Barbara A. Parfitt - Working Across Cultures: Study of Expatriate Nurses Working in Developing Countries in Primary Health Care

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WORKING ACROSS CULTURES

Working Across Cultures

A study of expatriate nurses working in developing
countries in Primary Health Care

BARBARA A. PARFITT
Department of Nursing and Community Health
Glasgow Caledonian University

First published 1998 by Ashgate Publishing

Reissued 2018 by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
52 Vanderbilt Avenue, New York, NY 10017

Routledge is an imprint of the Taylor & Francis Group, an informa business

Copyright Barbara A. Parfitt 1998

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.

Notice:
Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe.

Publishers Note
The publisher has gone to great lengths to ensure the quality of this reprint but points out that some imperfections in the original copies may be apparent.

Disclaimer
The publisher has made every effort to trace copyright holders and welcomes correspondence from those they have been unable to contact.

A Library of Congress record exists under LC control number: 9777558

ISBN 13: 978-1-138-36115-7 (hbk)
ISBN 13: 978-0-429-43268-2 (ebk)

Contents

I would like this book to be dedicated to all those nurses who from many different cultures and countries strive to make life a little better for those who live in remote and often poor and deprived situations. My special thanks go to the nurses who contributed to the study by sharing their experiences so freely. I would like to thank Baroness Jean McFarlane of Llandaff who gave me the confidence to start this project and Professor Christine Webb who acted as my supervisor. Most importantly thanks go to my husband Dave and my son Simon who supported me throughout

The focus of this study arose out of my own experiences of community nursing both in the UK and overseas. Following a period as a district nurse/midwife in central England I worked in two developing countries in health care development. I spent over three years in each programme followed by short spells in other programmes in two other countries. In total 10 years in which I was involved in a wide variety of activities with both government and non-government organisations (NGO).

My experience overseas gave me the opportunity to work within different health care systems than that of the UK. I realised for the first time how much health care provision was dependent upon economic and political factors. I also realised the long term effects that intervention by expatriates has on individuals, families and communities and how outside intervention influences the development of local health services.

When I first went to work overseas I was convinced of the value of what I was doing. I was very clear that I wanted to help and felt I had something to offer. I believed that I had the skills as a nurse to meet many different needs in the same way as I had at home.

After some time I became aware of many differences in the way that expatriate nurses practised and I increasingly questioned the validity of expatriate intervention. I knew that high quality care was given but I was unsure about how positive were the effects. I questioned why some nurses seemed to be able to achieve a great deal while others very little, was this because of their motivation and commitment or perhaps their preparation? Some were able to replicate the standards of British hospitals and clinics, although in certain circumstances with questionable success, while others used questionable methods with apparent success. Working overseas was for me a very positive personal experience but I asked myself how positive it was for those who received the care.

In most instances programmes carried out by expatriates were done so with the best of intentions and medical and nursing interventions were introduced to save lives and give both individuals and communities the best care possible in the circumstances. New approaches to health care delivery were being adopted with a greater focus on the community and the implementation of primary health care services. Government health services were often inadequate and poorly resourced and externally funded programmes were encouraged.

With Alma Ata and the declaration of Health for All (WHO 1978) there was an increasing recognition that communities should identify and meet their own health needs. The reality, however, seemed to be that many communities did not have the necessary knowledge, skills or resources to do this.

Both Western nurses and indigenous nurses have been acknowledged as an important part of the overall global strategy for improving the health status of the world. But my concern was that simply doing nursing was insufficient and the way in which care is provided has long term consequences. Surely to be a nurse is to be a carer who is beyond the influence of policies and above the restrictions of cultural interpretations of health. Yet I felt a disquiet about the influence that nurses might be having through their practise. I observed that some nurses approached their work with little sensitivity to the needs of the community whilst others related so closely they seemed to lose their objectivity. I questioned whether it was appropriate for expatriate nurses to work in these overseas community situations and whether the aid that they brought to the community did not in fact create more problems than it solved. It is easy to send people to aid others and it makes us feel we are doing something, yet identifying the influence this has on the individuals and communities, who are the target of our aid, must be critical.

It was with these concerns that I set out to do this study. I wanted to gain some understanding of how expatriate nurses practise and what effect they have on situations. I believe that the universality of nursing has made it applicable in many different settings, but I acknowledge that although a great deal of good has been achieved, long term problems for communities have also been created.

The question that I set out to explore can be summarised as follows. If nursing is a universal activity which can be practised anywhere in the world, why is it that in some circumstances what sets out to be an offer of help to those in need becomes a threat?

In preparation for the study I initially identified two areas within the literature that I needed to explore. Firstly, I needed some understanding of the role of Western medicine within the developing countries and, secondly, the role of the international nurse and nursing overseas. A third significant area that emerged during the review was the significance of personal values in influencing practise.

This thesis is written in the first person to facilitate clarity of meaning as suggested by Webb (1992).

In order to investigate issues relating to the practise of nurses in developing countries a literature search was carried out in three areas. The initial search focused on general issues relating to health care in developing countries followed by those concerned with international nursing. During the review of these areas it became apparent that it was also necessary to explore literature on the values that influence nursing practice.

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