New Cultural Aspects of Healthcare in The West

In our Woman of the Month interview, we interviewed Tandi Charmaine Kuwana, an Australian mental health nurse who is on a mission to create an understanding of the new cultural aspect of healthcare in the west with a special focus on refugees. Tandi, who is originally from Africa, uses her own background to create culturally informed interventions to the dilemma that healthcare systems are facing in western countries because of the influx of refugees with different cultures than their host countries.

Tandi explains that healthcare of refugees cannot be dispensed as business as usual, there is a need to have an understanding of things like why do refugees delay seeking medical attention? Or why in other cases do they engage in risky behavior such as attempting to ‘treat’ away diseases using rituals etc?

The cultural aspect of health; what does that mean?  Culturally, the belief surrounding health be it physical health or mental health has been that illness is caused by external forces closely tied to local beliefs and often attributed to supernatural powers, demons, misfortune or evil spirits. I remember growing up and hearing stories and seeing people with mental illness. I was told the cause of their illness was witchcraft or they were possessed by demons. I believed it but there were also those with a physical illness especially in its acute stages who would go to church or a traditional healer and be told it was because of ‘kuroyiwa’ (bewitched).  Some would go as far as being told to stop taking their prescribed medications and rely on traditional medicines. I was not old enough to question the efficacy of the religious and traditional healing then.

Fast forward a couple of decades and working in the mental health industry I still hear the same story. When one has had a psychotic episode, the assumption is there has been ‘foul play and witchcraft is involved or someone cast a spell on their family on their last trip back to Africa.’ This ideology then deters people from seeking psychological help and have them relying on traditional medicine.  The same can be said of physical illnesses when tests have shown one has cancer, HIV or suffered a stroke, there are still some people who will choose to rely solely on religious healing and neglect the advice of the medical practitioner.

You have said that countries which experience influxes of refugees need to change the way they look at healthcare, what do you think needs to be done? I think firstly, they have to invest in getting to know us and our history, culture and traditions. To plan and implement policies for migrants and refugees without their involvement has not been working. It will  be nearly impossible to implement a successful health promotion campaign aimed at certain populations of society without first understanding their help-seeking behaviours.

Imagine a mental health campaign aimed at migrants or refugees who believe they don’t suffer from mental illness. Most services here in Australia are not culturally sensitive and holistic in that they neglect spirituality and cultural factors. This may be the reason why some migrants and refugees do not engage in the current services and rely on religious and traditional healing. So the answer to this is to increase cultural competence in services providers, co-design and co-review current services with refugees and migrants and embark of targeted health promotion campaigns. We also have a growing number of people completing suicide in our community and these issues are not discussed and addressed.

Health systems have to invest in consultations with community members to ascertain the root of the problem and involve them in the current suicide prevention campaign. Those who have been displaced due to war need to be assessed for signs of Post Traumatic Stress Disorder and referred to appropriate services. Offering the services as voluntary has not worked especially for those who come from countries with no mainstream mental health services. Again they might assume the service is for others not them. 120917KUW-9945 A

Taking us elsewhere, let’s talk the psychology of societies; why do men feel the need to feel powerful when in a relationship with women?  Certain cultures believe men are the head of the household and hence they feel powerful. With that comes the issue of dependence on the part of the females especially those who are not financially independent.  As some parts of the world are in transition from traditional ways to modern lifestyles, the issue facing societies is the increasing role of women as a partner and their role in the workforce. For those who have migrated, the case could be the change in role in the family where the wife becomes the higher earner and in some cases the male becomes a  dependant.

Let’s take third world countries, for example, a majority of men are the sole providers and the higher earners, some have total control over finances and dictate how the household should run and that could lead to financial abuse. In other parts of the world, that tradition is totally accepted by many. I suppose, what I am saying is power and control go hand in hand. Those in power tend to control those that are dependant on them. In this era where women are seeking independence, I believe society should be advocating for interdependence where males and females acknowledge they need each other and can be equal partners. The fact that more men are in powerful positions has led to some abusing their power and preying on the vulnerable. I would like to believe society is moving in the right direction empowering women and giving them a voice. It has to be said, there are some women who also feel the need to be powerful in their relationships and control and abuse their positions

How do the power dynamics of relationships – according to cultural expectations demanded upon us by society, affect women’s health? Society is still transitioning from traditional to modern ways, this has heightened the conflict for women in general. The conflict between the role of women in the workforce, as a wife and mother is a struggle for many to balance. Add culture and traditions and this internal conflict can be stressful for women who are trying to define their place in society. This stress can be the cause of heightened anxiety and constant worry for women who are torn between not living to the expectations of the family or community or neglecting their own ambitions and dreams.

In many parts of the world, women are solely often responsible for childcare, care of sick family members and whatever their role in the workforce. My question is ‘who is looking after all these women? Expectations from family-in-law and apprehension about being thought of as a bad wife and mother sometimes increase women’s vulnerability to depression. These cases require men to be more supportive of their partners and get more involved in issues such as childcare and chores around the house especially for those in the diaspora where childcare and cleaning services are expensive. I go back to the issue of interdependence, men and women have to realize we equally need each other to function at our best. I am sure, a husband and wife helping each other make meals and fold laundry can be a source of joy for others.

What do you think can be done? The younger generation of boys has to be taught to be more domesticated and who better to teach them than their own fathers. Being the only girl in our family, I had to clean my brother’s bedroom and I would always ask my mother why I had to do most of the household chores. I grew up thinking I had to be exceptionally good at all domestic duties or I would not get married or my aunts would say you will be sent back. While I value the lessons, I knew from an early age I did not want to spend a huge part of my life doing domestic chores. Women should not be defined by the standards set by society. I think what makes it worse is some parts of the world like Zimbabwe where I come from, mental illness is a taboo subject and women raising concerns about issues relating to childcare and their role in the household can be misinterpreted as a sign of weakness. That puts a vast amount of pressure on women.

Tell me about your organization. Mental Wellness Keys was founded in September 2016. I was diagnosed with depression earlier that year and my General Practitioner referred me to a Psychologist. I struggled to accept the diagnosis because I always believed I was a strong woman. Working in the mental health industry, I had enough knowledge and insight to know what was happening to me. I guess, the internal conflict was difficult to get over. I had friends telling me I needed to go and see a Pastor and others suggested a traditional healer. I eventually started seeing a psychologist and its the best decision I ever made. Coming out on the other side, I asked myself how many other people are struggling with the internal conflict of deciding the right help-seeking route to take. I decided to be their voice and spread awareness of mental health in ethnic backgrounds. I now work helping with co-design of the the current mental health system in Australia.

Who do you work with? I work with community members raising awareness of mental health and illnesses associated with it in communities who attribute the cause of ill-health to supernatural causes such as demons, witchcraft, possession by spirits. I was a speaker at the African Studies Association of Australia and the Pacific and the G200 2017 Youth Summit in Dubai and my presentation was on multicultural mental health. I have now realised most western health departments do not understand current beliefs about physical and mental health that migrants have and hence services are not culturally sensitive. There is a lack of knowledge of the current help seeking behaviours of migrants which often lies in the realm  of religious and tradition medicine and more often than not they seek medical attention when its too late. Roots Tv and I will be hosting the first ever Mental Health Film Festival in Western Australia in April 2018. The aim is to fight the stigma and start these difficult conversations about mental illness in ethnic minority communities. I will be facilitating a  women’s wellness club for mothers from ethnic minorities and help increase awareness of mental health and encourage them to support each other to seek professional help alongside their religious and safe cultural/ traditional practices.

Are you guys involved in any work on suicide especially in migrant communities? In one of the suicide prevention programs I am involved in, we will be working closely with religious leaders with the hope that they encourage people to access mainstream health services. We identified it the first point of contact for many and to offer holistic services they will have to be a part of the solution. As a society/community, we should start questioning some of our beliefs. For those with kids growing in the western world, the younger generation cannot have the same beliefs about health. We also have community members with children with disabilities and family members are shunned because of the beliefs in some cultures. People with a learning or intellectual disability have been neglected in some communities. This leads to people again not seeking the appropriate help they need for fear of being shunned by their community members or believing ‘miracle water’ will work on its own. Services are available in Australia and efforts are being made to support individuals living with a disability but community members from non-western countries seek help when the situation reaches a crisis point. As subjects that we do not discuss, it makes it difficult for family members to seek the support they need to look after their loved ones.

I live in a new country, away form what I would call ‘home’ – in the sense that that is where my social capital is – what do you recommend for people like me, how can we keep our balance? Or rather keep it together in some ways?

I would say when one makes a decision to settle in a new country, its important they become part of the wider community and make new friends with those outside their heritage or ethnic background. By becoming a part of the community one lives in they should also stay true to their culture. This reduces loneliness often caused by lack of perceived social support.

Seek to do activities that you love that bring a sense  of satisfaction. I knit or crotchet and love the sense of accomplishment I get when my children wear scarves or beenies I have made for them. Going back to culture, some societies discourage women from talking about their problems but I suggest finding the right people to share these problems with especially those who are paid to do so. so. The rate of domestic violence is on the increase, women and men  should speak up against violence to men, women and children. I would also encourage people to limit their time on social media and increase the time they spend with their loved ones.

Volunteering your time and helping those in need can bring a sense of purpose. I remember when I was diagnosed with depression, I was told ‘ do more of the things you love.’ That’s the time I started my other business ZoraOrganics. I make body butters and hair products in my kitchen and sell them online.  I found a purpose and something to hold on to during a time when when I had been told there was a high chance I would not be able to return to nursing and had to change profession because of a work related shoulder injury. I spent so many sleepless nights worrying about the future and forgetting that i can still make an impact in mental health and thats how Mental Wellness Keys was born. i surrounded myself with people who I felt understood my situation. Luckily, for me my husband works in the mental health industry and he encouraged me to see a psychologist. I knew i could block out the witchcraft, demons and spirits conversations and concentrate on getting professional help and keep my faith and hope alive.

As a change-maker, I have taken it upon myself to be the voice of the voiceless and start the dialogue in communities who would rather not discuss mental health, domestic violence and child sexual abuse. We need to rally together and advocate for those who need our support. There is no shame in being vulnerable because I found strength in showing my vulnerability. I get people saying to me ‘ saka wakambopenga? ‘. Its okay because now I serve my community in ways I never imagined. No ‘handina kuroyiwa’ I had a shoulder injury just like a lot of other people out there who have them. Just because I am from Zimabwe it does not mean the cause of my injury differs from those who are Anglosaxons. I think the more we talk about these issues the more we start discussing options available to us.

Where did you grow up Tandi? I grew up in Chitungwiza but our heritage is Masvingo. I lived with my mother, a widow and my 2 brothers until I went to England in 2001 and undertook an undergraduate course in Mental Health Nursing. I moved to Australia in 2008 to work as a Registered Mental Health Nurse. I live with my husband and our 2 kids.