In the healthcare scenario laid out in the final paper, there is a 30-year-old, Asian, unmarried, homosexual woman named Jan who is strongly opposed to organized religions. Jan grew up in America, but will be working with a non-profit agency providing healthcare to underprivileged families in Kenya. She has 5 years of experience as a Registered Nurse and will be living in Nairobi, Kenya. Her worry is that she will make communication mistakes and possibly offend co-workers, supervisors, patients, and local people outside of her work setting. There are many things she will be able to do to educate herself about the Kenyan culture and belief system to prevent any offensive communication with anybody she comes in contact with.
Challenge #1 OUTSIDE OF a Healthcare Context: Nonverbal Cues
While visiting Kenya, Jan is going to have times where she interacts with people outside of the healthcare setting. There are many things that Kenyans do as a part of their culture that people in America would not be used to. If Jan were to walk into a dinner party with a Kenyan family, there are many nonverbal cues that are unique to their culture that she would notice immediately. She might notice that the dinner hosts are more inclined to touch frequently, stand closer to her, speak louder, and use face-to-face body orientations (Samovar Chapter 9 Lecture). Jan, coming from America, would be used to standing at an angle to avoid face-to-face contact, and having a large amount of personal space. In Kenya, people will stand very close to complete strangers and even closer when engaged in conversation. This lack of space is linked to their value system consisting of collectivism and unity (Samovar & Porter, 2007).
The culture distance, which is the extent to which there are significant difference between two cultures, is very far between Kenya and America. They have varying everyday communication styles and traditions that are very different from American customs. This may put Jan in a state of culture shock, being the “psychological and emotional reaction people experience when they encounter a culture that is very different from their own” (Oetzel Chapter 5, p 126). To overcome this culture shock, Jan will need to focus on the difference in proxemics, or personal space during conversation and daily interaction, between her culture and the Kenyan culture (Samovar Chapter 9 Lecture).
This difference in proxemics may cause Jan to feel uncomfortable when first experiencing Kenyan culture. She will need to prepare herself for her personal space being smaller and she might feel as though her space is being violated. However, this is not a situation in which Jan needs to accommodate. There will be many other settings where she will need to accommodate, but they are much more influential. This is a small-scale confrontation that can be handled. These nonverbal cues are prevalent throughout the country and no matter if she is in the hospital treating patients, or at a dinner party, they will be present. She might feel uncomfortable and take time to adjust to this new way of interacting, but it will follow her everywhere she goes in Kenya, making it important to accommodate to.
Challenge #2 IN a Healthcare Context: Religion
Kenya holds value in religion, while Jan is opposed to any kind of organized religion. When she enters the room of a patient, she may see praying depending on the severity of the situation. She may also learn about healthcare techniques that are based on supernatural and religious beliefs that she may find strange. The church is very prevalent in the healing process among African Americans as well. They will often pray and surround themselves with members of the church in order to overcome an illness or heal a loved one (Samovar Chapter 10, p. 368). The main religion practiced in Kenya is Christianity which accounts for a whopping 83% of the population (Central Intelligence Agency). This means that Jan will be exposed to members of the church visiting her patient and possibly even higher powers such as priests. Other people that she should expect to be involved in this treatment process are shamans, or medicine men.
Root medicine is an African healing tradition where magic spells are used to lift hexes, which will in turn heal the mind and body (Juckett, 2005). It is believed that the onset of sickness is caused by supernatural beings, paranormal beings, or evil humans (Samovar Chapter 10, p. 367). Many Kenyans will try to use traditional cures such as plants, herbs, and diviners who can get rid of the evil spirits (Wintz & Cooper, 2013). Traditional folk healers such as shamans and medicine men are called to service when an illness presents itself.
In Kenya, the main healthcare system utilized by underprivileged people – who make up the majority of the country – is the supernatural healthcare belief system. In this system, there are always underlying premises for diseases, which are based on the perception of the world being dominated by supernatural forces (Samovar Chapter 10, p. 367). Basically, your fate depends on the actions of God and the cause of your illness is attributed to spiritual factors, while your treatment is going to be based on spirits and deities (Samovar Chapter 10 Lecture).
The Kenyan beliefs are very different from the healthcare system that Jan is coming from. In the United States, a biomedical health belief system is in place. When there is a deviation from the norms based on biomedical science, the treatment is to destroy or remove the illness-causing agent (Samovar Chapter 10 lecture). It rests on the premise of cause and effect. The human body has been observed and studied and treatments have been proven to work. A fallback to this healthcare belief system is that social, spiritual, and psychological factors are not payed attention to as much as they could be (Samovar Chapter 10, p. 370).
Jan isn’t being asked to conform to a religion or become a shaman and learn spells, only to understand that the only healthcare her patients might have been exposed to is of the supernatural nature. Her ethnocentrism, or lack of room for cultural differences due to the notion of her beliefs being completely right, regarding religion needs to be put aside and she must accommodate to parts of the Kenyan religion (Martin Chapter 1 Lecture). Since she is strongly opposed to organized religion, this situation will be one in which she does need to accommodate to a certain degree. Both her Kenyan patients and Jan are on extreme sides of religion, one being immersed in it, and one being strongly opposed to it. She could deal with this by allowing the religious practices to be done during visiting hours, but when it is her time to treat the patient, record vital signs, and converse with the patient and family, there will be no interruptions. This will allow the family to do their healing spiritually, while Jan is able to do her work in the healthcare setting.
Challenge #3 IN a Healthcare Context: Families
In the healthcare setting, Jan will be treating patients and often their families will be a huge part of decision making. If she were to walk into a hospital room, she could expect to see the patient surrounded by all family members. The mother of the patient is most likely to take over the decision making when it comes to healthcare. Men are in charge of the economic and political decisions, while women are in charge of the care and rearing of the children, including healthcare decisions (DeFrain & Asay, 2014). This may cause problems when Jan is delivering information that requires a choice to be made at the patient’s discretion because the mother is most likely to take over that responsibility.
In Jan’s individualist culture, “a person’s rights and privacy prevail over group consideration,” which might cause problems in the direct healthcare facility (Samovar Chapter 6, p. 223). In the Kenyan collectivist culture, “the groups interests take precedence over those of the individual” (Samovar Chapter 6, p. 224). This might cause conflict because the family will want to be involved in the healthcare decisions. The decision is not up to just the patient, but the family as a whole. They value the support of their in-groups, being their family, over making single decisions. While it is normal for the family to want to be there and help make a decision, they might overpower the patient receiving treatment for the greater good of the family. This might not be what the patient necessarily wants, but feels they need to do in order to remain in good standing. Jan will have treatments she will feel are necessary, and maybe the patient will agree with her, but if the family doesn’t agree, then the likelihood of the patient coming forward or speaking up is slim.
In this case Jan will serve her patients best if she can accommodate the mother and family. Family and respect are a large part of Kenyan culture and will present complications in her treatment. If she can speak to not only the patient, but the family about treatment and then ask the patient in a private setting what they want, that would serve best in the situation. She doesn’t have to leave the family out of the decision, but making the options clear to the patient is essential. She could ask the family to step out of the room or wait until they are gone to speak privately with the patient. The patient might not be willing to speak up with the family surrounding them if their opinion is differing. However, the mother will have the final say regardless of her son or daughter’s wishes, but Jan will have done everything she could and informed everyone involved.
This adjustment Jan will need to make will be to the Kenyan collectivist culture dimension. Kenya’s individualist score is 25% while America’s individualist score is 91% (Hofstede Insights). This data proves that Kenya is a collectivist society and America is an individualist society. Individualism is characterized by “the degree of interdependence a society maintains among its members” (Hofstede Insights). In individualistic societies, children think in terms of “I” and value tasks over relationships. Speaking one’s mind is extremely important in this setting and it is considered a guilt culture, meaning each person’s priority is making sure they don’t look bad, regardless of their impact on their families (Samovar Chapter 6 Lecture). Children in collectivist societies think in terms of “we” and value relationships over tasks, being the opposite of the individualist society. Harmony and consensus are the main goals and this society is referred to as a shame culture, meaning one would protect their families from looking bad before they think about the impact on themselves (Samovar Chapter 6 Lecture).
Challenge #4 OUTSIDE OF a Healthcare Context: Discrimination
Jan is a homosexual woman who will be working in the capital of Kenya. While homosexuality in the United States is not yet a normality, it is considerably less accepted in Kenya. Jan may be subject to abuse and exploitation if she is found out to be homosexual. Kenya recently removed criminal punishments for adults who engage in homosexual activity (Wesangula 2017, Dubuis 2016). However, the culture is still very toxic. Homosexual sex was previously punishable by up to 14 years in prison and attacks on the LGBT community occurred frequently. Even with the lift on this law, there are still many attacks even though Kenya is considered to be a “haven” for LBGT refugees. Many countries in Africa still punish homosexuality by law.
Discrimination, “an action that maintains the dominance of one group over another,” will affect Jan in her everyday life in Kenya (Oetzel Chapter 4 Lecture). If she is verbal and open about her homosexuality, she may face consequences anywhere from being treated unequally to abuse. She needs to accommodate in this situation, regardless of how she acted in the United States, to secure her safety. She will need to not undergo any sexual interactions that might cause her to be labeled as a homosexual woman or even talk about it with Kenyan people. Even though there aren’t any laws in place that could send her to prison, she could end up getting assaulted, attacked, or harassed.
Reference List
Gregory Juckett, M.D., M.P.H., West Virginia University School of Medicine,
Morgantown, West Virginia Am Fam Physician. 2005 Dec 1;72(11):2267-2274.
Wintz, S., & Cooper, E. (2013). Cultural & Spiritual Sensitivity ─ A Learning Module for
Health Care Professionals and Dictionary of Patients' Spiritual & Cultural Values for Health Care Professionals. New York: Pastoral Care Leadership and Practice Group of HealthCare Chaplaincy. Retrieved November 20, 2017.
Central Intelligence Agency. (2017, November 29). The World Factbook: KENYA.
Retrieved November 29, 2017, from https://www.cia.gov/library/publications/the-world-factbook/geos/us.html
Samovar, L., & Porter, R. (2001). Communication Between Cultures: fourth
edition. United States: Wadsworth Publishing Company.
DeFrain, J., & Asay, S. (2014). Strong Families Around the World: Strengths-Based
Research and Perspectives. Retrieved December 6, 2017, from https://books.google.com/books?id=qovJAwAAQBAJ&pg=PA54&lpg=PA54&dq=gender roles in decisions healthcare kenya&source=bl&ots=A2oAeswOv8&sig=4eVmbW9-inK4EKJPvKUG61_T-ro&hl=en&sa=X&ved=0ahUKEwjpxJnC9fbXAhVWwWMKHT0cDc8Q6AEIUzAF#v=onepage&q=gender%20roles%20in%20decisions%20healthcare%20kenya&f=false
Wesangula, D. (2017, February 23). On the run from persecution: how Kenya became a
haven for LGBT refugees. Retrieved December 06, 2017, from https://www.theguardian.com/global-development-professionals-network/2017/feb/23/on-the-run-from-persecution-how-kenya-became-a-haven-for-lgbt-refugees
Dubuis, A. (2016, May 09). Kenya Could Become the Next Country in Africa to Legalize
Homosexuality. Retrieved December 06, 2017, from https://news.vice.com/article/kenya-could-become-the-next-country-in-africa-to-legalize-homosexuality