst
event, students had paved the ground for the hospital sta to hold this event during the months that the
students were absent. Returning the following year allowed the students to reevaluate the project and to
propose improvements. The remainder of the module will explore how your team can take the information
you've collected to build programs to increase the eciency of health care in your community.
1.3 Patient Privacy
Maintaining doctor-patient privacy is a serious issue in both the United States as well as abroad. Before
1
leaving, familiarize yourself with the common patient privacy standards here in the United States.
Then
spend a little time searching for any information on the privacy laws or standards in the country in which you
plan to volunteer. As a health volunteer you will be privy to patient information; information and records
are to be kept secret from everyone except those health professionals directly involved with the patient.
In the developing world, certain challenges may arise that are uncommon in health facilities in developed
countries.
Most importantly, upon arriving at the health care facility, learn how health professionals treat privacy
issues and follow their lead. Clinics and hospitals in the developing world may be overcrowded: multiple
patients to a small room or even a bed.
This makes it increasingly dicult for health professionals to
maintain dignity and privacy during examinations and patient consultation. To avoid violation of privacy,
it may be necessary to temporarily move patients to a private area or speak softly to ensure that private
information is kept secret.
Maintaining patient privacy is critical because of the social stigmas that surround medical conditions.
Connection between social stigmas and disease is not a new phenomenon; for hundreds of years, lepers (individuals suering from leprosy) have been cast out from certain societies. Stigma and fear arise predominately
from a lack of understanding of the causes and workings of these ailments. In many locations, HIV/AIDS
patients are ignored and shunned. Therefore, it is imperative that patient information in these cases be kept
secret, sometimes even from close family members.
Some privacy protection practices are common to health professionals who work in HIV aicted areas.
One of these is to refer to HIV or AIDS as bad blood.
A health professional would privately explain
to the patient that they are HIV positive and then suggest that in the company of others their condition
be referred to as bad blood.
confusion.
Some argue that using this phrase only perpetuates the stigma or causes
However, it may be a necessary tool to maintain patient privacy.
Social stigmas like those
associated with HIV/AIDS should be attacked on a wider scale and never at the expense of an individual
patient. Educational forums such as town meetings, schools, and clinic health classes are places to address
stigma and disease. Keep an open mind and respect the customs and practices already in place at the health
facility.
1.4 Patient-Student Interaction
As you begin work within the clinical setting there are a few things you should think about. If this is your
rst time working in a clinical setting, be prepared to see and experience things to which you may not be
accustomed. Viewing sick patients for the rst time may be shocking, particularly in developing countries.
Above all: remember to be respectful. Also, if you come from the United States or another developed nation
you may be viewed by patients as being more knowledgeable than you truly are.
This perception may or may not be manifested in how the patients treat you. For example, they may ask
for advice or simply listen attentively, taking your words very seriously. Be cognizant of the things you say
and do as they have an impact and will not only reect upon yourselves, but upon your home country, and
even Western medicine. Miscommunication can easily arise because medicine is a complicated and diverse
1 http://www.hhs.gov/ocr/hipaa/
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eld. For example, imagine saying to a patient, take this pill twice daily. Seems simple enough, however
miscommunication is still very possible. First, a patient unfamiliar with medication might be confused as to
how to take `one pill twice in a day.' You may need to say, "Take one pill when you awake in the morning
and take another pill at sundown." However, if the medication needed to be taken with food, even those
instructions might need to be changed to "Take one pill as you eat in the morning; take one pill when you
eat in the evening." Use these instructions only if you have found out what meal patterns are followed in the
community.
Second, in some locations patients have been known to view medications and accompanying instructions
as optional. This could lead to deadly underdosing or overdosing.
Third, patients may be confused as to when during the day the pill must be taken.
Can the patient
simultaneously take two pills in the morning upon waking up? Should the patient take one pill at noon and
wake up at midnight to take the second?
Fourth, patients have not been given a length for the medication regimen.
Should they take the pills
until symptoms disappear? Or should they take pills until their bottle runs out? Maybe they should they
just take two pills today and save the rest in case they become ill again in the future? These communication
problems are real and can create serious problems if not handled properly.
You will likely interact with patients frequently and in many dierent capacities. Communication between
health professionals and patients is crucial to both diagnosis and treatment. Several common communication
obstacles may stand between a patient and you as a health volunteer. Language and cultural barriers are
two of the most fundamental challenges you will face when communicating with patients in the developing
world. The best way to overcome the language barrier is, of course, a translator. Remember that translators
do not always convert your sentences word for word into sentences of another language. View translators
as brokering a common understanding between two parties.
Other languages and cultures use and rely
upon words and concepts that may be missing from the English language and Western medical knowledge.
However, the translator may lack medical knowledge. You may need to explain separately to the translator
some of the risks or dangerous outcomes that might be associated with not following the right administration
of the medication. A skilled translator can convey meaning through words or concepts that do not necessarily
ow from a direct translation. In this way, the fullest common understanding can be reached so that patients
and physicians can make informed decisions.
1.4.1 Obtaining Information from Patients
Learning local traditional beliefs about disease and medicine will help you to better understand your patients.
You are likely to nd a mix of traditional and Western beliefs concerning medicine. Navigation of complex
cultural beliefs can be best approached by listening and asking questions.
Addressing all of a patient's
health related concerns and beliefs, whether or not they t within Western medicine can be a successful
tactic. Some cultures believe that disease may arise through spiritual or religious forces.
2
A multitude of
beliefs about medicine exist that may help or hinder your attempt to provide Western medical care. Simply
asking a patient what illness they believe they have or how they may have contracted it may reveal to you
a wealth of information and earn patients' respect and trust.
Here is an example of the complicated intertwining of religious, cultural, and medical beliefs.
passage below, Dr. Paul Farmer interviews a patient in Haiti recovering from tuberculosis.
3
In the
This elderly
woman, when rst interviewed, a year before, had taken mild oense at his questions about sorcery.
"She'd been one of the few to deny she believed in it. 'Polo, cheri,' she had said, 'I'm not stupid. I know
tuberculosis comes from people coughing germs.' She'd taken all her medicines. She'd been cured
...
But
now, a year later, when he asked her again about sorcery, she said that of course she believed in it. 'I know
who sent me my sickness, and I'm going to get her back,' she told him."
'But if you believe that,' he cried, 'why did you take your medicines? '
2 For
further reading on intercultural communication between patients and doctors, take a look at Anne Fadiman's The
Spirit Catches You and You Fall Down.
3 Passage
from Tracy Kidder's Mountains Beyond Mountains.
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"The smile, he thought, of an elder explaining something to childin fact, he was only twenty-nine.
'Cheri,' she said, 'eske-w pa ka kon-prann bagay ki pa senp?' The Creole phrase pa senp means 'not simple,'
and implies that a thing is freighted with complexity, usually of a magical sort. So, in free translation, she
said to Farmer, 'Honey, are you incapable of complexity?'"
Have respect for the local beliefs when you explain the Western medical understanding of their condition
and their options for treatment. Do not discount non-Western medical treatments without evidence. Local
remedies and spiritual treatments may be successful at treating some illnesses and relieving symptoms.
Either way, they may also serve to make a patient more comfortable or content with the standard of care
being provided.
Any reasonable person would choose to exhaust all treatment options available; perhaps
a mix of Western medicine and local remedy would be best. Maintain an open trusting relationship with
patients. Ask what other treatments they are receiving; and realize that some, in fact, will be harmful. You
or the doctor will have to explain the dangers of specic local remedies carefully to each patient. To ensure
antibiotic treatment, Dr. Paul Farmer carefully addressed another tuberculosis patient. Instead of telling
the patient that tuberculosis is not caused but Vodou, he chose to say that he did not believe their specic
case was caused by Vodou. In this way, he did not discount the patient's belief in Vodou, he did not need
to, he simply explained that this situation was not Vodou related. A patient is much more likely to accept
this explanation rather than one that attacks their entire frame of understanding disease and medicine.
Remember, ultimately, their health care decisions are just that: their own.
1.4.2 Conveying Information to Patients
Conveying information to patients can be just as arduous as obtaining information. Follow closely to the
communication lessons taught in How to Explain a Process or Device in an Intercultural Engineering
Process. Tailor the complexity of your explanation to your audience, as you usually do in everyday life in
your own community. A patient with HIV will not need to understand the complex mechanisms by which
the virus suppresses the immune system; but patients should at least understand that they may become
more susceptible to other infections if HIV positive. Use the general to specic model: give an overview of
their condition rst and then add necessary specics. Also, follow the instructions on explaining dangerous
or important conditions. Dangers to the patient should be thoroughly and clearly enumerated. With any
disease, medication, or procedure an adequate explanation should be provided so that the patient understands
the risks involved.
An adequate explanation will vary by situation; but determining what will qualify as
adequate will require you to converse with each person and work towards a common understanding until
questioning through conversation reveals comprehension.
Being clear in these situations is of the utmost
importance because of the consequences involved.
Try to assess the health literacy of your patients so that you can most eectively communicate their
situation and how the facility can provide them with the best health care possible.
Patients that do not
understand may simply remain quiet or nod their head in fear of seeming ignorant or oending an authority
gure. Always ask patients to repeat important information and whether they need something to be explained
again. Use techniques found in How to Detect Cultural Dierences to respectfully inquire whether patients
have understood. Instead of asking: Do you understand me? Ask if patients could repeat information so
that you can ensure that you have not forgotten anything or made a mistake due to your poor understanding
of the language. Be prepared to spend more time with each patient then would normally be required for a
patient from your home town.
In addition, these intercultural communication techniques could be valuable to you when searching for a
project. For example, a possible student project could be to prepare pictorial guides to help new mothers
remember the essentials of infant care.
A pictorial guide like this would be a helpful way of improving
communication between health professionals and patients while also raising the level of care provided. Below
will be added an example of a poster drawing designed to impart important health information to patients
who cannot read. The message conveyed is that a pregnant woman should not carry a heavy load on her
head. The viewer can see that the woman on the right is not pregnant and carries a bigger,heavier load on
her head. The obviously pregnant woman on the left carries a much smaller load. (Copyright permission to
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post the image on this site is pending.)
Sometimes meanings, symbols, and other representations that make sense to you, will not make sense to
someone from another culture. Examine the four pictorial attempts at conveying when a child should be
given rehydration therapy. Each one has some American concept that did not transfer to the culture they
were seeking to reach. (Copyright permission to post the image on this site is pending.)
1.5 Standard of Care
During your project be aware of the overall standard of care that is provided by the health care facility.
It may also be valuable to investigate the community's conception of standard of care. Determining how
community members and health professionals view standards of care will help in your assessment of the
health facility and what problems you will address. Think about ways to maximize the standard of care.
Some improvements to the standard of care will require signicant resources and social change. For example,
in many developing countries, cancer goes virtually untreated.
1.6 Community Outreach
Community outreach may be part of your health solutions. Certain outreach programs may already be in
place that would be a valuable source of information and guidance. Outreach programs can have several
benets. First, outreach will familiarize members of the community with the health professional and Western
medicine in general. Familiarity may break down patients' fear and apprehension; this will make patients
more likely to seek future care.
health relevant health topics.
In addition, outreach is an excellent way to educate the community on
Finally, working within the community in such a manner will show that
administrators, physicians, and nurses care deeply about community health and that they desire to build
relationships.
Traveling out to the community to see patients can eectively increase the number of patients your facility
treats, monitors, and assists. Some health professionals will travel out to more hard-to-reach areas to see and
treat patients. If patients cannot be treated o site, physicians may then suggest that some seek treatment
at the facility. These programs do have a number of limitations, including the availability of transportation,
health professionals, supplies, and the money necessary to carry out this type of program. In addition, the
size of the area and the diculty of reaching remote areas may limit how often outreach can be accomplished.
Here are some projects in which students could get involved in community outreach: establishing programs
to bring food to HIV patients, performing testing for diseases like malaria and HIV, or simply supporting
physicians as they see patients o-site.
1.7 Education
Students can get involved in education as part of community outreach. Creating programs to teach community members about disease and health is tricky but can be very eective and well received. Community
meetings can be designed around topics like HIV/AIDS, tuberculosis, malaria or other infectious diseases.
Teach about the mechanism of disease transmission, the risks, and treatment options. But do not overlook
the need for programs for more specic topics and groups; for example, maternal health, child care, and care
of the elderly. Try to search out misconceptions or misunderstandings concerning disease and health. Sometimes misconceptions are dicult to uproot and may be detrimental to community health. Address these
misconceptions directly, but respectfully. Be very precise with vocabulary and translation. Remember that
using stories about what has happened in other communities or places or indirect communication methods
may be more successful and respectful. Education is often the most eective form of preventive medicine.
Educating children is also especially important. Oer to teach a lesson at local schools, create interactive
games and dances, or other projects to get children involved in learning about the health risks they face.
Since they are in a school setting, testing them pre and post project may be an eective way to see if your
message was understood.
Skits, games, songs, and other interactive activities are great ways to get the
message across.
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1.8 Assignment
Choose a country that you would like to visit for a health care project.
As thoroughly as possible, answer the following questions:
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•
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What health problems is the country facing?
What health care options are available to people in dierent areas?
Which organizations could assist you?
What cultural information should your team keep in mind?
Describe a health care project that you believe would benet the country you have chosen.
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List your project goals.
Explain how your team will involve the community.
Explain how your project will be sustained to provide positive and long lasting results.
List the biggest challenges you will face and how you plan to surmount them.
Research one of the following diseases: HIV/AIDS, tuberculosis, or malaria.
•
Prepare one PowerPoint slide with all of the information that you believe would be necessary to impart
to a group of individuals in the country you have chosen.
•
Prepare a short outline of notes that could serve to guide you when giving your presentation.
2 Student Commentary
2.1 Junaid Niazi: Medical Outreach in a Ghanaian Village
In the summer of 2006, Rice University's Humanitarian Medical Outreach sent me and seven other students
to a little village in Ghana named Kpando. Two days after arriving and settling into our surroundings we
sought out the hospital where we planned to volunteer. The day after that we each began work in one of the
hospitals wards. We were eager to get started. Having voiced an interest in public health, I found myself in
the maternity ward amid rows of nursing women and crying babies. Over the course of a week, I weighed
and measured babies, documented their growth, learned how to estimate the number of weeks a woman was
into her pregnancy, and handed out dietary supplements for both mother and child. Things were faring well.
Unfortunately, this was not the case for everyone. Most of the group spent the rst week either simply
observing clinicians or basically idling. After rotating out of maternity, I found myself in the same boat.
We had imagined ourselves serving in a more productive role. Over dinners we discussed our presence, role,
and brainstormed ways in which we could help. One thing that had particularly captured our attention was
the stigma HIV/AIDS entailed for the general populace and how the disease left victims virtually isolated.
These patients were either shunned and left alone or they were forced to hide their illness, unable to express
their thoughts and feelings as they slowly succumbed to the disease.
The fruit of our discussions was a two-pronged project focusing on education and support. The educational aspect involved delivering talks at local schools, churches, and public meeting areas. I particularly
enjoyed participating in these because we often talked to schoolchildren who listened attentively, excited by
the visiting yovos (foreigners). It was in this realm I felt we had the most positive impact. The for the most
part, our message echoed that of the local health workers. The message seemed to mean more coming from
outsiders. More importantly, the children asked us questions rarely posed to the health workers. However,
one large problem did arise. As employees of a Catholic hospital, the nurses would not answer questions
about condoms or advocate their use for prevention of HIV transmission. We brainstormed ideas to overcome
this problem, as we noticed that many community members sought answers to questions about condoms and
HIV. First, we sent one member of our group to carefully approach the head nurse about our concern. She
was empathetic, but still, she could not change their position. So after a little discussion, we oered the
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head nurse a compromise. We proposed that during these educational town meetings, our nurse act solely
to translate and explain our information in terms and concepts that were understandable. In this way, the
nurse was not responsible for any information we conveyed; she was simply assisting with a presentation
that we volunteers had put together. She accepted our oer. From this point forward, our meetings were
very productive and fully inclusive; nothing was purposely left out.
We explained HIV transmission and
pathology and our nurse simply translated our English to the local Ewe. Towards the end of each meeting
we received many questions about condom use and other aspects of HIV transmission. Community members
were very eager, open, and willing to learn. For all parties involved, the compromise was a great success.
The next part of our HIV/AIDS project addressed the isolation faced by people living with HIV/AIDS
(PLWHA). We believed a PLWHA support group would help alleviate the loneliness by providing an outlet
and encouraging PLWHA to share their thoughts and feelings with others facing the same social seclusion.
Therefore, we set out to explain our idea to prominent PLWHA of Kpando and surrounding villages to see
if they thought it a useful endeavor. We sought to recruit some members as local mobilizers. We were also
looking for someone who could lead the support group and ensure that it continued after we left Ghana.
Forming the support group took much longer than expected, since it depended coordination of many people
and communication was limited to talking in person. I took part in the initial recruitment and helped identify
the leader. Throughout our trip, the HIV/AIDS group met several times, one group for men, another for
women. After departing Ghana, we remained in contact with the chief medical ocer (CMO) of the hospital
to ensure that the HIV/AIDS groups were still meeting. Even from the beginning, the community had all
the resources they needed to implement a support group. All they lacked, due to fear, was the initiative to
reach out and form the group. We had the power to help them overcome this hurdle, and now they have
taken the responsibility to continue the project on their own. As Humed plans to return every summer to
Ghana, we can ensure that any problems encountered by the support group are addressed.
Throughout the undertaking and implementation of our HIV/AIDS project, we continued rotating
through the hospital.
I spent a majority of this time with the chief medical ocer learning about and
witnessing the most pressing health concerns burdening the local community. Discussing the people, culture,
and problems with the CMO and other Ghanaians with whom we worked proved the most enlightening and
truly tuned me into the challenges faced in a developing country in regards to health.
We viewed these
challenges, not as an isolated singular, but as an inextricable part of a larger, linked social context.
In retrospect, we should have done much more planning before we even embarked on the trip. It is imperative that you establish communication with your site directly. Finding opportunities via non-governmental
organizations (NGOs) is a terric idea because they will match you as best they can to a location and program that ts your criteria. However, even if you decide to utilize an NGO, obtain the contact information
of the supervisor of the site and get in touch. Relay to them your skills, training, goals, and hopes from the
experience and see if they think they can accommodate you. Likewise, ask of them their opportunities and
expectations. This ensures a good match and increases eciency when you arrive at your site.
During the trip, there were several additional factors that limited our ability to help. Not contacting the
CMO before leaving the US caused us to waste much of our rst week. Also, a class of nursing students had
begun a clinical rotation at the hospital at about the same time we arrived. While this problem is specic
to our trip, a broader message can be had: your work should never detract from, slow down, or prevent
others' work. Your presence should be geared towards increasing or maximizing eciency, especially for the
long-term (by now you must be familiar with the concept of sustainability). The nursing students oered to
let us partake in their tasks, but we refused. It would have been irresponsible to deprive them, those who
would serve Ghana in the near future, of the needed practice simply to keep ourselves occupied.
Finally, I just want to conclude by touching on what I consider the most important aspect of any
intercultural exchange: keeping an open mind and perspective. A signicant part of this includes striving to
maximize the time spent, learn at least a rudimentary amount of language, and immerse within the culture.
Coming to understand those with whom you will be dealing with is not enough. You must also reect on
your role in the service context. It is perfectly justiable to make your rst venture a feeler trip for you
determine if international service is indeed a path on which you would like to trek; in fact, for obvious
reasons this is a critical component for you to explore. Working on service projects internationally is a truly
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rewarding and enriching experience. It requires a great deal of hard work and patience on the ground as well
as during the planning and prepping stages. However, it pays o in the end when you make a dierence in
even one person's life. END OF MODULE
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