By Themba Ndovi
Healthcare is one is one of the measures used to assess the success of a state’s economy. The importance of healthcare to the world cannot be emphasised enough. Health is important the for the wellbeing of people. Good health allows people to function well in society, and thus, building up the economy. Integral to health and the wellbeing of patients, and the medical structure is communication. Communication is the most vital factor for almost all things to work in our society. Without effective communication; projects, structures and all events seem to fail dismally. The development of healthcare systems and communication is strongly linked to a society’s history and context. In order to fully understand a system, you also need to understand it’s people, structures and discourses, as the history of a place often provides reasons to explain the way things are in a society. In order to have a better understanding of all these concepts, I was able to have a glimpse of two extremes in terms of economic progression, healthcare systems, historical context, and community development strategies.
Along with three colleagues from the University of Cape Town, I embarked on a journey to Belgium in order to see, learn and understand about the different systems and structures in Belgium. It is also important, to see the close links that communication, culture, and healthcare have. I have taken a look from a South African (and African) perspective as well as a Belgian perspective. In many aspects, the two nations are very different, however, they do share a number of similarities too which I hope to convey in this passage of writing.
It is often said that “A healthy nation is a wealthy nation.” More importantly, however, healthcare improves the quality of life of families and is important to the society because people do get ill, accidents and emergencies happen and this is where hospitals and healthcare staff need to step in, treat and manage different types of diseases. Many of people’s aspirations and desires cannot be met without longer, healthier, happy lives. Healthcare is defined as “the diagnosis, treatment, prevention and management of disease, illness, injury, and the preservation of physical and mental well-being in humans”. The healthcare industry is divided into several areas in order to meet the health needs of individuals and the population at large, with services being delivered by medical practitioners, health and rehabilitation professionals, and allied health professionals. The role of public health and health promotion in the provision of healthcare services cannot be over emphasised.
I will further reflect upon and evaluate the impact that culture and the society has on healthcare as well as the people’s attitude towards healthcare.
The World Health Organisation (WHO) states that health policy is “the decisions, plans, and actions” that are taken in order to achieve particular healthcare goals within a society. The aim of healthcare policies is to define a vision for the future which in-turn helps to establish targets and points of reference for the near future. It also outlines priorities and the expected roles of different groups; and it builds consensus and informs people. In other words, this is the foundation of any healthcare system.
Culture, however, is a way of life and it is the way we do things. It is defined as the way of life of a certain group of people or society and it includes the way people think, their beliefs, behaviour, customs, traditions, rituals, dress, language, art, music, as well as writings. The cultural differences and way of life of people have a significant impact on the way they see their health and wellbeing as well as their behaviour towards healthcare. It affects their attitude and understanding of the cause of an illness and how to manage them as well as the consequences of medication and medical treatments. This also has an effect on people’s expectations on healthcare delivery.
There are diverse groups of people living in South Africa and Belgium. These are both as a result of migration and they are diverse in the fact that they are of different age, sex, gender, race, ethnic background, colour, religion, beliefs as well as cultural background. It is important for health and social care practitioners to understand and cope with all these differences as they affect the way people react to healthcare provision. In this way, Belgium and South Africa are quite similar, however, the significant differences arise in the way things are carried out in healthcare, policy making and community activity. With South Africa’s devastating history and the past apartheid regime, a lot of people of colour (and particularly black people) have been left behind economically. These groups living in poverty, therefore, struggle to get employment, have a very low standard of living, and do not have access to basic needs – especially comprehensive healthcare. In South Africa it is the majority who are severely disadvantaged. In contrast, in Belgium the minority groups living in poverty are disadvantaged in relation to their setting and context, however, it does not seem as severe as it is for those who are disadvantaged in South Africa.
After having spoken to someone who, unfortunately, had lived through poverty in Belgium, we were able to unpack what it really meant to be living through poverty in a first world country and how that impacted the impoverished service users. This lady was in fact very open and ready to speak to us about the ordeals that she has had to encounter and how the policies and the structures of the Belgian system influenced her, her family, and their situation. The lady explained to us that she, like many others, initially struggled to gain access to many basic amenities. She had a low level of education and struggled to get permanent employment. Most of the work and jobs available for people without secondary or tertiary qualifications are often not permeant or are very low paying, or in worst case scenarios, both. The Belgian government provides a grant to people living below a certain income. Housing is also provided by the government, however, required an application to filled out by the individual and then further processed. Although the system is not able to reach everyone that is affected, I think it is simple enough for the people to understand, and structured in such a way that resources are distributed equally, unlike the case in South Africa. South Africa has structures and systems in place in order to combat situations like these, however, I think the major downfall comes through the distribution of resources and being organised in such a way that system is able to help as many affected individuals as possible.
I felt very happy and pleased to hear, when she mentioned that she indeed did have access to good comprehensive healthcare. The Belgian healthcare system is structured in such a way that allows Community Healthcare clinics (CHCs) to be setup. These clinics are based in and around communities and serve the residents of those communities. All residents are only required to have a form of identification and then they can be assisted. This is very critical to the healthcare system, as it allows patients to see a medical professional they are familiar with, it allows the health system and referral system to work smoothly and efficiently and most importantly it allows for patients to receive healthcare quickly. The one important factor about the CHCs is that patients are not charged medical bills, it is subsidised by the government. This is one of the many ways the Belgian government tries to manage and helped the disadvantaged people of the country too. Without deeper insight, one may think that Belgium, in comparison to South Africa, is able to manage its impoverished population with better care, however, there are a number of other factors that play a key role in determining the success of the policies and management plans that the governments have in place. The two factors that I think play an important role, especially in the South African context, are the population size and the history of the racial background of the country. The population size makes it very difficult for the government to effectively reach out to the majority of affected people. The South African Apartheid history also plays a significant role, as the nation was racially divided, and saw black people and non-white people being excluded and discriminated against. This led to white poole being in higher positions in many societal aspects, and the non-white population became severely disempowered and disadvantaged. Therefore, the majority of the impoverished population is made up of non-white South Africans. Therefore, any reform policies and management plans must take into considerations, culture and history. Which both Belgium and South Africa must do due to the diversity of the populations, with multiple cultures, groups of people, languages and discourses.
Discourses can be seen as the way a particular group of people communicate, and it is often seen amongst a group of people within the same cultures. The idea of discourse is often important in the healthcare context, and treating patients. This allows for a form of healthcare to take place where the patient is allowed the freedom to describe how and what they are feeling. This is the idea of narrative medicine, which I will discuss in further detail alongside culture.
Different discourses are important, because they are integral; to the formation of communication in a particular group of people and forms an integral part of that group’s identity. It is unique to group of people, they’re speciality and their way of living.
I was able to appreciate and understand the uniqueness of different discourses when touring around the University of Antwerp Hospital, the Amphia Hospital in Breda. We were taken around these respective hospitals by nurses and shown around the different wards and really got an in-depth look at how the healthcare system in Belgium and The Netherlands works. The nurses in each of their respective wards, made a very big effort to take us around and fully grasp what it was like to work in their positions. This eagerness and passion to teach us, and show us around was already a big indicator of how well the healthcare system runs in The Netherlands and Belgium. The nurses that took us around were all dutch speaking, however, could speak english very well too. The nurses that I managed to go around with, were able to explain a variety of concepts to me, however, they would get stuck on the odd english word or even entire sentences. What struck me about this, is that I was often able to complete their sentence or pick up whatever it is they were trying to because of the shared medical discourse. We may not have had the same ethnic cultural background, but we shared the same medical culture, and therefore, discourse, thus we were still able to communicate, even though that too was in a different language. The idea of discourse is applicable to many contexts and scenarios, but no more so than medicine.
The idea of culture is one that has many different definitions, however, is important to each and every individual and group of people. In 1952, the American anthropologists, Kroeber and Kluckhohn, critically reviewed concepts and definitions of culture, and compiled a list of 164 different definitions. In the world today, for the purposes of respectful social interaction, it is important for people to understand each other’s culture. I personally view culture as a common way of life amongst a group of people. Culture encompasses a variety of things, such as; food, what people wear, how people wear it, religion, our language, how we speak, marriage, music, our beliefs in terms of what is right and what is wrong, how we sit at the table, how we greet visitors, the way in which we treat loved ones, and how we go about our day-to-day lives. Before I further explore the idea of culture, I believe it is important to note that I learned that, in fact, culture plays a big role in every part of the world. From South Africa, to Belgium to various other reports of the world. It influences all that we do, even in our professional work capacities. This brings up the idea that people, can in fact have several cultural identities, and that the idea of culture extends beyond the household setting. This broadens the concept of culture even further. Therefore, there are ‘medical cultures’, ‘business cultures’ and ‘political cultures’ etc. The different characteristics of culture are, for example, that culture comprises of different layers. ‘Culture is learned’ and this suggests that culture is something learned from those that you interact with and not something that you genetically inherit. I think that culture serves an important role in our society, because it offers guidelines and forms a path for people to think in a uniform way. Culture affects almost every single facet of life. Culture doesn’t only affect the arts, but also has an impact on the science world.
In conclusion, the trip to Belgium was, simply put, an eye-opening experience. This was an invaluable opportunity to gain insight into a first world country, and see how healthcare, communication and community outreach policies are run. The trip to Belgium taught a lot lessons to myself and my peers. The importance of history, culture and discourse to healthcare cannot, and should not, be understated at all. These all go hand-in-hand in order to provide comprehensive healthcare to patients. The ideas of discourses, communication, and culture all need to be further investigated deeply in order to reform a better medical structure all over the world. The fact that were able to enter another country, experience the culture, the way of living and observe and learn about the various structures, is truly amazing and inspirational.