And they rarely go to a hospital, not even to deliver their babies. “You go to the hospital in Ghana to die,” said Robin Toft Klar, DNSc, RN, assistant professor of nursing, illustrating a significant cultural difference in how the health care system is viewed in the African country.
Dr. Klar and other UMMS faculty shared insights gained from ongoing research for the Worcester Infant Mortality Reduction Task Force into the “culture and context” of women from Ghana in the presentation “Women’s Self-Care Practices in Ghana: What Family Doctors in Worcester Need to Know.” The task force, created in 1996, continues to try to unravel the mystery of why Worcester’s infant mortality rate, particularly for babies born to immigrants from Ghana, is higher than the state average.
Because Worcester is home to the third-highest Ghanaian population in comparable U.S. cities, and 90 percent of babies of African ancestry in Worcester are born to immigrant mothers rather than native-born mothers, understanding these cultural and societal differences may help Worcester doctors offer better guidance to their patients.
After a brief overview of the its findings from task force co-chair Sara Shields, MD, MS, clinical associate professor of family medicine & community health, Klar and Rosemary Theroux, PhD, WHNP-BC, associate professor of nursing, discussed research conducted on four two-week trips to Ghana over the last four years. They interviewed women in focus groups, as well as 174 “informants,” such as health care workers and religious leaders.
Theroux presented an assessment checklist that included questions on how many hours are worked (the average woman from Ghana might work two jobs so she can send money back to her home country), how long the patient has been in the United States, whether a traditional Ghanaian diet or other practices are still being followed, and what is their source of support (in Ghana, it truly does take a village to raise a child so if the woman is isolated from that support system in this country, it could cause more stress).
The way women view the medical system in their home country can transfer to their adopted country, especially when it comes to preventative health measures, which are nonexistent in Ghana, said Theroux. “When they get here, they really need help in navigating our health care system,” she said. “Many topics are difficult to discuss. They are a much more private culture than the U.S.”
This concern for privacy, and the tight-knit nature of the Ghanaian community in Worcester, also explains why a patient may be reluctant to use a medical interpreter from her own country. Audience members at the presentation described patients who stopped talking freely once an interpreter was brought into the exam room.
Theroux said she is already seeing results from the years of research by the task force. She recounted a recent office visit with a pregnant woman from Ghana, who—when asked—said she was not using the traditional herbs that women in Ghana often use to help with delivery. While the herbs haven’t been explicitly implicated in causing issues in pregnancy, they have been identified as a potential issue. “If I hadn’t been to Ghana, I might not have been able to know to ask that,” said Theroux.
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