Often, when a toddler falls over he or she is completely dependent on an adult’s reaction whether the toddler will cry and scream or whether they will laugh and brush it off. If an adult smiles and nods, the toddler will scramble up and continue along their merry way. If an adult gasps and rushes over, the toddler will burst into tears and wail for someone to hold them.
I am quite used to watching these reactions among children hospitalized in Canada. However, I often witness the former, regardless of how a child’s mom or dad reacted. They were accustomed to getting their way, and felt free to protest when facing the potential of being poked for blood work again. A tantrum or acting out of fear is an understandable reaction. Based on my pediatric experience in Canada, I entered a pediatric rotation at 37 Military with the expectation that Ghanaian kids would not be much different from their Canadian counterparts. However, I was wrong. Besides the obvious difference in skin colour, the Ghanaian children’s level of bravery and stoicism is much more distinct.
Over the 7 days I spent on the unit, I helped with many dressing changes. Most of the children were between the ages of 5 and 10 and had sustained severe lacerations from motor vehicle accidents. The wounds were enough to make me cringe; however each child took the procedure in turn. Without the relief from a prophylactic pain medication, the young children held in their exclamations of pain and cried silent tears.
There was one girl, around 12 years old, who had a dressing change done every second day on her leg. She was involved in a motor vehicle accident that left her with a large laceration on her left leg from her knee to her ankle. The dressing change was complex and lengthy. Before the procedure the nurse carefully explained that if she cried her wound would bleed more than if she remained quiet. There was no effort made to shield the girl’s eyes from the dressing change, and so she held her own leg as they took off the old dressing, cleaned the wound, and put on clean gauze and a tensor bandage. My colleague and I stood by, watching in both awe and wonder, as this girl did not cry out throughout the procedure. Her face showed her obvious pain, and though the nurse did not console her in anyway, my colleague and I rushed to her side to rub her arm and let her squeeze our hands. We were unsure if this was the proper action, however the girl looked at us with both hope and thanks. Even the bravest children need a little bit of extra support sometimes.
The other children followed the same pattern as this girl. It was both fascinating and heartbreaking to watch them put on brave faces and resist cowering away as the dressing change was completed.
This obvious display of bravery and resilience from the Ghanaian children was not what I expected. They have a strength and determination that should be admired. I both appreciated and questioned it. Coming from a different culture where children are sometimes over protected and coddled well into their teens, I see the importance in teaching a child to be strong, resilient and independent. However, I also believe that showing kindness and support is just as important. There is a good balance between the two, however it is tough to achieve.
A child’s reaction to pain is also very important, as fear and crying are normal physiological reactions to pain. It can be disconcerting to watch a child go through a traumatizing experience such as a dressing change or IV insertion without having them react to the pain. It leads to questions such as: is the child feeling the pain? Have they been taught to suppress such emotions? Will this experience affect their well being in years to come? Pain management is an important aspect of treatment within hospitals both at home and in Ghana. However, it is often overlooked in Ghana because of limited available medication and an expectation that pain be tolerated. In addition, the children’s stoicism could be a factor in the lack of prophylactic medication before dressing changes or other painful procedures. It is a part of Ghanaian culture to be stoic and brave, but this lack of reaction to pain should not be taken for granted in hospitals, and should be questioned and studied more closely.
It is easy to say that the Ghanaian children’s bravery was an unexpected strength. It was however a wonderful surprise to see such beautiful and independent spirits at such a young age. It may be an unexpected strength, but it should never be an overlooked strength.