What Travelling the World Taught Me About Patient Care

sas pt care

When I heard about Semester at Sea for the first time, I admit it was the idea of travelling the world that attracted me. I knew from a little bit of experience that travelling would enrich my perspectives and teach me more than any classroom, but really I was just thinking about all the places I had always dreamed of visiting, that could now become a reality.

Justifying such a long absence from campus meant that I had to identify teachable moments the program could provide. I came up with a whole report which I presented to my faculty (and which they miraculously accepted). I mentioned the virtues of travelling, and the work I would have to put in to carry a double course load, and then I mentioned the research I wanted to do: experiencing first-hand the public healthcare facilities in the various countries, as well as visiting alternative healers and assessing their role in primary healthcare.

My faculty thought this appropriate, and I did all these things during my voyage. No doubt it was an incredibly educational experience. My grasp of public healthcare skyrocketed, and I really got to appreciate the worth of alternative healers in the primary healthcare setting, and the role that they could play in disease prevention and health promotion.

What I did not anticipate was how my experience would influence my approach to patient care – in fact, it took me a few months back on home ground to verbalise it. Maybe I knew some of these things already, and maybe the voyage just solidified them in my mind. But that is inconsequential.

From the Japanese, I learned humility. The bow was not entirely new to me, due to my background in karate, but the ubiquitous custom in Japan crept into my soul. Yes, there are different bows, but I saw old wrinkled grandpas bowing to little children, and the two-way respect and humility was special to me. Healthcare workers can easily get carried away by their importance in hospitals and clinics – we savin’ lives, yo! The bow reminded me of the worth of humility.

Funny story – for the first few days after our departure from Japan, we were inclined to bow to each other on the ship. In a few days, the custom had become normal to us.

From Buddhist cultures, I learned not to touch a person’s head (unless it is with therapeutic intention). It is such an instinctive thing, to pat a child on the head. I do it, a lot. But I’ve noticed that children don’t like it. Yes, they might like it when their mother plays with their hair, but have you ever seen a child who thinks it is nice to be patted on the head? Now that I think about it… I haven’t. Anyways, in Buddhism it is not appropriate to touch someone on their head. Incidentally, it is also not appropriate to point the soles of your feet at anyone. In any case, I learned to re-assess my “terms of endearment”. A child patient is still a patient.

From many cultures, I learned to give and receive with two hands. I had thought that this was mainly a South African thing, but that was a silly assumption. Before, I had considered it simply as “a nice custom but not mine” – but the more I encountered it, the more I realised how much I liked it. Think about it: turning to face a person fully so that you can give or receive something with both hands, forces you to give them your full attention. I first noticed a few weeks ago how terrible it looks when a doctor takes a document from a patient with one hand outstretched, hardly looking at them.

I learned the value of talking about food and other everyday things. When you are new to a person’s environment, maybe talking about their religion or their visits to a traditional healer is not the best icebreaker. But around the world, people will tell you about their food. What they had for breakfast – or what they would have, had they the money. They will tell you about their marketplace, and even about their toilets. With patients it is the same. In many cultures, somebody will not come right out talking about what they consider to be embarrassing symptoms. They need an icebreaker. We all need to eat, and that is an equaliser in awkward situations. And any case, it is not such a bad idea to know what dietary habits your patients have.

I learned the value of speaking someone’s language. Without fail, people’s faces lit up when we spoke to them in our broken attempts at their language. We said hallo, and how are you, and where is the bathroom? We asked about train timetables and bookshops and good food. Our tones were all wrong in Mandarin and we spoke too slowly in Vietnamese. In Morocco I relied on the tiny Latin foundation I have to decipher French and Spanish. But without fail, a foreigner would be more warmly welcomed if they showed that they TRIED. How much more will a sick patient not appreciate it when their doctor, who speaks one of the other official languages in South Africa, shows that they can try.

In the same vein, I learned to tailor my English (because invariably I had to switch to English) to someone who does not have a full grasp of it, without speaking down to the person. People are inclined to think that anybody who does not speak good English, but the truth is that I met some of the most intelligent people I have ever met abroad, in countries where English is not the main language.

patients quoteI am sure that some will think that these things are silly. Many will say that the importance is the medicine you practise, the diagnoses you make and the treatments you dispense. But we need patients to work with us on their treatment plans. We can dispense the medicine, but we can’t make them drink it. We can’t make them control their blood glucose. We can’t make them practise safe sex. They need to believe that the doctor believes in their worth to do that. They need to believe that being healthy is not a myth. And I guess I’m just an idealist who still thinks that if enough people are courteous and kind, eventually, the world will catch on.

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21 thoughts on “What Travelling the World Taught Me About Patient Care”

  1. as always your observations are acute and well phrased. physicians needs a patient’s cooperative consent in order for a successful treatment especially where chronic or vague complaints of ill-being are involved. I am convinced that most illnesses are not separable from complex environmental factors and the way a person is linked to it.

    the regard other do or don’t have for a person’s value contributes greatly to their sense of well-being and will contribute to their quality of life and health. physicians without regard for the basic individual integrity reinforce feelings of helplessness. illness and the way we treat patients and people in general are often symptomatic of what is wrong with the environment in the first place and a hint at where to make some maybe small but none-the-less vital changes to treat a patient successfully and with a chance to make long term changes.

    not touching a patient without their expressed consent in that sense might just be the first step to demonstrate that the patient is held in high regard by his or her physicians and the first step to her or his willingness to regain health.

    thank you for another great post! barefoot greetings, kristina

    1. Thank you, Kristina! I always appreciate your thoughtful feedback. I really enjoyed the part about illness being symptomatic of what is wrong with the environment. I feel that the further we get in our training, the more people begin to forget the worth of interpersonal dynamics – as if a good contextual assessment is no longer necessary now that we’ve got the SKILLS. Anyways, I really hope that the holistic patient approach can regain strength in the medical world.

      1. it will, under circumstances that are not necessarily desirable. for lack of other options, for example, that we increasingly face. the next decades will bring unprecedented challenges to understand what it actually means to be human, and our medical professions worldwide will reflect that understanding or lack hereof. Thank you for your answer, by the way. greetings to you and continue your thoughtful reflections! kristina

  2. Hat dies auf Art & Writing rebloggt und kommentierte:
    i read this blog regularly for its insightful and acute observations. the barefoot medical student almost runs a kind of small press here, putting much work and time into well researched blog articles. have a look at this article, for example, really regarding the way health care provider’s attitude towards their patients.

    i couldn’t agree more with her. physicians need a patient’s cooperative consent in order for a successful treatment especially where chronic or vague complaints of ill-being are involved. I am convinced that most illnesses are not separable from complex environmental factors and the way a person is linked to it.

    the regard other do or don’t have for a person’s value contributes greatly to their sense of well-being and will contribute to their quality of life and health. physicians without regard for the basic individual integrity reinforce feelings of helplessness. illness and the way we treat patients and people in general are often symptomatic of what is wrong with the environment in the first place and a hint at where to make some maybe small but none-the-less vital changes to treat a patient successfully and with a chance to make long term changes.

    not touching a patient without their expressed consent in that sense might just be the first step to demonstrate that the patient is held in high regard by his or her physicians and the first step to her or his willingness to regain health.

  3. The two-hands thing. I’ve never thought of it that way, but having spent several years teaching in a black school I find myself also doing it still. Thanks for sharing these thoughts. They have just as much application on my field of counselling as it does in medicine, I think.

    1. They definitely do – I would wager that they have application in any field that deals with people, and in fact in our everyday contact with one another. Thanks for stopping by, I always enjoy meeting new S’Affer-bloggers!

  4. great post! thanks for sharing! =) ur entries have always been something that I look forward to and this, as usual, is thought provoking and well phrased! Didn’t know that the two hands thing is being practiced in South Africa as well, always thought that its just an Asian thing! Love the way you interpreted this custom as a way of giving full attention and respect!

  5. I agree with Kokkie & you – it applies to any situation where you are dealing with people. I was a travel agent for 10 years, and the fact that I had travelled and lived in countries where English wasn’t the main language made it that much easier for me to communicate with foreigners, as well as locals who’s first language was not English. You are right – it takes quite some skill to be able to master speaking “broken English” without sounding condescending.

    As for your other points, I completely agree. Travelling opens your eyes to value of culture, and the nuances that a culture give interpersonal relationships. I truly appreciate what I learnt from my journeys.

  6. I really liked this post a lot. Actually this is the first time I read your blog, one of my friends from college sent me the link to this post because I really really really like to travel and in a few years I would like to go travel abroad.

    I can relate to a lot of things you said, even though I never practiced medicine abroad. But still, in my own country (Portugal) a lot of the things you said are very useful.

    Thank you for the post!

  7. I remember a time long ago when the first Cuban doctors came out to SA to help in rural hospitals – we all found some way to go and see how they were practicing medicine with not much hope or faith in them – only to learn SO many lessons in primary healthcare and respect from these gentle and kind doctors who took so much time with each patient and spent much time discussing prevention with each and every patient. The one major difference I saw between the SA state doctors of the time and these young Cuban doctors was the total respect the showed to their patients. Good lessons learned. I LOVE how you explain the two hand thing – its so very true – I just never thought of it that way.

    1. We have some Cuban-trained students at our school. They struggle to adapt to the different approach to medicine, but I agree with you that it is incredible to watch them work. There is so much we can learn from each other, if only we are willing!

  8. Great post! From now onwards I will try to always give and receive with both hands I never thought about how rude it was not to.See you made a difference in my life without giving me a single pill 🙂

  9. I really enjoyed what you said about humility and how many healthcare professionals lose that sense of serving others as they see themselves as set above the people they are caring for. It’s such a beautiful quality to have and one that people value when they see it in others particularly in someone who has more authority or seemingly has a power over us. So thank you for reminding me that there are many people out there seeking to be humble and understanding the meaning of true, person-centred care 🙂

    1. Ah, thank you for your kind comment!I think many doctors forget because they feel that their job is to save lives first and be kind second, and I can understand why there is that perception (especially in emergency situations), but in the end I think that being person-centred will make a massive difference.

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