We are family!

One of the many privileges of living in another country is getting to experience and learn from another culture. I have been blessed with a number of Ugandan friends and colleagues who have let me ask them many questions about how and why things are done a certain way, where traditions have come from and what is important here. It has given me the opportunity to consider why I do what I do in the UK, how what I think is influenced by how I have been brought up and the culture around me, and what I can learn from the Ugandan way of life. And one of the main areas I’ve been thinking about is family.

I have a very small family (in numerical size and stature!) – one brother, one aunt & uncle, two cousins. In Uganda, this would be considered strange as large families are the norm. Most people have multiple siblings, aunts, uncles, cousins etc. Life expectancy is lower here than in the UK so it is not unusual for children to be brought up by other family members and some men have more than one wife, so may have children from different marriages in one family unit.

My small but great immediate family in Uganda!

I was recently invited to attend a traditional Ugandan wedding and the difference in size of families was soon apparent! It was an amazing time of story telling and dancing, as they acted out the groom being sought out by the aunties and presented to the bride’s parents for approval. But whenever the aunts, cousins or siblings were called upon to do something, a line of people appeared. I kept imagining my one aunt dancing on her own as she found me a husband – Sally I think you’ve got off lightly in your UK responsibilities! It was a wonderful day full of beautiful bright outfits, great music and drumming, and lots of food, and I’m grateful to have been able to attend a wedding here.

However the biggest difference I have noticed is related to the role of family here and I have seen this daily at work. There is usually only one nurse to cover a whole ward of patients, so when a patient is admitted, it is a family member who provides all their care, from getting food, to helping them bathe and dress. Unless the patient has no family or no contact with them (which is very unusual), a family member will always come and be with them for the whole admission, usually lying on a mat on the floor day and night even when they are in hospital for weeks. They have often travelled from miles away, stepping out of studies or away from work to be there, and this is done even for second and third degree relatives. The same is true if money is needed for investigations or medical treatment – family will rally round to raise money in whatever way possible, including forgoing school fees or selling animals. Please don’t think I’m saying that Ugandan family members love each other more. There is just an understanding that there is less support available from the government and other organisations to support people here so they accept that family step in to fill in that gap, whatever the cost. And this is something that has inspired me in the Ugandan culture as I have thought about what being family means.

Coming from the UK’s more individualised culture though has also brought it’s challenges at work here. Autonomy (a patient making their own decisions about their body and healthcare) is something I was taught at medical school and that I have spent years practising and advocating for. In palliative care in particular, we spend a lot of time sharing information with patients so they can make informed decisions about whether they want certain treatments and investigations, what their priorities are for their care and where they want to be cared for, including when they die. This includes discussions with family and those important to them if the patient wishes, but is ultimately the patient’s choice. In Uganda, the family play a key role in decision making. It is common for families to be told about a patient’s diagnosis or prognosis before the patient, or for them to decide about what treatments the patient will have. This is particularly true if the patient is female or elderly, because the senior male is usually the decision maker in the family. An added challenge is that person is often not present in the hospital because they are the breadwinner so working, which means ensuring they have all the information to make a decision can be difficult, especially when you throw in phone signal and language barriers too. Because many healthcare decisions are influenced by their cost, the family member/s who can afford to pay for the treatment usually have a significant role in the decisions made as well, and they are sometimes abroad. This has been a real learning curve for me (and something I am still working at!) to figure out how to work in another culture to my own, respecting the differences in values and beliefs, but also doing what I think is right. I have tried to do this through ensuring the patient is at least as fully informed as they wish to be about their condition, giving them the opportunity to share their priorities and wishes, and ensuring the family decision maker have heard all of these too. It is something I am still reflecting on and I hope what I have learnt will help me support patients and families from different cultures and backgrounds when I work back in the UK too, but I would be interested to hear what others think. But as I said above, it has been a constant reminder of the privilege of working and living somewhere else and all we have to learn from each other including in our differences.

10 responses to “We are family!”

  1. We. Are. Faaaamily! Sorry, had this in my head whilst reading. Really interesting blog post! You’ve done so well to adapt to the culture, especially in a work setting which sounds very challenging. Thanks for sharing xx

    Liked by 1 person

    1. Haha I’ve been singing that all week after writing the blog! Thank you Tom xx

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  2. Kate, you’re right, I’m glad I’ve not been called upon to dance on my own, eek! Last weekend, we were lucky enough to attend a Welsh-Nigerian wedding. There was a lot of dancing, postrating, offering of bribes and, of course, beautiful colourful outfits… Great to hear your thoughts on the differences in culture. Lots of love from all of us xxx

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  3. Such an interesting post,Kate,,gave me lots to think about!Now that our NHS is so overstretched it may come to the point of family members taking over caring roles and being involved in decision making!

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    1. Thank you Margaret. Yes that is true and will be interesting to see how we respond to that with out British culture if it happens!x

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  4. Yes it’s fascinating to here how palliative care is handled in other countries, I hope decisions are not based on money though, as that would be heart breaking. It’s so eye opening getting a first hand experience you need to write a book after your finished x

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  5. Hi Kate
    Great to read this and love the gomesi dress!
    In the West I guess we’ve handed over these responsibilities to ‘professionals’ and it would feel so weird (as a man, anyway) to do personal care for a family member but writing that feels at the same time ridiculous.
    Re autonomy we have to be so careful not to impose our values, but on the other hand a system that is traditional and familiar could evenso be oppressive of, in particular, womens’ rights. Did you encounter a range of views or is there a firm consensus?
    BW
    Richard

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    1. Hi Richard, nice to hear from you! Thank you, the gomesi was fun but far too long which made walking and carrying gifts a challenge!
      Very true, it is one example of something that seems striking to me from my British culture but is normal in Ugandan culture. Having said that, there are different opinions particularly amongst those who are younger or have been able to attain higher levels of education. We were just discussing this morning how to support a female patient who has significant neurological impairment and her only family member who is available is her son in his 20s who does not feel comfortable providing personal care for his mother. So it is still important for us to find out the individual views of the patient and family, but also to remember that cultural practices can change over generations.
      Thank you for your thoughts, Kate

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  6. This is really great Kate- we are a small family but we love being together!
    The cultural differences between nations affecting the approach to palliative care is so interesting. xx

    Liked by 1 person

  7. Bit late coming to this party as your blog has only just shown up on my FB page. Personally I would love the idea of caring for a relative in a hospital setting, but that’s the nurse in me coming out. It really is fascinating hearing the cultural differences, especially in decisions making.
    As for you Howorth’s you are huge in our estimations. Love you all xxxx

    p.s. email address has changed. X

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