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.
I 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.