Health Sciences at Belmont University


I say “Mattress,” you say “Matt-er-ess.”

Dr. Ruby Dunlap's Uganda Fulbright Blog
Christine and Eva.JPG “Does the U.S. have a big problem with culture?” asked Eva, her small face full of concern. We had just finished reading and discussing Wellman’s chapter on “The Diverse Learning Needs of Students” in the 2009 Billings’ textbook on Teaching in Nursing. The “problem” in this chapter (pp. 21-22) is expressed partly as a catalogue of failures, failure to recruit sufficient minority nursing students and nursing faculty, failure to adequately support the minority student, etc. “Well, children in the U.S. go to similar schools,” I said, “and almost all of us speak the same language. We do have some cultural issues but I don’t think we have a ‘big problem’ with culture. What about Uganda?”
“Oh, all children in Uganda learn English from the beginning,” she said, taking her cue from me. “We don’t have a big problem with culture in Uganda.” (See photo of Eva, the young woman wearing the black sweater. Christine is busy at the computer in front of Eva who is speaking with Keren.)

The size of a “problem” as ambiguous as culture is, of course, subject for debate. Just how big is the problem of culture? Is it headache sized which a couple of acetaminophen would treat or is it more like major trauma or cancer? Does the way we discuss or write about it have the effect of social symptom amplification just as attending too much to a physical symptom can amplify that?
We Westerners are busy with culture: we study it, we write papers about it, we create cultural assessment tools. We do culture care, we build culture centers, and we do research on it. We take emic, etic and ethnographic viewpoints. We publish articles on it in journals we have designed specializing in it. We include it in our courses, we’ve done probably hundreds of dissertations on it, we get degrees in it from our universities. We analyze and chatter about culture all day long until our culturally proverbial cows come home.
We diagnose deep and superficial culture, a taco perhaps being an example of superficial culture and the social distance one’s body should be relative to another’s body perhaps an example of “deep culture.” We discuss the relative merits of “cultural competence” versus “cultural collaboration.” We debate about power gradients between majority and minority, between dominant and non-dominant cultures. We even have created nursing theories based on culture.
There are folks who make fine livings on culture talk along both ends of a power gradient. But we still define culture as “learned beliefs and behavior.” Learned belief and behavior can be changed or unlearned, the learning and unlearning more like clothing one can put on or take off than like blood or guts one cannot.
I am beginning to think that for at least some Ugandans, culture is viewed more like blood and guts than like clothing. How one views “culture” is itself a cultural feature, a learned belief. I’ve heard “It’s their culture,” hundreds of times out of Ugandan mouths to explain and justify all kinds of behaviors. The tribal group, that is, the cultural affiliation in Uganda (and there are 64 distinctive ethnic groups in Uganda alone) seems to be the single most important thing about the individual. To be fair, cultural affiliation in Africa is strongly tied to land ownership and livelihood; if this were true for most Americans, we might find our views of culture moving towards something like blood and guts, too.
I asked students to write about their roles as children, as married persons (all of them are), and as members of a social group. Without exception, they wrote that their group affiliation was the most important thing about them and learning to fit into the role expected of them by the group was their single priority as individuals. It is a theme which has little to challenge, counter or nuance it in what I’ve read about or experienced in Africa thus far.
That culture can have a toxic or dark side I think every Ugandan would agree. In the riots a couple of weeks ago, my student, Moses, reported that the rioters would catch a stray individual and ask that person to say the Lugandan word for, “Mattress.” If the person pronounced it, “Matt-er-ess,” adding a syllable, he would be beaten, in some instances to death. The pronunciation betrayed the person’s cultural origins.
“Ah,” I said, “an old play on a new stage.” The students looked puzzled until I reminded them of the story of one of Israel’s tribal fratricides in Judges 12.

The Gileadites captured the fords of the Jordan leading to Ephraim, and whenever a survivor of Ephraim said, “Let me cross over,” the men of Gilead asked him, “Are you an Ephraimite?” If he replied, “No,” they said, “All right, say ‘Shibboleth.’” If he said, “Sibboleth,” because he could not pronounce the word correctly, they seized him and killed him at the fords of the Jordan. Forty-two thousand Ephraimites were killed at that time. Judges 12:5-6 NIV

Screening persons for genocide by a linguistic idiosyncrasy has this long and distinguished precedent which was toyed with again in the streets of Kampala in very recent history. This, too, is cultural.
The curious thing is that Africans of whom I ask the question, “What do you think is the greatest challenge Africa faces?” will invariably say, “It’s tribalism” which is another way of saying, “It’s culture.” How should one think about or deal with this thing called “culture” which we Westerners may view as morally neutral but which can as easily be manifested as one tribe’s members machete-hacking another tribe’s members to pieces (as happened not too many years ago in neighboring Rwanda) as it can be a joyous tribal dance full of celebratory color and sound?
Eva, a teacher at a diploma nursing school in Kampala, told me she teaches “counseling” among her course load. I knew that “counseling” in Uganda is not a mental health intervention but had come to believe it was related to HIV testing and follow-up. According to Eva, it is that but much more. “Counseling” exists in nursing curricula in Uganda to teach the nurse skills for health instruction across tribes. Fixed beliefs and practices around causes and cures of disease and health abound with tribal and regional idiosyncrasies. Ugandan nurses must have special competencies for managing the huge variation in this across the country. And this is one relatively small African country!
Travel and intermarriage are beginning to soften some of the perception of rigid tribal distinctiveness, my students tell me, but the sense of group affiliation still exists in full potency and each Ugandan knows exactly how his or her tribal loyalties are ranked even when parents come from different tribes.
Group 2.jpg Perhaps culture, like the thought provoking statuary on Belmont’s campus of a dollar sign either being controlled by or controlling an individual, can be servant or master. Certainly the human self should never be reduced to a specimen of its culture. The jacket of culture need not be a strait jacket. And certainly culture should not be thought of as static, a cautionary note for writers of culture textbooks.
“What challenges do you have with your younger students?” I asked mine, who are almost all teachers of nursing themselves. “What challenges do you have with your older students?” (See photo of “Dr. Ruby” with students.)
“Our younger students don’t pay attention because they are busy texting their friends on their cell phones,” they said, “and our older students don’t pay attention because they think they know everything already.”

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