Cultural Beliefs about Pain – By Danielle Perreault & Sarah Mackie
We hit the floor running as soon as we landed in Accra, Ghana. We got in on Sunday night and had Monday to settle in, tour the campus and get organized. Then on Tuesday morning we dressed in our white nursing dresses and were picked up by the University of Ghana Nursing Bus. Our amazing driver Richard (who lets us turn on the air conditioning to escape the heat!) took us to our orientation at the 37 Military Hospital.
We are placed each on different units at 37 Military ranging from Pediatric Emergency and Inpatient, Surgical/Medical Emergency, Maternity, Infectious Diseases and ICU. We will spend five weeks at the hospital and will finish the rest of our ten weeks in a village named Apemanim and then doing community visits. On our tour we learned some history about the hospital. 37 Military is a teaching hospital and UN Level IV Base Hospital which received its name during World War II. It became necessary for Britain to take over defence and security of the West African sub-region and as the war brought more casualties an urgent need for medical facilities arouse (Barracks, n.d.). General Griffard requested that a Military Hospital be set up and on July 4th, 1941 it became operational as the 37th General Hospital within the British Empire (Barracks, n.d.). It is the second largest hospital in Accra (the capital city) and the third largest in Ghana. It is now open to the public and has 450 patient beds, although they care for hundreds more than that every day.
Lt. Colonel Sally Mensa is our host nurse from 37 Military and helped organize our placements. She took us on a tour of the maze of units where we are each placed and we found out she is fondly referred to as Abyuwa (which means young person) by all her colleagues. We were also introduced to the local bats that live in the hospital trees and they are huge, about the size of crows in Alberta. Throughout our first week at the hospital we noticed a lot of differences and similarities to nursing in Canada. As we settled in during the week, learning more about the nursing care, culture and how each unit works, the one difference we noticed was the minimal use of pain medication. Ghanaian cultural beliefs around pain are inherently different than ours in Canada and it seems to be passed down to younger generations. Ghanaians are incredibly patient and have an unbelievable pain tolerance. Their cultural beliefs around pain are that it is a sign of weakness and emotion is rarely shown even if someone is in severe pain. We have personally experienced the tolerance and strength when dealing with injuries and illness, in both adults and children this past week. There have been patients, even young children with a fractured femur, tibia and fibula all in one leg that don’t shed a tear or flinch when being examined. We found this very impressive and vastly different from Canadian patients’ ability to deal with pain and their expectations of pain management. In Canadian hospitals we are used to giving round the clock pain medication and patients will call the nurse as soon as pain arises. We were taught early on in our program that adequate pain management facilitates faster recovery, but this is hard to apply in the Ghanaian context. Lack of resources and cultural beliefs around pain reinforce the way pain is managed. It makes one wonder if the Ghanaians have faced other hardships that make physical pain seem inconsequential in comparison. Neither approach to pain is right or wrong, but it is something that is a striking difference between the two cultures.
Koskinen & Tossavainen (2004), discuss that cultural competence is an ongoing process in which the health care provider continuously strives to achieve the ability to work effectively within a client’s cultural context. This week we struggled in finding a balance between advocating for pain management and understanding the cultural beliefs around pain. Throughout this placement we are going to gain more experience and insight into Ghanaian culture which will help us provide holistic care to meet patient’s needs. We have been blessed with incredible nursing staff and doctors that are so excited to teach us about the health care system, treatments, and culture in general. There is also so much to learn in just one conversation with a patient. We are very excited for the endless learning opportunities and adventures that lie ahead of us and already know this is going to positively impact our future nursing careers. The cultural competence and global awareness we will gain from this clinical will not only reflect in the outcomes of our patients but in our daily lives as well.
“Cultures can only be understood relative to one another and that a particular behavior can only be understood within a cultural context…cultural difference is neither good nor bad, it is just different (Koskinen & Tossavainen, 2004, p. 112).
Koskinen, L., & Tossavainen, K. (2004). Study abroad as a process of learning intercultural competence in nursing. International Journal of Nursing Practice 10, pp. 111-120. Retrieved from CINHAL.
Barracks, N. (n.d.). Military Hospital. Brochure Publication.