Crossing borders, intraculturally and transculturally
Because of sociocultural norms, people often feel more comfortable sharing ideas, issues, or worries with others of the same gender. Here in Pakistan, women commonly talk about household concerns, shopping, or vanity, whereas men typically discuss business, money, and the like. Similarly, in healthcare, Pakistani men and women find it easier to interact and communicate with healthcare providers of their own gender. Sometimes, when a nurse or resident of a client’s gender is unavailable, compromises are made, particularly when the patient is in emergency care, a critical care unit, or a general ward. Compromises are less likely to be accepted, however, when assistance is needed in antenatal clinics, labor rooms, and postnatal care wards. Also, when it comes to breastfeeding, women prefer women for support.
When I was learning about reproductive health during my nursing program, I was taught each and every aspect of the topic—from conception to birth, from abortion to family planning, from prenatal to postnatal—but when the time came to apply theoretical concepts practically, I felt as though I was back at zero. When it comes to reproductive health in Pakistan and providing culturally sensitive care, men have to forgo in practice what they learn in the classroom.
Stated simply, the hurdle is being a man. Men can’t ask about birthing, menstruation, feeding, or other such issues and are unable to be involved in those processes because it is not considered culturally appropriate. If a man enters a ward, the women hide themselves and are apprehensive that they might be interviewed about something that is very personal. Patients in every bed refuse to answer questions or allow us to enter their spaces.
When this happened to me recently, I felt dejected and temporarily left the area. After breathing a sigh of relief, I commandeered a spare overhead table and started writing down on paper everything I knew about reproductive health that a client might want to know. After listing all the information that came to mind, I asked myself: “Why can a gynecologist in Pakistan be a male but a midwife or reproductive health nurse cannot be a male? Are nurses less knowledgeable? Don’t male nurses know as much about these issues as female reproductive health nurses or midwives?
Taking a long breath and holding my file confidently, I went to the bedside of a nearby patient, excused myself, told her who I was, and asked for permission to conduct an interview. After a bit of hesitation, the lady replied, “Yes.” I assured her that, just as a female nurse would do, I would maintain her dignity. I also told her: “You have the right to not respond to questions about which you feel uncomfortable. But remember, this is about your health and the health of your baby, so it would be good if you reply to every question I ask.” She smiled, and, with that, I began the interview.
I recorded the following: 1) patient’s name, 2) complaint, 3) health data that ranged from preconception to last menstruation, from para to gravida, and including diet, vaccination status, and routine work habits. I tried to investigate each and every possible aspect related to her maternal health and present complaint, and she responded willingly. At the end, I summarized all of the important notes I had taken about her history and expressed gratitude for her responsiveness. One more question
As I was moving away from her bed, a small but major thing clicked in my mind. Although I know that I am knowledgeable and prepared, even as a male, to accomplish all nursing tasks associated with an antenatal ward, my priority as a nurse is the client. Had I asked the woman if she was comfortable? Had I given her an opportunity to discuss her fears and problems? Had I adequately explored, beyond diet or exercise, what was happening with her health? No, I hadn’t.
At that moment, it occurred to me why patients prefer having care provided by someone of their own gender. Women face experiences that are common just to them, and they really want to share with each other. Closing my eyes momentarily, I suddenly felt a light coming toward me, and, right then, I got my answer. Maybe I won’t understand the perspective of a woman client the same way a woman can, but I can at least try. After all, a man is a human who also carries emotions in his heart and can therefore empathize with a client, whether of the same gender or not.
Turning back again toward the client, I put a smile on my face and excused myself to disturb her once again. “May I ask you one more question?” I ventured, and she gave permission. Wanting to give her the opportunity to ask or share anything she wanted, even though not on my checklist, I asked, “To be more comfortable, is there something you think you should discuss with someone?”
She stared at my face for few seconds, and, unexpectedly, I saw tears in her eyes as she replied: “No, I am feeling much better now. At last someone has asked what I think and what I actually want. I have to bear all the pain in this complete process, but everyone is thinking about their trouble. Everyone is instructing me to do this and do that. No one has asked what I feel, what I think.” Abruptly turning her face to the other side of the bed, she stopped speaking. At that moment, an older lady, the patient’s attendant, asked me to leave, and I did as requested.
Suddenly, I heard a voice behind me say: “Thank you. Thanks for your help.” I turned around and saw that the client was now smiling. Returning her smile, I left the area saying, “You can call me if you need any assistance.”
Afterward, I reflected on the experience. I reminded myself that, apart from other practical assistance, effective communication is of great help to the client. In my sociocultural context, I am not allowed to help women during the birthing process, but I can help them before they enter into that event and after they have experienced it—both prenatal and postpartum.
Male nurses can increase their study and research in this field, if they are really interested. They can help clients while respecting sociocultural norms and preferences, as I did throughout my rotation. I have determined to continually keep current on the subject while still studying other nursing fields. And in the future, I want to help male nurses, especially in Pakistan, increase their knowledge of and ability to practice in sexual, reproductive, and maternal childcare. Understanding reproductive health should not be limited to female nurses. Male nurses can also be an essential part of this important area of healthcare. RNL
Sarmad Muhammad Soomar, in his final year as a BScN student at Aga Khan University School of Nursing and Midwifery, Karachi, Pakistan, plans to graduate in October 2016.
To read about crossing borders transculturally
, see “When cultures clash
,” by Sally N. Ellis Fletcher.