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Tit For Tat !

Tit For Tat !
November 16
14:40 2019

By: Dr. Abigail Joseph

Belize is considered a culturally diverse country. We are ALL different in our own way. We think differently, we see things from different angles and we interpret the same things differently. Imagine going to an art gallery. Your interpretation of a specific art may be very different from that intended by the artist. Looking at the brush marks and patterns, the color choices all stir different emotions for different people. One person might comment – “It speaks to me!”, while if I looked at it I’m almost positive the art doesn’t speak my language because I would hear nothing.

It’s just the way we are. DIFFERENT. My dad is the main cook in my/his house (we have difference in interpretation to that one as well), anyways back to the story – his technique in lighting the stove is quite different from mine. The stove comes with a “lighter” button, so what my dad does is turn on the burner he wishes to light and then proceed to pressing the button. Most of the time about 4-5 seconds have passed, so when he presses the ignition it generally does a large puff. My mom throws a fit every time he does it because her view is that someone will get burnt. But for my dad he is fascinated by the puff part of the fire and since he has never been burnt he keeps doing that. Eventually, I have come to terms with the fact that it is something he will always do and I make sure I’m nowhere near the stove when he does it – and just leave him be. People are different and the sooner we realize it and come to terms with it the easier life becomes.

Now at times our cultural differences extend beyond our homes and the interpretation of art. Sometimes it infiltrates our workplace. This is particularly challenging because if you have a workplace like mine where you interact with people of different ethnicities and educational backgrounds, holding your tongue can be particularly challenging. I remember one time while doing 2 years of service in a very rural part of our country there was a phase where many were sick with what appeared to be the flu. As a doctor, my job is to treat the sick – but I am also responsible for preventing illnesses and protecting those that are in the waiting room. If you are observant, whenever you walk into a clinic or hospital there are always posters about hygiene, washing of hands and some would have cough etiquette or signs that say masks are available. Now, because I worked with persons of a different race and of a different language from mine, I tried being considerate and printed pictures to represent the forms of prevention. I also made sure that when persons were coughing in the waiting room the nurse would give them a mask upon triage. It wasn’t long before there were rumors of me and name calling using their language – “scornful” was the exact word one of the patients told the other.

My secretary came in to my office and explained to me that there was chatter in the waiting room – the reason people were given masks was because the doctor scorned them and didn’t want to breathe the same air. For a moment my heart was broken that anyone would think that of me, when my intention of enforcing protocol (masks are not my idea, but rather one that comes direct from the Ministry of Health for your protection) was for the safety of each person sitting in the waiting area. Rumors are very easy to spread and a very hard thing to control, and many times these rumors arise from a bad experience where someone did not take the time to explain and made sure that their explanation was understood.

The only thing we can do is to seek to understand before making a scene. It is highly possible that maybe my triage nurse didn’t take the time to explain the need for the mask and just handed it to the patient. It is highly likely that the patient is illiterate and was unable to read the signs around the clinic that explained the purpose of the mask. To be honest, there are people reading this now who do not know the reason why you are asked to wear masks at the clinic. Masks are to prevent you from breathing droplets coughed by other patients which may be a different strain of the influenza or even a bacterial infection such as Tuberculosis, but also to prevent you from coughing droplets of your own infection into the atmosphere that others may accidentally inhale. Its purpose is for the protection of everyone. But if we don’t take the time to explain things, an individual leaves with a false impression.

Earlier this week I scrolled on Facebook and saw a couple comments by doctors in response to a post made on BBR (Belize Business Review). I didn’t search for the post, but from what I gathered through commentary, basically the patient suggested that doctors are incompetent and their only “cure” for Diabetes is to “chop” off a person’s foot without any regard for the quality of life after. People are entitled to their opinions. However, it is a problem when it becomes a target practice. After reading it all, I was also saddened at how rock bottom our health literacy is. It is easy to become angered reading posts on Facebook or listening to the daily shush in the waiting rooms, it is natural to become defensive, but at the end of the day Health Care workers are called to Educate, take time to explain and if necessary – more than once. If we only react, it completes the cycle of ignorance. Developing a culture of respect between patients and professionals is Important. While patients are not charged for their words, we are looked upon with greater scrutiny. It is just the way of the world.

A study published in the Journal of General Internal Medicine stated that the average doctor gives a patient about 11 seconds to describe their symptoms before interrupting them. Another study from the same journal stated that only 1 in 3 doctors give patients the opportunity to explain themselves fully at the beginning of a consultation. I am uncertain which is worse. This is probably due to the doctor/patient ratio at our centers and time “permitted” for each consultation. This factor affects our listening as well as allotted time for us to explain thoroughly. Health care workers and patients are on different sides of the same spectrum and it is prudent that we get them to see our point of view in order for them to understand. It is easy to discharge a person and send them off with medications in a bag, or just deal with the complications when they arise. While it takes more from us to explain, it benefits the patients that are willing to listen and take heed in the longer run. Quit fighting Tit for Tat and join a much bigger battle. A fight worth fighting.

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