Indication

Ronald E. Pust

doi:10.1370/afm.1318

Published eLetters

If you would like to comment on this article, click on Submit a Response to This article, below. We welcome your input.

Submit a Response to This Article

Compose eLetter

Title *

Author Information

Contributors
First Name and Middle Initial * First or given name, e.g. 'Peter'. Last Name * Your last, or family, name, e.g. 'MacMoody'. Email Address * Your email address, e.g. higgs-boson@gmail.com Occupation * Your role and/or occupation, e.g. 'Orthopedic Surgeon'. Affiliation * Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.

Statement of Competing Interests

Competing interests? *

Yes

Please describe the competing interests

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

What code is in the image? *

Enter the characters shown in the image.

Vertical Tabs

Jump to comment:

The Risky Business of Cross-Cultural Medicine
Brian Neese

Published on: 17 January 2012
Great article!
Benjamin Gonzalez

Published on: 17 January 2012
Global Issues...Global Questions
William B. Ventres

Published on: 16 January 2012

Published on: (17 January 2012)
Page navigation anchor for The Risky Business of Cross-Cultural Medicine
The Risky Business of Cross-Cultural Medicine
Brian Neese, International Health Specialist
Dr. Pust writes a moving article about practicing obstetrics in rural Kenya. The author, however, is not a rural Kenyan, and that is the color that contrasts this tragic portrait. The issue is one of history and culture, power and race, and the way medicine bridges some gaps, while exposes others.
In common usage, cross-cultural medicine pits a very stark and acknowledged contrast of one culture (people group,...
Show More

Dr. Pust writes a moving article about practicing obstetrics in rural Kenya. The author, however, is not a rural Kenyan, and that is the color that contrasts this tragic portrait. The issue is one of history and culture, power and race, and the way medicine bridges some gaps, while exposes others.
In common usage, cross-cultural medicine pits a very stark and acknowledged contrast of one culture (people group, nationality, language) against another. What happens in that exchange can nullify objective truths, evidence-based medicine, rigorous bench science, and the most quality of expert recommendations. For Dr. Pust, the medical intent for a health delivery was clear, and the path to that goal went unequivocally the way of symphysiotomy. He was correct in his assessment, and he was right in his clinical decision, but in the end he needn't be either. What mattered most, and what would determine one decision tree from another, was wrapped into a colonial experience generations old.
Colonialism? What does colonialism have to do with delivering babies in East Africa? Turns out, it matters a whole lot.
I have worked in the same region of Kenya, and can attest that the western presence among Kenya's intellectual and medical elite is complex. There is a desire to shed such influence, to prove to themselves and to others that Kenyans can, and indeed are taking care of Kenyans, while still receiving the ongoing benefit of close exchange with their western counterparts. It is this complicated intersection where Dr. Pust discovered the imminent influence of colonialism in modern Kenya, and that it does still matter, even to the point of life and death.
Culture levels the medical playing field in ways which physicians are not comfortable. We establish truths through science and want to enact them in our practices. But we cannot force compliance, we cannot live with our patients to ensure the offending agents or behaviors are removed, nor can we hold sway over a local custom if we are not locals.
What we can do is educate ourselves on those customs, learn a people's history, speak the local language, be exceptional listeners and observers, ask questions, and show great effort towards bridging the cultural gap. This speaks volumes to patients and to professional peers of other cultures. It is here that we, as ones proposing to cross the cultural divide, can enable a transformation for good. Isn't that worth the risks involved?
Competing interests: None declared
Show Less

Competing Interests: None declared.
Published on: (17 January 2012)
Page navigation anchor for Great article!
Great article!
Benjamin Gonzalez, Student
Ultimately, it comes down to who makes decisions in patient care. One would hope that a physician would have this responsibility but this is obviously not always the case. As a medical student, I have had some opportunities to travel and work abroad but never came across situations like the one written in Dr. Pust's article. I think when people think of working abroad in developing countries they don't think of limitati...
Show More

Ultimately, it comes down to who makes decisions in patient care. One would hope that a physician would have this responsibility but this is obviously not always the case. As a medical student, I have had some opportunities to travel and work abroad but never came across situations like the one written in Dr. Pust's article. I think when people think of working abroad in developing countries they don't think of limitations to care because the nation is focusing on "advancing" and a certain treatment is too primitive. People usually think of resource poor settings where anything goes if it means a patient has a chance of being cured or surviving.
This was a very interesting article. Thank you for sharing.
Ben
Competing interests: None declared
Show Less

Competing Interests: None declared.
Published on: (16 January 2012)
Page navigation anchor for Global Issues...Global Questions
Global Issues...Global Questions
William B. Ventres, Visiting Research Professor
The work of global medicine is not always about what you do. It is often about what you do next.
When entering into foreign cultures, it is common not to understand much of what goes on. It is also common to make mistakes, both of commission and of omission. (I have frequently found myself completely confused teaching medicine and public health here in El Salvador. I have made - and will continue to make -...
Show More

The work of global medicine is not always about what you do. It is often about what you do next.
When entering into foreign cultures, it is common not to understand much of what goes on. It is also common to make mistakes, both of commission and of omission. (I have frequently found myself completely confused teaching medicine and public health here in El Salvador. I have made - and will continue to make - my fair share of missteps.)
In the face of such muddling through, what to do next appropriately starts with the process of taking a step back and looking at the situation with an inquiring eye. Ron Pust's essay, "Indication," is an excellent example of how to go about this process. In it Ron examines his presence as a consulting family physician in Kenya. It is a story not just about the merits of symphysiotomy, but also about how culture and personal politics and history all fit into the "bigger picture" of medicine, whether practiced in Africa or the US.
It is interesting that Ron ends his essay with a question. I bet he is still asking himself about his role in the Kenyan situation he describes. I suspect that he is asking himself, as well, about his role in what has become a global health movement.
I know, too, he is asking all of us who have become or intend to become involved in this movement to do the same.
It is what we should be doing.
Next.
Competing interests: None declared
Show Less

Competing Interests: None declared.