Blog Viewer

https://www.infirmiere-canadienne.com/blogs/ic-contenu/2019/07/29/reflexion-personnelle-sur-la-sensibilite-aux-diffe

Jul 29, 2019, By: Amy Olson

Three years ago, I was a triage nurse in a busy pediatric emergency department in Canada. I remember clearly the day a man and his wife brought in their 10-month-old boy, asking for a rabies vaccine. They were recent immigrants from Pakistan, and had lived in Canada for only a few months.

Their son was smiling and interactive. I asked my typical opening question, “What brings you to the emergency room today?” The father responded by telling me that his son needed a rabies vaccine. They had been walking at a nearby park when a dog came running up to their son, licking his hands and face.

I was puzzled. No dog bite? No. Just a lick? Yes. “Well, sir, your son does not need a rabies vaccine.”

At this point, the man proceeded to tell me that he was a family physician from Pakistan, and in his country, a lick from an unknown dog constitutes a need for the rabies vaccine series. I was puzzled.

“Sir, you are in Canada now; this dog was more than likely a fully vaccinated animal, out for a walk with its owner. Did you find the dog’s owner and speak with them?” No, he had not.

The man was persistent, so I went to speak with my charge nurse. The pediatrician in the department overheard me sharing with her. The pediatrician told me, “That boy does not need a vaccine.” I told my supervising nurse and the pediatrician that the family would not leave. My supervisor said to go ahead and triage them, and she would speak with them and reassure them that their son did not need a vaccine.

Reality of life in another country

Fast-forward a year and a half later. This morning I watched a stray dog run past the gate of my children’s school in Rwanda. I slowed my car, stopping for a moment to see where it was headed. I saw the school security guard chasing after it. Reassured that it would not get into the school or near the kids, I drove on.

I am now living in Rwanda, a rabies-endemic country. As a family of five, we had the option of receiving a pre-exposure rabies vaccine at the travel clinic before moving overseas. The cost would have been more than we could afford, and with friends living in Rwanda reassuring us that the vaccine was a fraction of the cost in-country, we decided to take our chances. We arrived in Rwanda prepared to take appropriate steps if any of us were exposed to an animal. We told our kids the basic information: stay away from dogs in the neighbourhood, don’t pet animals that you don’t know, and for goodness’ sake make sure you let us know if you get any sort of animal bite or scratch.

A few months into our time in Rwanda, we made a trip to Akagera Game Park for our first safari. The first day, in the parking lot of the game lodge, my husband was loading our cooler into the car with our seven-year-old son. A baboon approached. In order to appear larger, my husband raised the cooler over his head, yelling loudly to scare off the animal. But just before the baboon ran off, it swiped my son across the back of the leg. Was he scratched? We didn’t think so. Maybe? He had previous marks on his legs from playing outdoors, but were the marks from the baboon? Did the skin break?

Later, I found myself researching rabies on the World Health Organization website. Being a pediatric nurse, I knew the basics. However, as I had not faced rabies on a daily basis while living in Canada, my knowledge was limited. When I started reading the WHO protocol on rabies exposure, I immediately thought of that Pakistani doctor/father who had come to my triage desk the year before. I realized that if his son had been in a rabies-endemic country, he may indeed have needed a rabies vaccine from his exposure.

For my son, after reading, researching, debating, and looking at his leg multiple times, we decided to go ahead and give him the five doses required for the rabies vaccine. Since rabies is 100% fatal and not treatable, we were not taking chances. Nine months later, still in Rwanda, my daughter would be bitten by an unvaccinated cat, requiring not just the rabies vaccine, but also an injection of immunoglobulin.

New worldview

There is nothing like learning from experience. Before moving to Rwanda, I had thought I was a culturally sensitive person. But my responses were based only on living and working in North America. Because of my time living in East Africa, my worldview has now shifted. When I return to Canada in a few months, I will come with a fresh perspective on nursing and health, gained from my experiences living in Rwanda.

We may not all have the chance to live and work internationally, but we can do our best to educate ourselves about other worldviews, cultures, and perspectives. As nurses working in Canada, with a vast range of immigrants and international populations, we have a responsibility to try to see things from the perspective of our patients. Looking back, I can see how I was not culturally sensitive to this Pakistani father several years ago in Canada.

If I could go back and change my response, I would be more empathetic. I would take the time to educate him, talk with him, and reassure him. I am reminded always to be learning and to stay humble. The other day my daughter asked me, “If you could give one piece of advice to everyone in the world, what would it be?” My answer was, “Never stop learning.”

Additional Resources

WHO Guide for Rabies Pre and Post Exposure Prophylaxis in Humans

Rabies: The Facts

Frequently asked questions about rabies for Clinicians

Amy is a pediatric RN who has spent the last three years living and working in Kigali, Rwanda, training nurses. She is currently pursuing her MScN through Western University in Ontario, studying the effectiveness of the pediatric nursing course she helped developed in Rwanda. In July of 2019 she will move back to Langley, BC with her husband and three kids.