Multicultural Experiences

The Honor Society of Nursing embraces diversity in the broadest sense of the word, including diversity in career paths, educational backgrounds, gender, race, geographic borders and culture.

No matter where they live, nurses are increasingly providing care to growing diverse populations.

Diversity Among Botswana Nurses

By Sheila Dinotshe Tlou, nurse and farmer

Gaborone, Botswana - The establishment of global partnerships in all fields of employment and study has resulted in many nurses working on continents that are far away from their homeland in cultures that are totally alien to them. Diversity issues within the nursing profession can be numerous, but for the country of Botswana, the most relevant and noteworthy are the cultural and professional ones.

The republic of Botswana, located in Southern Africa, has a population of 1.5 million. Since independence, Botswana has achieved a stable democratic government and substantial improvement in its economic levels, and health and education systems. The per capita income is the equivalent of $2,600 in U.S. dollars and is one of the highest in sub-Saharan Africa (World Bank, 1993). Botswana has worked to implement a primary health care delivery system, and approximately 90 percent of the population now lives within walking distance (10 km) of a health facility. The overall mortality rate is now 9.7 per 1000; life expectancy is 66 years, and the infant mortality rate has fallen from more than 100 per 1000 in 1971 to 32 in 1994 (Ministry of Finance and Development Planning, 1991).

Botswana has at least 11 ethnic groups or merafe but is a relatively homogenous population because the main official language, Setswana, is spoken by almost everyone. Cultural norms and practices in most merafe are similar. It has therefore been traditionally easy for members of the nursing profession who are Botswana to expect and maintain a certain code of conduct. Botswana, who belong to tribes of Bantu lineage, comprise the majority of the populace. This tends to create a peaceful and smooth, but boring and intellectually unchallenging work environment.

The tranquility could not last long, though. In the late '80s, Botswana experienced an economic boom that resulted in expansion of health care facilities. The resulting shortage of personnel, coupled with divergent economic situations in neighboring countries of Zimbabwe, Zambia and Malawi, led to a significant movement of nurses from these countries to Botswana. This brain drain has continued to date, thus nursing in Botswana comprises a rainbow of professional nurses from all over the world but mostly from Southern Africa. The gains are numerous. For one thing, Botswana has one of the best nurse-client ratios in Africa, and the health indicators such as the low mortality rates and high immunization rates are a tribute to the primary health care system and the dedicated nurses. It is also highly motivating to note that despite our cultural diversity, there is homogeneity when it comes to operationalizing the concept of "caring" to patient populations.

The issues are just as numerous, but I will dwell on the three which have been outlines by nurses as the most important and needing urgent intervention:

Equity in pay

In order to induce them, expatriate nurses are usually recruited at a higher salary than local or citizen nurses. They have other fringe benefits such as education allowance for their children, and at the end of every two-year contract, they are given a gratuity. The whole pay package can be twice that of a citizen nurse who has the same qualifications and experience. This phenomenon is the source of a great deal of resentment and tension among nurses and their employers (the government) and has raised complaints about "equity and the socioeconomic welfare of the Botswana nurse."

Language problems

Who translates for whom when there are language/communication problems between an expatriate nurse and a Botswana patient? These nurses usually communicate only in English, but Batswana of all educational levels prefer to speak Setswana, and where a patient is illiterate there can be real problems, because Batswana nurses often refuse to interpret. "It is not part of my job, and these nurses should learn Setswana fast," many of them say. This has resulted in frustrations, especially for patents whose needs end up being only partially met.

Recognition of credentials

Nursing education programs in Southern Africa are as diverse as the nurse themselves. This is a problem for employers when they try to recruit or hire, as well as for the Botswana Nursing Council: the licensing body. The solution has been to create the East, Central and Southern African College of Nursing, whose mandate is to harmonize professional nurse training programs in the region, and to facilitate free movement and licensing of nursing in the region. Its recommendations will be implemented in 1999/2000 to solve future credentialing problems.

Certain issues have to be acknowledged and dealt with in order to reduce conflict and tension and to promote productivity related to care of clients. Cultural and ethnic diversity among nurses in any country can be a source of sharing that promotes formal and informal learning in a variety of settings. It enhances knowledge and has a tremendous potential for improving the nursing profession and care in general.

This article originally appeared in second quarter 1998 issue of Reflections on Nursing Leadership. Sheila Dinotshe Tlou, RN PhD, is a senior lecturer at the University of Botswana Department of Nursing Education and is a member of the nursing research advisory committee of the International Council of Nurses.