Cultural differences and factors to consider for emergency medicine doctors working in crisis zones

Written By Michelle Chan

There are many cultural differences that emergency medicine doctors working in crisis zones must consider. In certain circumstances, not taking these into consideration could even cause a patient’s condition to deteriorate. In this article, cultural differences around the world will be explored, and how they could pose a potential issue for emergency medicine doctors treating patients, and specific countries will be used as examples. By being more aware of the cultural differences in foreign countries, emergency doctors can be better equipped to help their patients.

Gender roles in healthcare

In Afghanistan, a rule was created that from December 2024, girls and women are not allowed to undergo medical education due to Taliban rule (1). They have been banned from working in medical non-governmental organisations and with the United Nations, apart from specific roles in health care and also education (2). Furthermore, female doctors that are currently working may be restricted from seeing patients as they must have a male relative accompany them while travelling to work or during work hours (2). This is particularly relevant regarding maternal and child health as skilled female healthcare workers are hindered from providing emergency care in a country with high levels of maternal and infant mortality. This can also lead to a delay in treatment and the lack of staff could also lead to a further delay in patients being treated, leading to their condition potentially worsening.

Traditional healing practices

In Sub-Saharan Africa, burns are common for many reasons, for example in rural African houses cooking with open unguarded fires or using fire for heating purposes, increased fire risk from Hamarttan winds, burning people to ward off evil spirits, etc. (9) (10) (11). These burns can be treated with traditional medicine, such as plant and animal products, in emergency care (3). Whilst traditional medicine is affordable, there is a lack of research on their effects and thus dosage, effectiveness, and adverse reactions are unknown. Furthermore, it could exacerbate their current condition, leading to a snowball effect. The reason for this practice of using traditional medicines could be attributed to not being able to afford proper medicine, inaccessible healthcare facilities, lack of trained professionals, and superstition (people may think burns are due to witchcraft and thus can only be treated through traditional methods) (3) (11).

Language barriers

There are many issues regarding language barriers in accessing emergency care such as miscommunication, increased risk of errors, and delays in critical care. This is even more of an issue if the local community has their own dialect, for example in remote indigenous areas. This can delay the delivery of emergency care in crisis zones: certain problems may not be addressed; medications may not be delivered; allergies may not be communicated; proper mental support (such as the need for accompanying family members) may not be addressed; the primary cause of their condition may not be found; delivering treatment may be difficult; satisfaction levels are decreased; and misdiagnoses can occur (4) (5). This all leads to poorer health outcomes. In crisis, when time is of the essence, not being able to communicate is a major issue.

Stigma around mental health

In Latin America, collectivism and familism influence stigma towards mental illnesses. Collectivism is defined as ‘the tendency to view oneself as a member of a larger (family or social) group, rather than as an isolated, independent being’ (6). Familism is defined as ‘a social pattern in which the family assumes a position of ascendance over individual interests’ (7). This is evident in generational and social aspects in Latin American culture as family seems to be very important in their culture. My interpretation of this is that regarding collectivism and familism, people may not want to be a burden on their family and would rather keep peace than ‘disturb’ it by bringing up the stigmatised topic of mental health. This can lead to mental health issues being less likely to be reported and this stigma can lead to feelings of shame.  People may even be concerned regarding the treatments for mental health, due to lack of treatment or fear of becoming victims of prejudice or discrimination, leading to reluctance in undergoing treatments in emergency care settings (8) (12).

Conclusion

Whilst this only scrapes the surface of the cultural differences and factors to consider for emergency medicine doctors working in crisis zones, it demonstrates an essential factor  to think about whilst treating patients, as their cultural views can significantly impact their interaction with healthcare.Uprooting their way of life even more than it would’ve already been uprooted in a crisis zone can be distressing. So, healthcare professionals respecting the culture of communities whilst going through a crisis can bring a bit more comfort to an already stressful time.

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