"Flavouring" ethnicity, culture and discrimination ...

... in the context of preparing our health care professionals.

Much has been written in the Ghanaweb-Feature Article as of late in relation to the idea of ethnicity, culture and discrimination by Kofi B Kukubor on the 29th November 2006, of which he concluded with the assertion that “…deprive a people of their ethnicity, their culture, and you deprive them of their sense of direction or purpose”. This is absolutely true!

In the context of preparing our health care professionals such as doctors, nurses, occupational therapists, physiotherapists, pharmacists and so on, I intend to briefly highlight and to ‘flavour’ the idea of ethnicity, culture, and discrimination as expected of a curriculum that purports to train/educate dedicated professionals to serve within a multicultural/ethnic/tribal society. Surely, there are multiple barriers to be overcome by the educators and practitioners as well and we must bear that in mind.


One thing to be equally borne in mind is that every health care worker be he a doctor, nurse, pharmacist or x-ray technician for example, comes from a particular social group…and we cannot come to a care situation free from our religious, social differences. As Henley and Schott (1999) asserts, “…the only person who can tell you that will or will not be right for them is the patient. If we really want to find out, we have to ask”.


This approach links with the notion of social capital which is a property of groups rather then individuals .One can argue that social capital is a mechanism that ties individuals neatly with the health institution and organisations through certain types of social and other networks. What is urgently required here is, our active participation in these networks which fosters social trust which in turn underpins cohesiveness and collaboration. What I mean by social capital in this context is that, it is an idea which lays much emphasis on cooperation, participation and social inclusion.


A noted question often asked by your doctor and or the nurse is one’s ethnicity, tribe and culture which may seem intrusive into your private world? Oh no!, not at all!, but a quest to enhance ones care needs if appropriate. Ethnic or ethnic culture refers to the broad cultural patterns linked to countries or to nationalities. Avtar Brah points out that ethnicity are maintained through ’…a belief in common ancestry, claims to a shared history that gives shape to feelings of shared struggles and shared destinies, attachment to homeland which may or may not coincide with the place of residence, and a sense of belonging to a group with shared language, religion, social customs and traditions’ (Brah, 1993).


Culture as a term describes the pattern of life, beliefs and customs of whole populations or subsections of populations including specific ethnic groups. Cultures generates their own sets of beliefs about the meaning of illness for example, mental health, the factors that influence it, interpretations of ill health and appropriate responses to it In general therefore, culture influences how we respond to the world around us.


Furthermore, in an effort to provide culturally congruent care to patients it will be reasonable for our health care professionals to note that caring exists in all cultures and that the way caring is carried out is culture specific. In addition, our understanding of the meaning of care varies cross-culturally which must be considered within a caring or social encounter.

Let me take for example, the nursing curricula which aims to prepare students for clinical practice and to some extent some educators go to great lengths to address the cultural needs of clients. Curricula content frequently recognises that conflict exists between students from diverse cultures/ethnic/tribes. They are also cognisant with problems experienced when assessing and using services.


Gleaning from my observations and supported by the literature, it can be asserted that anti-racists and anti-discriminatory strategies have been ignored in education of health care professionals such as nurses, doctors, pharmacists, occupational therapists etc (O‘Hagan 2001). There is still a reluctance in Ghana and even in Britain to explore racism and or tribalism, the conflicts that exists and the perceptions and experiences which contribute and reinforce tensions (Shah 1998).Experience suggests that lecturers in nursing and in medical care are unskilled in recognising or handling racism and tribalism in the classroom or clinical setting. There is a need to suggest that nurses or medical lecturers need to understand how students from other cultures or tribes cope with studying outside their tribal regions or homeland.


Discrimination is a contentious issue to write or to talk about because it has the ability to ignite explosive responses. In any case, why do we discriminate against the other person? To some of us who has lived, studied and worked within a multiracial/multi-ethnic/multi-tribal settings during our lives, the experiences gained are too emotive to be shared in this article.


In my view however, discrimination is a theoretical concept relating to the analysis of situations and problems but broadly the term refers to the beliefs, practices and institutions that discriminate against people based on notions of perceived or ascribed race. It is worth noting that racism and tribalism is a complex and sensitive issue which engenders anxiety, stress, evokes blame and incurs feelings of anger or guilt amongst students and lecturers.


Should we knowingly or unknowingly create a culture of tribalism or racism either ‘covertly’ or ‘overtly’ as seen in the Macpherson Inquiry (1999) here in England, then the democratic processes currently instituted in Ghana will fail to materialise. This understanding is a recognition of the unconscious, deeply rooted and socially constructed beliefs which inform prejudice and stereotypes.


A definition used by Foster (1990a, p. 5):‘Practices which restricts the chances of success of individuals from a particular racial or ethnic group, and are based on, or legitimised by, some form of belief that this racial or ethnic group is inherently morally, culturally or intellectually inferior.’ Reflectively, one can guess the impact this definition will have on our current ailing educational process!

In the process of educating our health care professionals to take heed of cultural issues in their everyday practice it is important to make students and educators feel that they have an important role in caring for patients rather than learning through principles or abstractions.


As a lecturer said to me in response to a research question some time ago:


“keeping things topical, things that are happening everyday, really humanising learning within a multi-ethnic/multi-tribal/cultural setting so that you can make a difference to the lives of sick people”.


To nurture tribalism via the ignition of tribal sentiments as a political mechanism in which to govern, does lead as to the abyss and we must watch out-fellow brothers and sisters.