Week 4 (June 3-9)
Research Experience
This was our last week at this research site, and we definitely made the most of it! We were joined by a new interpreter who has a lot of experience doing qualitative research, and her help made a significant difference in the ease of interviewing. She was able to identify those who would probably agree to an interview and walk up to them and get them on board in a seamless and effortless way (something that our other interpreter is not particularly gifted at and something that is impossible for me to do with the amount of Swahili I currently know). Interviews with the new interpreter also tended to elicit longer and more thoughtful responses, even though I was asking the questions in the same way. Maybe her presence and her way of explaining the project just put people at ease.
Ultimately, we conducted 67 interviews at this research site. Probably around 50 included my questions, which is far beyond the 20 that I was hoping for. These included interviews with students at the nursing school next door to the hospital. This week was the start of the students' clinical rotation, so they were all over the hospital. I went to the school to ask the principal for permission to talk to her students, which she granted. Those interviews were great—the students spoke a lot of English and were very interested in talking about their opinions and what they learn in school. I tried the freelisting activity again with the new interpreter, but in the end I decided to give up on the idea of doing it as a separate activity and just added a couple questions to my interview, which seemed to work a lot better. Most people I was interviewing did not really know how to write and had trouble understanding when I asked them to generate a bulleted list of words, but were more able to share in conversation form.
Findings
Findings from this week confirmed the general trends I had been noticing. Physicians assess pain through taking a patient's history and looking for visual and physical cues, including facial expressions and reactions to palpation. Students consistently listed these methods as those that they are learning in school for pain assessment, and doctors agreed that this is what they practice. Numerical scales were never mentioned unless I brought them up, and even then, most did not know what I was referring to. The pain assessment here seems much more thorough and holistic than the American use of numerical pain assessment scales, so I was not surprised by some confusion and disdain towards the method. One student asked me how doctors know that their patient is telling the truth about their pain. She also wondered if in America we had a machine that can assess pain.
In general, people seem to view pain as a normal part of life, and find communicating about pain to be normal as well, especially with close family and friends. Most importantly, one must communicate their pain to a doctor, because the doctor is the only one who can actually do anything to alleviate it. I am interested to see what the new research site will bring, as the patient population is much sicker (most are on palliative care) than the one I have been at for the past month.
