Addressing Cultural Competency in Pharmacy Education through International Service Learning and Community Engagement
Abstract
:1. Introduction
2. Design
- knowledge—to possess a baseline level of disease and drug knowledge to manage HIV/AIDS and its associated complications;
- skills—to engage in multidisciplinary patient care, to work collaboratively with ethnic and racially diverse staff, health professionals and patients and to use knowledge of health-related culture/ethnic beliefs, values and practices when designing care plans;
- values—to contribute to patient care and societal benefits through advocacy for health improvement and to be accountable for positive patient outcomes.
Reflect on personal attitudes, beliefs and assumptions. Gaining insight how these affect care and delivery. | |
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Generic Cross-Cultural Topics | Specific Learning Activities |
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3. Assessment and Discussion
3.1. Assessment—Students’ Reflection and Explication of Their Learning
- living with the disease—acknowledging patients as experts;
- living with the disease—cultivating community responsibility;
- culture and beliefs influencing health;
- traditional versus Western medicine;
- overcoming communication barriers;
- multidisciplinary teams providing care in resource-limited settings;
- non-professionals as healthcare providers; and
- providing care that is both patient- and population-centered.
How is it that people can break away from the stigmatization of having HIV/AIDS in this society and have the courage to come out and get treatment? I can’t help but believe that… the drama crew consisting of clients with HIV/AIDS is one of the keys to this success... What’s great is that the atmosphere that they create is something that draws people in voluntarily; people get tested of their own accord rather than something they are pressured into negatively. It really creates the ideal environment for detection and prevention of HIV/AIDS. …Given the enormous stigma and discrimination that individuals with HIV/AIDS are faced with in their communities… Members of the drama group are truly an inspiration... They are not hiding behind their disease, and are living openly with HIV. This mentality may take years to develop, but they truly do act as role models for others who are fighting to combat stigma.
What surprised me the most is that clients who are HIV positive are able to take such a devastating disease and channel it into such positivism. Such a drama program is so congruent with their mandate of “living positively with HIV”. The drama group—HIV positive members—was not a self-pity group but rather a group of individuals that have chosen not to allow this disease to take control of their lives. They have been able to accomplish this through music, dance, and theatre to empower other clients like themselves.
…on a visit… the social worker at CURE Hospital—pediatric surgical hospital—commented that many mothers in the rural communities believe that the root of [hydrocephalus and cleft lip] stems from witchcraft and displeasure of the gods… Mothers believe that [those] congenital malformations are the results of curses by those who wish ill of the parent or gods who punish the mother through their children. Had I not read a similar scenario in “The Spirit Catches you and you fall down,” I would have thought the concept of witchcraft and curses was absolutely absurd compared to conventional or western ideals regarding pathology.
I always had the belief that those who believed in black magic, witchcraft, and spirits were less educated and those who have been less exposed to western medicine and culture. However, I was taken aback when my host sister who is an educated, high achieving A level student with aspirations of becoming a doctor or nurse proclaimed she believed a boy in her class was bewitched leading him to lose his mind… she said, “A very smart boy at my school today forgot everything (how to read and write)… yesterday he performed well on his exams, and those who were jealous cursed him… that’s why I fear doing too well on exams…”
…many of the pharmaceutical agents…used in practice are derivatives of plant-based substances… we saw and tasted aloe vera… crushed and smelled the leaves of Camphor… picked leaves off the Artemisia plant, an agent that is the active ingredient in Coartem... a common traditional herbal remedy used by locals to treat malaria when boiled and drunk. When I think of medications, the first thought that comes to my mind are tablets and capsules. It wasn’t until I was walking through the botanical garden in Entebbe that I realized that I was actually standing in a “natural” formulary, because many of the plants are made into drugs. In that instant, it made it possible to understand that though agents may look different… some of the herbs and plants that the locals used were very similar to what we may have as prescription.
Before I came to Uganda [for this ISL experience], I saw communication as a problem… a barrier, and I had a great fear of not being understood. What I‘ve realized is that not being able to communicate through language isn’t a disadvantage, but rather an opportunity; an opportunity to exercise other means of communication [pictures, body language, song and dance] and understanding of one another through other means and media. It wasn’t difficult, because sometimes [communicating to others] can be as easy and simple as a smile…
A group of kids were waiting in the TASO pediatrics clinic…we wanted to try out some of our activities for a workshop we were developing but we did not speak the local language. The only commonality between the kids and I was a smile… in the past I’ve realized that the most learning takes place through “watching” and “doing”… we corralled a group of [children] who spoke minimal English… taught and demonstrated proper hand-washing technique [at the water pump… 50–60 adults stopped in the midst of what they were doing to watch… by one simple act we… educated 10 kids but also 60 adults… I never thought it would entice the adults as well…change through demonstration was more far-reaching in conveying information than I thought…
Every month the medical team consisting of doctors, clinicians, nurse officers, and pharmacy technicians [there was no pharmacist!] will sit down together for a conference to review all the files of HAART therapy patients. In those reviews, they will re-evaluate their CD4 count and the trends they see, whether their antiretroviral therapy is appropriate, and address any other alarm medical concerns they can identify while looking at laboratory results and counseling report.I saw how TASO utilized their resources to the fullest—all clinicians, pharmacy technicians [there was no pharmacist!], counselors, and other staff were expected to work to their fullest capacity to get the job done, and when they could not go about it alone, they consulted together. Coming from a country with some of the best healthcare in the world, I really do envy the advanced collaborative efforts of these clinicians, this is something I would like to see happen more in my own health institutions.
[In the Pediatrics ward] there’s always a nanny present to take the height and weight of the children prior to every appointment and also to observe the children in a process they call “Play therapy”. Children often have difficulty vocalizing how they feel and any discomfort they may be experiencing, therefore the nanny’s role is to watch and document any changes in behavior, activeness, and or visual appearance. I don’t think I would have ever expected to actually see a trained and hired nanny in the clinical setting.
Not only were children medically tended, their families were also provided a facility to work alongside various professionals—counselors, doctors, nurses, religious leaders—to provide care for their children/family and thus allowing them to continue. Poverty is a resonating theme. …CURE hospital ensures meals are provided for the families, transportation is arranged, laundry space is available, and provision of spiritual faith and healing, not to mention coordinated fundraising with parents for the child’s treatment. It is an all-encompassing, inter-disciplinary facility and not simply a medical institution.
3.2. Discussion
3.2.1. Lessons Learned and Application to Other Settings
3.2.2. Future Directions
3.2.3. Limitations
4. Conclusions
Acknowledgments
Conflict of Interest
References
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Share and Cite
Kassam, R.; Estrada, A.; Huang, Y.; Bhander, B.; Collins, J.B. Addressing Cultural Competency in Pharmacy Education through International Service Learning and Community Engagement. Pharmacy 2013, 1, 16-33. https://doi.org/10.3390/pharmacy1010016
Kassam R, Estrada A, Huang Y, Bhander B, Collins JB. Addressing Cultural Competency in Pharmacy Education through International Service Learning and Community Engagement. Pharmacy. 2013; 1(1):16-33. https://doi.org/10.3390/pharmacy1010016
Chicago/Turabian StyleKassam, Rosemin, Augusto Estrada, Yvonne Huang, Birpaul Bhander, and John B. Collins. 2013. "Addressing Cultural Competency in Pharmacy Education through International Service Learning and Community Engagement" Pharmacy 1, no. 1: 16-33. https://doi.org/10.3390/pharmacy1010016