During my internship in a paediatric psychiatric unit for young babies, together with a nurse, we were visiting a young mother from Ivory Coast and her 6-month-old baby, who were being assessed together. During the visit, the mother decides to give a massage to the baby to relax her. The nurse I work with feels somewhat distressed about this, mistaking the young energetic gestures of the mother for inaptitude or bad treatment. I am familiar with this practice, which is quite common in Africa, and I try to prevent the nurse writing a negative report following her culture shock. Indeed, a negative report could have taken the child away from the mother, however the objective is to assess and support the parent/child relations.
1. Identities of the actors in the situation
Protagonist – Social worker on internship in the hospital: 28 years old, born in France but parents originally from Mali. Keeps contact with her family and Malian culture.
Person at the source of the shock:
Nurse: French woman, 30 years old, no previous connection with African cultures
Other people present:
Mother: 38 year old woman, originally from Ivory Coast. The mother benefits from a special accompaniment procedure for psychiatric problems.
Baby: A 6 month old boy born in France, mother from Ivory Coast and the father from Tunisia. The baby is very calm during the incident and actually falls asleep after the massage.
2. Context of the situation
The encounter takes place at the home of the mother. This special type of visit implies an observation by a nurse and a social worker in the home environment. A written assessment is prepared which has an impact on important decisions such as the capability of the mother to take care of the baby or to take the baby away.
3. Emotional reaction
“I was surprised by the reaction the nurse had to the massage. I was very concerned that the shock experience would result in a negative evaluation of the mother, so I gave an explanation about this cultural practice that is quite wide spread in some African countries.”
4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.
Personal and professional values are also at stake in this situation.
On a personal level, the narrator shares the cultural references with the mother concerning the practice of giving massages to babies that is wide spread across several African countries. This practice is connected to several values and norms:
- Relational, collectivist orientation: Western African cultures are positioned closer to the collectivist orientation than to the individualist orientation dominant in Europe. This has an impact on child-rearing practices. In line with the interdependent orientation there are many activities and practices that focus on reinforcing connections and relations. The frequency and intensity of physical contact also points in this direction.
- Physical contact: in several African cultures physical contact and proximity is highly valued, between adults as well as with children. This is well illustrated by the tendency to carry the child attached to the back to be in physical contact during the daily activities.
- Massage is used as a daily technique to contribute to the baby’s physiological development: the dynamic touches, gestures and stretching are thought to develop strengths, flexibility and muscle tonicity.
On a professional level, two values of the narrator are at play:
- Non-judgemental, open posture: the professional implied in an accompaniment process has to avoid premature judgements that may have a drastic impact on the life of the beneficiaries. Instead, sufficient time should be allowed to explore the situation of the beneficiary.
- Intercultural awareness: the avoidance of judgements is particularly true for intercultural situations when one has to establish an opinion on a person with very different cultural references. Sufficient care must be taken to avoid judgements based on our own values / norms. In this situation, the nurse has experience in an area populated by migrants from Africa, yet she does not seem to have learnt about their cultural practices.
Observation: the professional has to develop good observation skills, detecting and analysing the information available. In the situation the nurse should have checked how the baby reacted to the massage. If she had done so she would have observed the reaction of the baby to the massage and she would have seen that the baby fell asleep and in no way showed signs of discomfort.
5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?
6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator.
Dominance of internal attributions and psychological explanations: in line with her training, the nurse puts the emphasis on internal explanations connected to the character or predisposition of the mother. Since the mother has had psychological problems in the past the clinical explanation is even more important and at the first signs of divergence from the ordinary (the massage) the hypothesis of aggression and psychological problem appears.
The place of physical contact and touch: European cultures are less tactile; touch occupies a more humble role in day-to-day interactions. What’s more, when Europeans touch, it often tends to be a lighter touch stopping at the skin, not going in to touch the muscles. If babies and young children receive more touch, these are also lighter.
Autonomy and individualism: principles influencing the education of children: European children spend less time in close physical contact with their mothers compared to West-African children. If the practice of carrying the child on the back or the stomach is indeed gaining place, this is mainly a means of transport and less a way to ensure contact during the mother’s daily activities.
Importance of direct communication at the expense of contextual communication and observation: in the modern west, the dominant communication style is direct, putting the emphasis on the verbal message, which is assumed to carry the meaning. We pay less attention to the observation of movements, arrangement of objects etc. These also imply less efficiency in identifying signs through contextual communication and observation. Together with the preference for internal, psychological explanations, this is an important obstacle for the recognition of cultural differences.
7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?
This incident illustrates how professional culture leans towards internal explanation, psychologically analysing the other’s behavior. Both, the preference for the direct communication and the lack of habit and training in the context of communication we discover a significant barrier to the consideration of the context and cultural references.
At the same time the lack of consideration of cultural practices can lead to a biased assessment, which may have an impact on the user and the relationship they have with the professional.
The incident also provides a nice illustration of cultural differences concerning the body which often surprises people with universalist tendency, for whom the differences in practice and representation of the human body are suspicious, since the human body must be the same everywhere, without regard culture.
Finally, the incident illustrates how cultural professional knowledge can be a resource in the social field and in health.