Barreras relacionadas con las aseguradoras (EPS)

Some junior Ugandans acknowledged actively seeking to work alongside volunteers simply because they had limited exposure to working with ‘white’ volunteers. Charles, a junior doctor, explains:

“I never worked with white people before until about a year ago. I did not know what to expect and to be honest I had my concerns. People [Ugandan health workers] who worked with volunteers at the time said they [volunteers] bring their own cultures to Uganda, and preferred working among themselves…later I found out volunteers were fun, caring and responsible.”

From Charles’ experience above, and many similar others, exposure to the professional lives of different geographies and cultures can contribute to change in their perspectives on life, work, attitudes and cultural stereotypes. Increasingly, such exposure is encouraged, and in fact viewed as ‘core’ competency for health professionals (Kodjo, 2009). The ability, and awareness to perform effectively and appropriately when “interacting with others who are linguistically and culturally different from oneself” is often referred to as ‘cultural learning [competency]’ (Fantini and Tirmizi, 2006, p.12). Such ability and awareness do not only apply in transnational interactions (i.e. Northern volunteers engaging with host community in the global South), but also in local interactions. This is true in the context of Uganda, a nation of stark contrast, diverse lands and peoples (Thompson and Cechanowicz, 2007). There are many traditions, cultures, and health practices that impact on how people interact and relate to each other. To think of Uganda as a country with one or similar cultures would do no justice to the diversity that exists in the country. Leslie puts into perspective the diversity of cultures Uganda embodies, and the importance awareness of such diversity has for care delivery. He says:

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“…Here [Uganda] people have different beliefs, tradition and cultures…people from other African countries living with us also come with their own cultures. As clinicians, we are expected to have an awareness of such diversity and to respect all people at all times in order to provide care.”

For that reason, intercultural exposure and learning in the context of Ugandan health systems refers to consideration on the part of health workers and health systems more generally, the importance of culture, the assessment and the adaptation of services to meet cultural needs. An awareness of cultural differences and the ability to embed cultural knowledge in practice is viewed as crucial to inclusive health care delivery. The importance of cultural awareness is increasingly being emphasised in Ugandan public health (Thompson et al., 2007). A strong desire to engage with volunteers to gain knowledge and exposure to intercultural learning emerged particularly from junior Ugandans such as interns and students. Betty, one such Ugandan, reflects:

“…we are taught the importance of understanding patients’ traditions and cultures to provide effective care…engaging with volunteers will enable me to understand cultures that exist in Europe and how it may differ from ours [Ugandan cultures].”

As evident above, volunteering presents opportunities for people of diverse cultures and experiences to engage and learn together. A great deal of the learning that occurs through volunteering is borne out of immersion and exposure to a different culture (or practice). The importance of this type of learning is that it requires participation and encourages individuals to step outside of their own worldview and consider how it may relate or differ another worldview (Comhlámh’, 2013). An understanding of culturally sensitive or situated knowledge has been identified as an essential skill for volunteers working in the global South. Limited cultural understanding has been cited among student health workers in the US (Bond, Kardong-Edgren, and Jones, 2001), and cultural ‘immersion’ has been used to inform cultural understanding (Hunter and McKenry, 2001). For example, Thompson, et al. (2007) examined the impact of nursing practice on two American University nursing staff who participated in a cultural immersion experience in two Ugandan hospitals. The authors identified patterns of cultural variations among the nursing and health care practices which they said were consistent with the diversity that exist within the Ugandan public health and Uganda more generally.

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In similar light, junior Ugandans expressed a desire to engage with volunteers to experience cultural immersion in order to incorporate cultural sensitivity in their clinical practice. Lucy explains:

“…I think volunteers and their culture bring real challenges to us…their presence tests our ability to effectively communicate with them while at the same respecting each other’s cultures, and practices.”

Working with people from different cultures can be a daunting prospect but Lucy recognises it has the potential to inform her clinical practice. This view is also echoed by Betty who suggests that volunteers act as a bridge between the two ‘cultures’ and a conduit to “promote understanding and shared values”. These suggestions are particularly important given the cultural insensitivity imbued in AID, and often the distant and the unequal relationships between volunteers and their hosts in global South contexts (Simpson, 2004). Therefore, intercultural learning as expressed by some junior Ugandans has the potential to inform culture sensitive clinical practice, but also provide an opportunity to dispel inherent myths about culture superiority often associated with global North volunteers (see Perold et al., 2013). Similar to Thompson et al.’s (2007) observation above, it is possible that UK volunteers destined for Uganda were themselves seeking, among other things, an experience of cultural immersion in order to gain intercultural competency. The fact that knowledge of intercultural competency is looked upon favourably in the NHS if demonstrated at junior level by returning volunteers (see Gedde et al., 2011) adds weight to this proposition.