Being culturally appropriate (#149)
To understand and overcome socio-cultural issues in countries in the developing world to facilitate participation of mentors from the western world.
Methods and Results
The common barriers and possible solutions are:
1. Inadequate awareness of the mentor about the socio-cultural background in the country. An initial period of learning by the mentor would really help bridge gaps.
2. The social structure: Where family structure is strong, the individual’s autonomy often gives way to family’s autonomy. But the patient still has fears and anxieties. To address them, the family’s co-operation is essential. If the family is antagonised, we lose the opportunity to help the patient. Prolonged and repeated discussion with several members of the family may be necessary before we are able to help the patient adequately.
3. Attitude to death: Different cultures look at death in different ways. Some communities consider it a bad omen to talk about death. Apparent cultural acceptance of death does not necessarily translate to peace of mind.
4. Religion: Though some common principles guide the devotees of a religion, there are often major differences in the way it is practiced as well as in rituals. A textbook reading of practices in various religions needs to be supplemented by a study of the local customs and practices.
5. In a country with poor resources, the palliative care team would have considerable work load. Expectations from the team need to be realistic.
6. Resources: The low cost of palliative care is an advantage that can be successfully exploited by using as inexpensive modalities as possible.
The developing world needs the knowledge base available in the developed world. Transmission of this knowledge is effective through mentors if the local socio-cultural factors are learned.