Connexions module: m15801 1 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. • Second, collaborate with the community to identify a health problem that your team desires to address and a feasible and manageable solution. • 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/ http://cnx.org/content/m15801/1.2/ Eective Instead, it will be wise to adopt a Connexions module: m15801 2 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 http://cnx.org/content/m15801/1.2/ Connexions module: m15801 3 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: • Are the existing health facilities sucient for the size of the community? · · • • • • 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: • • • • • • • 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: • • • 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 http://cnx.org/content/m15801/1.2/ Connexions module: m15801 4 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/ http://cnx.org/content/m15801/1.2/ Connexions module: m15801 5 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. http://cnx.org/content/m15801/1.2/ Connexions module: m15801 6 "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 http://cnx.org/content/m15801/1.2/ Connexions module: m15801 7 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. http://cnx.org/content/m15801/1.2/ Connexions module: m15801 8 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: • • • • 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. • • • • 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 http://cnx.org/content/m15801/1.2/ Connexions module: m15801 9 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 http://cnx.org/content/m15801/1.2/ Connexions module: m15801 10 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 http://cnx.org/content/m15801/1.2/
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