By Sipho Ndereya
The Patient Partner Project was introduced to me as a Special Study Module (SSM) in my second year as a medical student at the University of Cape Town (UCT). The project description advertised an opportunity to deepen my understanding of the importance of context, culture, language and communication in the clinical setting and an opportunity to see how a better understanding of these aspects can lead to a more holistic understanding of patients as people. The project also offered internationalization which presented a unique opportunity amongst the Special Study Modules. I was attracted to the project because I was sure that the content I would learn would benefit me as a student and a developing health professional. I was intrigued by the idea of seeing another part of the world as a part of the project.
In November 2018, three of my classmates and I were granted the opportunity to travel to Belgium and visit Karel de Grote University College Antwerp. This piece of writing is a reflection of my thoughts, feelings and assumptions before, during and after the international mobility. I will reflect on my thoughts and feelings before leaving for Belgium, my experiences at Antwerp University Hospital and Amphia Hospital in Breda and discuss how the internationalization has benefited me as a developing integrated health professional while reflecting on how communication played a role throughout the experience.
I felt excited about travelling to Belgium as it was my first time flying overseas. I was eager to explore the city, eat Belgian waffles, and learn more about Belgian culture. While I was excited, I was also worried about what my experience as a tourist would be. I was concerned about possible language barriers when interacting with people. I was not sure how I would be treated by people in the country. I thought of John Berry1 who asked, “What happens to individuals, who have developed in one cultural context, when they attempt to live in a new cultural context?” I decided not to fret about this because I knew that I was not travelling alone, and I knew that we had hosts who were happy to host us.
Hospital visits were a major part of our internationalization program. All four UCT students visited different wards in Antwerp University Hospital and Amphia hospital in Breda in the Netherlands. We shadowed nurses who worked in these wards so that we could observe how healthcare is delivered and learn about the different healthcare systems in Belgium and the Netherlands. Every nurse I shadowed was able to speak English, Dutch and sometimes a host of other languages. They answered all my questions about the healthcare systems they worked in and acted as translators when I wanted to ask patients questions about their experiences in the hospitals.
Prior to visiting both hospitals, I felt anxious about navigating language barriers between myself, the health professionals and the patients because. I was afraid my inability to speak French and Dutch would be disappointing for the patients and complicate my interactions with the health professionals. However, the nurses’ ability to speak English made communication of information easy and this realization made me feel comfortable during my entire experience. I also realized how language can help one feel integrated in an institution2. Through the use of healthcare discourse, my understanding of terms, concepts and theories allowed me to understand and participate in the conversations with health professionals in the wards. When I met a refugee who spoke neither English, French nor Dutch I realized how a lack of a shared form of access can bar an individual’s access to healthcare and limit the individual’s ability to integrate become a part of the society they have joined1.
The number of patients in each ward was considerably lower than I have been exposed to in the public South African Hospitals that I have been to. There were also more nurses per ward at both Amphia Hospital and Antwerp University Hospital in comparison to the public South African hospitals. I felt concerned about the South African health system and thought about how the patient to health professional ratio can affect communication between health professionals and individuals as well as overall care. When I discussed my thoughts with the nurses I was shadowing in Breda and Antwerp, they explained that they shared similar concerns about their own working environment. We discussed our ideas on the causes of the healthcare problems and theorized about possible solutions. Prior to these hospital visits I thought that these concerns were unique to South Africans, I realized that having the opportunity to discuss your concerns can eradicate the feeling of isolation that one feels when one believes one is suffering alone. I found it comforting that even though the contexts, healthcare systems and health professional to patient ratios in Breda, Antwerp and Cape Town differ, the people working in the institutions share similar concerns. I think that there is value in people from different backgrounds and similar concerns coming together to share ideas and find solutions for the problems that they face.
As well as visiting hospitals, we also traveled to Gent to visit a community health centre in the suburb of Nieuw Gent. The centre we visited is one of ten CHCs in the city. The CHC was particularly different because of their patient population which they described as “super diverse”. The CHC serves a population of young patients with a minority aging population, representing 91 ethnic origins and mixed socio-economic status3. The business manager of the CHC took us on a tour around the facility and showed us how the team uses a primary healthcare approach. She explained how their multi-professional team is community-oriented and collaborates for patient management. We were shown statistics on the health problems faced by community member, research on how many community members were affected by language barriers, and we were shown how the CHC contributes to providing social support in the community. She explained how the CHC’s community orientation meant that the health professionals and social workers worked towards understanding each individual’s narrative so that they could provide holistic care.
I felt excited about Nieuw Gent CHC because it had a variety of patients with a range of backgrounds. I thought about the South African context where the primary healthcare approach is in use4. I felt impressed by the CHC’s research into their community, its medical, economic and social concerns. I think that their research and understanding of their community helps them to formulate appropriate plans for healthcare and community intervention. Divinsky5 explains that a clinician’s understanding of a patient’s life story improves the relationship he or she will have with the clinician, it improves the overall quality of care and improves job satisfaction for the clinician. At the end of the visit I felt inspired about taking the time to learn more about people and their narratives as a part of the healthcare process.
An integrated healthcare professional is characterized by his knowledge and skills in his professional field, his ability to communicate empathically and his ability to reflect on his actions with a goal of constant improvement.6 Becoming an integrated professional is a lifelong journey. I believe my experiences in Belgium allowed me to develop in every dimension. Each activity throughout the experience elicited different thoughts and feelings on which to reflect. I think that constant reflection allowed me to process my thoughts and feelings timeously and contributes to increasing my knowledge and developing my ability to empathize. My knowledge and understanding of different healthcare models were broadened as I learnt about the Belgian and Dutch healthcare systems. The focus on communication throughout the trip helped me to understand the importance of different forms of communication as well as familiarizing oneself with patient narratives. I believe that this understanding has strengthened my inter-personal skills and that taking the time to understand patient narratives will improve my social understanding and ability to empathize.
I am extremely grateful for the opportunity to visit Belgium. I was exposed to healthcare systems foreign to my own and given the opportunity to see how these systems work. The experience allowed me to reflect on language and communication affect general social interactions as well as the interactions between patients and healthcare workers. It was a unique experience that I will never forget.
- Berry JW. Immigration, Acculturation and Adaptation. Applied Psychology: An International Review. 1997; 46(1), 5-68.
- Gee JP. An Introduction to Discourse Analysis Theory and Method. 2nd ed. London, England: Routledge Taylor and Francis Group; 2005.
- Author unknown. Welcome to Community Healthcare Centre Nieuw Gent [Notes]. Nieuw Gent Community Healthcare Centre; information provided 2018, Nov 22.
- Alperstein M, Atkins S, Batley K, Coetzee D, Duncan M, Ferguson G, Geiger M, Hewett G, et al. Primary health care fresh perspectives. Cape Town, South Africa: Pearson Educational and Prentice Hall; 2009.
- Divinsky M. Stories for life: Introduction to narrative medicine. Canadian Family Physician. 2007; 53, 203-205.
- Duncan M, Gibbs TJ, Olckers L. Developing health science students into integrated health professionals: a practical tool for learning. Biomed Central. 2007 November 15