#TeMa

Season #2

Episode SIX of Philsophers Chatting with Clinicians welcomes Philosophy welcomes Dr Theresa Aoko Otieno and Otieno Martin Ong'Wen to discuss health and pain through the sociao-cultural lens and what we can learn about culturally competent care from the Kenyan perspective.

About the speakers:

Dr Theresa Otieno is currently the Youth Representative at the National Technical Working Group on Reducing Emissions from Deforestation and Forest Degradation (REDD+) Readiness Project.  Prior to this role she worked as the Thematic Lead Project Assistant on Governance, Social and Ethnic Cohesion and Civic Spaces.  She recently gained her PhD in Environmental Policy after studying Philosophy at the Bachelor and Masters level.  Dr Otieno is particularly interested in how community and environment come together and how we can create systems of cohesion to better serve the planet and humanity.

Linked In: Dr Theresa Otieno

Otieno Martin Ong'Wen, known to the international physio community as the @KenyanPhysio for his work on Instagram, is a Physiotherapist, educator and speaker.  He works in a rehabilitation space seeing people with pain, injury and those recovering from cancer.

Twitter: @OngwenMartin

Laura Rathbone is an advanced physiotherapist working with people experiencing complex and persistent pain, as well supporting clinicians to develop their biopsychosocial practice, update their pain knowledge, integrate psychological processes into their rehab practice and maintains the community reading and discussion group Pain Geeks

 

Transcript: Automatically transcribed by temi.com

Laura Rathbone: (00:02)
Hello, we're back with another great conversation between, uh, philosophers and clinicians exploring health, pain, ill health, um, and what it is to be human. My name is Laura Rathbone. I am a specialist physiotherapist, uh, working exclusively people who experience complex and persistent pain. Um, and I work to support clinicians as they develop and specialize their clinical practice and rehabilitation, uh, towards a modern, progressive inclusive understanding of pain and pain care. Um, and this is philosophers chatting with clinic. So I invite a philosopher or a student of philosophy to come and talk to us about their understanding of pain, their understanding of health. Um, and I bring them in together with a clinician who is also working on the same problem of pain, the same problem of rehabilitation and health. Uh, and we come together to have a lovely conversation challenging. Sometimes, sometimes we agree sometimes we don't.

Laura Rathbone: (01:07)
Um, and yeah, so that's what this podcast is all about. Thank you to everybody that's been waiting for the next episode of this podcast. Um, I love getting all your messages about how you are enjoying some of the older episodes. Please do go back. If you have, haven't heard one of the older episodes, there's some great, great conversations there and some really challenging perspectives. Um, but you know, the last two years has been tricky for me balancing all of my roles out, especially having a young family, but I am happy to be able to get this next episode out to you today. And I hope that you enjoy it also for your information. This podcast comes with a trigger warning, uh, somewhere between the 30 and 45 minute mark on this podcast, the topic of female genital mutilation and circumcision is discussed, not in depth.

Laura Rathbone: (01:55)
Um, but it does come up as, as part of the wider conversation around pain. Um, as a, within spiritual religious practices, a small note on the, this recording Martin, the clinician in this discussion was joining us, uh, from outside of a field hospital, uh, down on the border of Kenya, uh, during the height of the pandemic. So you will hear some extra background noise and at some point, uh, connection drops off. Um, but we manage. And, um, I just ask that you bear with us and that you, you, you continue listening right through to the end because this was one of my all time favorite chats. So thank you.

Laura Rathbone: (02:33)
Hello and welcome. Um, thank you for popping along to, uh, this little podcast, and I'd just like to say, uh, big thank you to my guests. So today I am sat here with, uh, Mr. O and Martin GUI who are joining us from Kenya. So, um, Theresa, can I just invite you to introduce yourself, please?

Dr Theresa Aoko Otieno: (02:57)
Thank you very much, Laura, for this opportunity to bring us together, to have such a relevant discussion and timely as well. My name is Theresa Aoko Otieno. I am a Kenyan aged 33 years. I have a background in philosophy studies, which I did, uh, masters and bachelor level. I also have studied, uh, clinical pastoral counseling, right? Uh, after my fourth form education or my scan secondary, uh, school education, I went into study, um, clinical pastoral counseling. This meant visiting patient in hospital setups ranging from mental health, spinal injury, general words, months unit, and, uh, across issues to do with the drugs and substance abuse, cancer, HIV, and many others. So I have, um, clinical experience where I have with patients journey in them so that they're able to, uh, identify their hopes, their needs and their resources in their healing process. I've also gone back to school to study environmental policy at, uh, doctorate level, because I also have a passion for environment, but I have a long term experience working with nonprofit, uh, organizations where I have interacted a lot with communities on the ground. This gave me an opportunity to be able to intersect or, uh, integrate philosophy with real life experiences and also among groups that are the literacy level, words are down, but then it gave me the opportunity to be, um, so, uh, Socratic in a way that I could promote the Socratic dialogue, facilitated communities to find their own solutions to their own problems. So I have a vast wealth of experience from both practical and theoretical. Thank

Laura Rathbone: (05:02)
You. Oh my God. Your CV is amazing. I was just thiking. Wow. Um, the things that you've experienced and that incredible knowledge that you've amassed was, is so like unique as well and wide ranging. I'm really looking forward to hearing your thoughts and, and ideas when as we move through this discussion. So thank you so much for joining us. Um, Martin, please may, uh, you introduce yourself. Thank you.

Otieno Martin Ong'Wen: (05:36)
Uh, thank you so much, Laura, for having me, um, on here and, uh, yeah, my name is Otieno Martin Ong'wen. Um, also known as the Kenya, physio and Twitter and social media, or sometimes you can find myself, uh, calling myself Machiavelli in relation to the Italian prince and Tupac (2Pac). Since I was, I was, uh, I was a fan of, um, Tupac's poetry, as well as, um, songs. I thought maybe Italian prince and Tupac have people like who, um, kind of relate to, uh, yeah, but I'm a physiotherapist. And, um, um, I, uh, um, I studied, um, a diploma in physi physical therapy, um, and other numerals online courses in relation to physiotherapy and also just learning about, um, how best to help my patients. So I'm, I'm a perpetual student and you'll find me, um, uh, in a lot of places where there is knowledge related to how best do I become, um, useful to my patients.

Otieno Martin Ong'Wen: (06:50)
So, yeah, that's me in a nutshell. Uh, and so I'm still, I'm a clinician I teach sometimes. So I used to teach and at the Kenya medical training college, a school where I went to as a student, and I've been, um, a big champion of continuous medical education in the physiotherapy space. And also, uh, now just starting to integrate the knowledge that I have, um, um, to try and educate patients since they're the people who need the knowledge, uh, in a simple manner, as well as educate other healthcare professionals on, you know, what is just, what do a physiotherapist do. And some of the things that we, um, um, can be really good at since they is the inter professional relationship is very little in my home country. So yeah, I guess that's me in a nutshell and I love people, so yeah. And I love to smile a lot.

Laura Rathbone: (07:52)
Thank you. And I just wanted to, um, make a note, um, that you are currently sat outside. It would seem at a unit. Do you wanna just introduce people to where you are and why they might be hearing some background noise?

Otieno Martin Ong'Wen: (08:06)
Oh yeah. So, um, right now I'm not, um, usually I'll, I'll look for a quiet, like a really quiet place. Um, but I mean, um, one of the hotels in Busia, so Busia is, uh, the border, uh, to Kenya and Uganda. So I'm right now, I'm working at, um, hospital that is, um, an isolation unit for COVID 19 patients. So, um, the noise in the background is so out of my control because I mean an environment that is not home, so, yeah. Sorry about the noise, the background, but yeah. Um, at the moment I'm, Inia at a Lupe, there's a hospital called a Lupe and that's where we have, um, COVID 19 patients coming in,

Laura Rathbone: (08:53)
Please don't apologize for the background noise, just, I think most of us listening and, and certainly me sitting here thinking, I just keep, I'm just thinking, you know, thank you for being out there and doing this hard work and, and, and putting yourself in, in what is potentially quite a risky position in, in the name of healthcare. And, you know, I'm sure all your patients, so very grateful for the work that you're doing and, uh, you know, we all just wish that you stay safe and that you are okay and you get through this process, you know, in good health and good mental health as well. Cuz it's a, it's a strain, I think on a lot of clinicians on the front line. So, um, just for the people listening, that explains why you might hear a bit of sound and also why might need to be flexible and, uh, appreciative of, of your time whilst you're so busy as well.

Laura Rathbone: (09:41)
So thank you very much. Another nice thing that we get to to do today is that Theresa and Martin are actually brother and sister. And so this is also an opportunity for us to, uh, bring these two sort of bodies of, and sort of thinking and critical reasoning together. Um, I wonder, and you know, I know we've talked a little bit just before we came on to record, but I wonder, is this something that you used to do a lot as children? Did you, I, I sort of have this idea that you must have been like sat around philosophizing together. I don't know, is this a, or is this, is this actually the first time you get to pick each other's brains?

Dr Theresa Aoko Otieno: (10:22)
Actually, Laura can't think of it. I think Martin should have been the philosopher and I have a doctor, uh, in this, uh, on a later note because actually I wanted to be a doctor because of my mother up in the hospital setting and had picking us from school and having us wait for her in the physiotherapy department as she saw our patients in the afternoon, so that you could go back home together. I literally grew up knowing the corridors of Kenya national hospital, so well, and I wanted to be a doctor, but somehow I thank God. I'm not because I think I am very afraid of blood and the face of blood would've just, uh, had a really, uh, heavy impacts on me. So in, in, if it were not for that, then Martin in his interest in philosophy should have been enough lose support.

Dr Theresa Aoko Otieno: (11:19)
But I think he would've been quite stubborn because knowing him and growing up with him, had he been one, he would've been very stubborn, but he's also quite gifted. I saw him very curious and, and uh, about animals and they were, he, he treated them so close, like almost human beings like himself, you know, and was also so curious about them. Things like scorpions, total, things that not even touch or come come here, Martin literally made a home for them in our house. So I think he, he, he is well sited to, to be a physiotherapist.

Otieno Martin Ong'Wen: (12:05)
Yeah. I guess, uh, that got me into a lot of trouble growing up. Um, but yeah, I, uh, I did, I did enjoy, I, um, just trying to find out, uh, what do they feel as animals, you know, and, you know, kind of, do they, do they feel the things they feel, do they, you know, do they think, like we think, uh, you know, I, uh, just the curiosity of it and, uh, my dad was a philosopher. So, um, uh, he is, he is still lost for cause, um, um, I, uh, you know, growing up in Kenya, um, we, you were trained or we still use a lot of the British, the colonial system of education, which was sorry about that, which was, uh, um, more of, uh, this is, this is a ruler, it stays a ruler and you know, you don't have to, uh, think outside of it being a ruler.

Otieno Martin Ong'Wen: (13:04)
So most of the educators were, um, whatever I say is the most correct thing. And you, you are not given an opportunity to ask what about this, or why don't we look at this from a different perspective. Uh, but my dad was always, um, uh, giving us the opportunity to question and he will answer, uh, or try to give us an opportunity to learn from our experiences and from our mistakes. So well, so growing up in that environment kind of, uh, gave me, um, the opportunity. So my mom is a physio. She has the most, um, heartwarming smile you'll ever see in a human being. And she's so empathetic and she is, she loves everyone. So she is considered as the mother of PT in Kenya. So all the figures, there's usually a fight between me and the other physios. That's my mom. That's not your mom.

Otieno Martin Ong'Wen: (14:02)
You know, so I try to, I try to kind of like, uh, own that space, but, uh, she is, so she is, she's the one who taught me, um, empathy, compassion, and the warmth of, you know, really trying to, um, be in the patient's food or work in the patient's shoes. Um, but also have the questioning capability of, you know, um, a philosopher. So from, from a lot of that, the questions, you know, why is this, why is this happening? How do we go about this? So that I lot for my dad as, and also my sister. So we looked up to my sister because she was the first one and she was the smartest, she's actually the smartest in the family. Um, but yeah, you know, we, we tried to kind of like compete intellectually, but she beats us all the time.

Laura Rathbone: (14:53)
Oh, it's so great to have you on the part. Thanks so much. You both have so much knowledge and experience and, and I'm grateful that you've agreed to be part of this. This podcast of, as you know, is, is about bringing philosophy and health together and exploring how these two and skills spaces, um, um, work and interact. Um, but like both philosophy and health are culturally constructed. And so there are great differences across countries and cultures in how these two areas function and hold societal meaning. So how does philosophy and health come together for you to Martin Kenya? Um, like where do you see the conflicts or challenges, um, and where can one help the other to develop in more meaningful ways?

Otieno Martin Ong'Wen: (15:41)
Um, yeah, so a lot of times, well, I can start from, you know, Kenyans, um, our resilient people. Um, a lot of the Kenyans are really resilient, hardworking people. And, um, a lot of them, uh, will come into hospital when, um, things are really bad, you know? Um, I I'm, I'm, I'm so sick that I cannot continue doing the things that I am. I normally I do on a day to day basis. And those things could be like feeding, um, uh, feeding families or, you know, trying to look for food, uh, for their families, uh, you know, trying to look for, uh, better, uh, lives, uh, for the people they love. So a lot of it, um, you'll find that people come to hospital on when they're in so much pain, um, or they are whatever is bothering them when it comes to ill health is technically at the last stages almost, you know?

Otieno Martin Ong'Wen: (16:48)
Um, so people, people don't just walk into hospital because they have a headache. Uh, they don't just walk into a hospital because they feel they have a flu. Um, it'll take some, some time and some convincing, especially for the males, you know, uh, to come to hospital. Um, so, but then, yeah, we, we are all human beings and we experience pain. Um, and despite the fact that each and every person has got their own, um, personal perceptions or other personal feelings that, of what they consider to be pain, um, we have, um, a very resilient population, uh, to disease, you know, and it varies in the rural areas. They, um, technically they, they, first of all, there is very little access to proper healthcare provider. So guess what, if I'm sick, I, you know, need a few hubs in there, uh, try to look for medicine, which sometimes is really far away from where I, where I am, or I have to call a relative through my, take two to three days, uh, to get the medicine to me.

Otieno Martin Ong'Wen: (18:03)
So people in the villages are more resilient to, I won't say that, that I won't say that disease doesn't affect them from a normal, physiological and anatomical and all those processes, but there is no, there is no luxury of me just walking into hospital, you know, cause I don't have the finances. Uh, first of all, the hospital doesn't exist. Um, so, um, it's all different. And you know, we also have, um, a lot of, um, cultural beliefs on what diseases are, what, what, you know, this is like, let me give you an example of cerebral policy. So a lot of people feel celebral policy is, um, something that happens to your child. When you have been Bewitched by a neighbor who doesn't like you, or probably you did something wrong to the ancestors, um, and whoever died cannot be inspired to solve the problem that you have at the moment. So there's, um, but we do have the modern, um, healthcare system where we have trained doctors, we have trained nurses and different specialties, um, like myself physio. So we go through the process of, uh, scientific training, um, to understand, you know, what really hails people. So we tend to have a, um, the job of bridging culture, religious beliefs and science to each and every patient that you meet. So that's from a medical perspective. Um, I can let my sister, uh, chime in on what she feels, you know, it is,

Dr Theresa Aoko Otieno: (19:54)
Uh, yes. Uh, I largely agree with, uh, Martin and I can say with the onset of devolution, that is, um, uh, the transfer of services from national government to county governments. There are opportunities for rural communi is to actually access healthcare and it's improving with time. However, in this, in, in this rural communities is where we find, uh, cultural perspectives quite entrenched than in urban centers. And this influence a lot how people perceive or the philosophies they have towards, uh, access medical health and especially the Western conception of medical health of, or, or accessing their medical, uh, services. So this, in a way, the cultural perspective, perspectives and attitudes have a lot to do with, uh, the, the normal mainstream, uh, moral philosophies that we know about. And this, we are talking about ethics issues to do with ethics issues to do with morality, what becomings, what we see as right, and what we see as wrong, you know, uh, and how do this influence our day to day behaviors?

Dr Theresa Aoko Otieno: (21:11)
And you find, um, concepts such as, um, UIA, uh, are quite Western, but in the traditional African community, this is unable because human life is create. We, we, we, we, uh, we, we are, we are more bloodshed. So we cannot imagine taking away somebody's life because one that is a bad creating, a bad for yourself, you know, and this person's spirit is going to on you, you know, and not just you, but also your, your generations to come. So while there will be justifications in the Western, uh, concept of, of medicine for, in the African context that does not apply, that person just has to natural debt, you know? And so that will be considered morally wrong while in scientific hypothesis, it could be considered, um, logically, right? Because if this person is vegetative, then there's no need to keep them hanging on, on the machines and there's no sign for, uh, you know, better improvement for life.

Dr Theresa Aoko Otieno: (22:30)
So why not take away the suffering and just let them go in peace. So you find, uh, the, the, the, from the point of view of mainstream philosophy, their similarities and their, their, their, their, um, contrast as well. If you come to issues to do with mal and Benefic doing no harm to anyone, you know, the Hippocratic court that applies both context, people, both in the medical profession and even in the rural communities or local traditional communities, believe that you have to do well to people do prevent evolve from happening to them. You also have to do no harm to them whatsoever. So you find that, uh, this philosophy is both informed how people perceive, um, treatment and, uh, cultural attitudes play a very big role, even in terms of, and, uh, in, in, in, in, in terms of social, um, social setups in the traditional African community, how women in health will be different for, from how many in health would also be different from how children will access health, or even how they will be treated across the board.

Dr Theresa Aoko Otieno: (23:50)
So, um, women will have issues to do a lot of privacy. Uh, men on the other hand can see any doctor, but then, uh, women women's privacy is, you know, very much treasure children on the other hand are the responsibility of women in the traditional setup. So it is women to take care of children when they're sick. And so their grandmothers will be, uh, really worried and concerned and their mothers as well. So you find that, um, this, all these dynamics, how people relate, what they perceived to be right and wrong, what they believe in, uh, their values or their sources of knowledge will determine so much how they think about healthcare.

Otieno Martin Ong'Wen: (24:38)
Yeah. Um, and maybe I can just chip in, um, well, from, from a traditional perspective, like traditional dealer was considered, uh, it was usually like family thing. So they were considered like, uh, so you having knowledge on how to heal someone, um, was considered separate. And, um, technically there was no actual way of paying for it. Um, you know, for services, like, you know, when you go to a hospital, you need to pay, uh, money for healthcare services, but from a traditional perspective, you, you either got, um, chicken or somebody give you a gift or probably a piece of land or, or goat or whatever. And that still happens today. So, um, and it was your responsibility as a healer to ensure that there is no suffering and pain was considered, you know, pain, pain in an Africa, uh, setup is considered some sort of suffering and either a punishment, you know, it is, it could be either punishment from the God's, um, a punishment from somebody, um, some wrongdoing that either your ancestors did, or you did, or somebody in your family did, you know?

Otieno Martin Ong'Wen: (26:00)
So, cause there's after a lot of patients who come in and say that, you know, my, my pain feels like a cause, you know, you know, they don't, they don't, they don't correlate it to an anatomical structure. Like we tend to, we tend to try and correlate some of the painful feelings that we have to a particular body structure or the different physiologies that happen within the human being or within the human body. So, um, those are some of the differences and, uh, yeah, it was, um, I consider, you know, some of the things that we refer to as soft scales, as very important for, you know, the traditional healers, how they communicate to patients, we can learn a lot from them, you know, in on matters empathy. And we, we, we, we've seen a lot of, um, uh, clinicians trained on how to be very good at picking what is actually really wrong with this person from medical standpoint, but they never that's that, that is where it ends, you know?

Otieno Martin Ong'Wen: (27:13)
So that is very scientific in terms of the healthcare process. But if you look at the traditional healer, they, they try to out, you know, how is your home environment? And a lot of the treatment was done in the home environment. So sometimes whenever I'm in the rural areas, I try to go to the, you know, my patient's homes. I want to see how do you live? Like, you know, what, what made you break your uncle, really? What you trying to tie are good. You know, those are some of the things that, um, a lot of times are not considered. So yeah.

Laura Rathbone: (27:52)
Oh, this brings us beautifully to exploring the bio psychosocial approach to health and healthcare really doesn't it. Um, this is something that we are all talking about around the world, creating meaning and societally relevant healthcare systems that are sensitive to the culture and the people that it's embedded within, um, the biomedical model and Cartesian dualism, like whilst acknowledging that it has allowed for amazing discoveries and treatments. Um, we can, we can also acknowledge that reductionism has limited our view on health and the person can sometimes get left out of healthcare, uh, despite our best efforts. So clin my question is then clinicians brought up in the biomedical tradition. Um, sometimes find that, you know, we find it really hard to bring the person interview and we can find conflict between medicine and spirituality and religion. So how do you, how do you see this, where you are, um, and, and in your practice and how do you think we can work to navigate this?

Otieno Martin Ong'Wen: (29:06)
Yeah. Um, it's uh, so, you know, when I was in school, um, learning all, um, the different, um, Kinzie methods on treating how to treat my pain, um, and what could be the possible cause of, you know, set joint, you know, opening and closing. So some, I had a lot of difficulty trying to explain to patients who, you know, like what, what the hell, what the hell? Like, what the hell are you talking about? I, I cannot, I cannot correlate to whatever you're explaining to me. Um, and it's, to me that is not important, but I was trying to U I used to catch myself in the clinic trying to explain what a center, a preceptor looks and what it does in terms of motion of the body. But my patients were, you know, just take, do whatever you need to do to make me feel better.

Otieno Martin Ong'Wen: (30:12)
I'll go home. I am not interested whatsoever on how spinal flexion extension works, you know? So I, I really check the, I, there was that, um, difficulty trying to incorporate, you know, doing stuff. So I just, I was like, I will, I will do what I, what I need to do in the clinic, but I'll talk, try and find out a lot about what does my patient do to make themselves feel better. So I tended to kind of tailor my treatments to what, what the environment looked like. So, um, yeah, there is, there is a lot of disconnect between science and what our patients perceptions in terms of pain.

Dr Theresa Aoko Otieno: (31:04)
Yes. And I, to go back to what you just said about the C dualism and how it applies in the traditional African context is that the, the, the body and the, and the soul and the mind are very much intertwined and health health, the concept of health, a concept of pain, uh, and actually even metaphysical just as, uh, Martin was talking about, you know, witchcraft or, um, an evil eye, you know, someone, they, they, they will attribute sometimes illness to an evil eye that is someone be looked at you with an evil eye. And, you know, you can't really, uh, empirically, you know, explain or empirically try to justify the evil eye. They'll just tell you that someone looked at me with an evil eye, you know, and that's why I'm not feeling well, I'm sick. I think they are cause of my illness. So the equal I is beyond the, the, the, the physical experience, we also have, um, results to do it, um, breaking, tap, breaking off, um, traditional, uh, rules and regulations of how life is supposed to be give.

Dr Theresa Aoko Otieno: (32:20)
So if you did this, then that is also attributed you, and this cannot be while, while people can see the mistake you did, but then the ancestral bit of it is beyond physical experiences. We cannot at, uh, um, attach it to any empirical, um, explanation also, um, issues to do with witchcraft cannot be empirically explained, but, uh, they, they transcend the, the, the, the, the body and the get into the, uh, spiritual real, you know, where you engage. It is more about the mind engaged. And it is, um, the being of that person that actually feels sick, but then empirically, but medically explain that maybe this person is having a kidney problem, or this person is having this type of illness that can be justified, uh, through a lab tests, you know, and the results will actually verify that the, the lab results, the x-rays and order of you will verify that this person is suffering from this kind of, uh, disease.

Dr Theresa Aoko Otieno: (33:33)
So, uh, this perceptions would influence a lot, uh, what people think or what people associate the cause of pain to be, so that it's having an effect in their body. So the cause effect, um, uh, cause effect, attribution comes a lot, not from necessarily an empirical perspective that they've eaten something, uh, that has affected their senses. Uh, but because of something that has happened in the spiritual that has affected their body, yes, pain, the instances where pain is not just associated with bad domains in the spiritual, but also socially the instances where pain is associated with group achievement, uh, examples include, uh, circumcision and female genital mu mutilation, their rights of passage from, uh, childhood to adulthood and circumcision. For example, for men, this is a true sign of manhood when you stand there and you go through that process without showing that it is affecting you, when you stand strong, you know, you, you don't cry, you don't show emotions, you don't, uh, TW or, or, you know, run away. You withstand the entire there's.

Otieno Martin Ong'Wen: (34:57)
No, there's no, by there, there is no, I see, um, you, you have to stand there and endure, um, the pain that, that goes with the process, you know, so, um,

Dr Theresa Aoko Otieno: (35:17)
Yes. And you can imagine that, uh, the nerves of course will already start the pain, but socially withstanding that pain and enduring that pain is a sign of strength is a sign of manhood is a sign of, uh, passing from child into adulthood. Same as FGM is kind of preparing you for adulthood, because then the assumptions that are made about your sexuality that ought not to be exposed or not, not, not to be enjoyed. And therefore FGM comes in as I assigned to, to, to, to inflict, uh, inflict a pain that will lead towards discipline, you know, and that, you know, uh, sexual pleasure is something that will not really be encouraged because of issues to do it fidelity in marriage. And what have you. So FGM is on those process processes that strives to ensure that women remain, uh, faithful to their husbands, you know, and therefore that is something that is admirable in this context, it is socially acceptable.

Dr Theresa Aoko Otieno: (36:29)
So the issues, the, the instances where pain was not just, um, associated with, um, with, uh, bad or men or a bad time in the spiritual environ, but socially it was accepted and celebrated as a way of achievement. And as a, as a way of growth, while in the medical profession, this will not make sense at all at all. Cause then you are interfering with the normal body functions and processes and, you know, the way everything else is intertwined is, is, is there for a reason and should not be tempered with, so while this will not make sense in the biological perspective, it'll make sense in that cultural perspective.

Laura Rathbone: (37:13)
Yeah, this is a really hard area for us to discuss, um, cultural, all practices that inflict pain as a necessary part of the experience, bring us into a really sharp, personal, cultural, ethical, emotional conflict. Um, FGM genital mutilation is not a topic that we tend to explore often, um, and an in depth discussion around like the ethics and practice of FGM is way beyond what we're, what we are going to achieve here on this podcast. But it's important to acknowledge that FGM has been outlawed across, um, 51 countries, uh, around the world, 22 of those on the continent of Africa where this practice is most prevalent, but that being said, FGM is a global practice. It's being carried out in every country, within every continent on the planet. So it's a very relevant topic for us as clinicians to be exploring from the perspective of safeguarding and working alongside communities to, uh, build meaningful change and, um, relevant, appropriate, accessible, um, meaningful healthcare systems.

Laura Rathbone: (38:26)
And we probably aren't going to be able to do that if we are only coming from the sort of stigmatizing judgmental perspective of closing down those conversations, it's, it's necessary for us to also look at these, these, these practices through the eyes of the community, um, that practice it, but that's gonna require, um, us to be able to take a, a stance or a philosophical stance in a order to explore that that will, will conflict with our own. And I guess that's exactly why I do this podcast because, um, the practice of philosophy as clinicians is a hugely important part in our jobs, in our roles, in understanding the people that we work with and providing appropriate and, and accessible services. So, um, I'm, I'm grateful for the opportunity for us to explore a little bit of these conversations and, and to, to see how we can take perspectives and stances in order to understand them further.

Laura Rathbone: (39:29)
The really hard bit though, is that cultural practices which require paying, um, as a necessary for ritual experience, bring us into this really hard place individually. And we don't want to look at them. We don't want to look at these practices cuz it makes us feel a certain way. I think it's really interesting that you discuss how FGM is hard for clinicians to understand that have come from the biomedical tradition because of this idea of separat in between the spiritual realm and the physiological one, which is exactly, really what that Cartesian split. It was all about this separation of soul from body, which like allowed us to, um, develop our current biomedical knowledge and practices and treatments. But it does also create this gap between, uh, spiritual and religious communities and the healthcare system, which I know that I have experienced in my practice, um, and in my access of healthcare as well.

Laura Rathbone: (40:26)
Um, so like, so, so how do we move on from here then as clinicians, because it seems really relevant in pain, um, where pain can be used to harm groups, say, for example, with those who have sinned or, uh, who are punishment and cleanser group move them through, as you say, like Aite of passage. So both of these outcomes and like contextual, um, ways of understanding pain, like we see this in the clinic. So I, I will hear people who are living with pain or who are experiencing pain or patients who are in active treatment, talk about pain as a punishment, um, or as a personal challenge. So how do we, how do we navigate this, do you think?

Otieno Martin Ong'Wen: (41:13)
Yeah. Um, I guess, uh, you know, considering, um, what, what Sarah message just say is, you know, that pain being considered as an aspect of growth has been a very big contributor to reasons as to why, um, the, some of the male, um, patients with cancer come into the clinic really late, you know, so they, they take this, um, sort of pain as a process through which men should go through, you know? Um, and, uh, they, uh, those time I was in, uh, like rural Tru and I was trying to find out from the people that, you know, what is I, I asked a simple question, what do you consider skeletal pain? And then they told me, um, that it is pain. They feel when they get shot by an arrow or when they get shot by a gun while cut rating. So to you, you know, considering all the factors that could be contributing to hip pain, they don't that the, the, the, the medical model doesn't come in me trying to figure out the, is it, uh, chop and tech bursitis, uh, what, you know, they, um, they consider that pain as part of, uh, being a man, you know, and that is something that a man should feel.

Otieno Martin Ong'Wen: (42:52)
Um, so me, me trying to find out to them what was pain and even the biopsy psychosocial aspects through describing what pain is cause they will go covering, they will lose their son or their cousin, and they don't consider that as they consider that as a warriorship, they consider that as, um, a brave depth. So to the extent that the man who doesn't go cut rating is you cannot make any conversation with any other persons in a meeting that requires contribution in terms of wisdom or anything else. So to me, I was looking at, you know, what are some of the BI, the bio, uh, the psychosocial aspects to, why are you feeling the way you feel? And there was no correlation there. So it forces me a lot of times to be really each and every place where I go, I have to try and find out what are some of the cultural practices that you, that you practice?

Otieno Martin Ong'Wen: (44:03)
What are some of the, uh, beliefs in and around the human body and the structures that you believe in? And I have to work, I have to kind of like really figure out how do I connect the, some to a cultural practice and, or a re a religious practice that will be useful or will marry to have improved health outcomes. So sometimes I try to kind of like, you know, get patients to, you know, it's, it's, it's almost like, um, I don't want to say duping them, or, but it's, uh, or tricking them or being a trickster, but it's just trying to see what is it that is culturally useful, um, that I can use, uh, to encourage something beneficial from a scientific perspective, you know, to kind of come up with good health outcomes. So, and I feel, I feel that it's something a lot of clinicians don't don't do you know, you, we try to understand, um, what does it look like?

Dr Theresa Aoko Otieno: (45:17)
I'm

Otieno Martin Ong'Wen: (45:17)
Curious,

Dr Theresa Aoko Otieno: (45:19)
Um, I'm a bit curious if, if did, if you found out or if you ask them as well, how they get to heal the gunshot wounds or the are wounds that they get, or a type of ones they suffer from when they get, uh, when they come back from the rate. Cause their process is usually very violent, uh, in between the risk of injury. Did you any chance find out how, how they treated wounds? Did they go to a hospital or did they just do it at

Otieno Martin Ong'Wen: (45:53)
A lot of them don't come to hospital, uh, because they, you know, sometimes the, the police consider it as it's considered illegal somehow. So it's against the law in courts to do, to do that, but they'll still do it anyway. So they have, uh, traditional hubs that they, they pick in the forest that they put in the wounds and they heal. Like you see somebody with a gunshot wound and you ask them, did you go to hospital to get treated? And they're like, no, um, actually choosing cow and a mixture of this, this and that. And some of those plants I have no clue about because you need to actually, um, it's, it's a, they won't, some of them wouldn't tell you because they feel that that is a secret for the traditional healers and you need to have come from a family within their environment to be able to gain that knowledge.

Otieno Martin Ong'Wen: (46:56)
So, um, again, traditional healers are considered as, you know, very respectable persons in the community and, um, I will know what they use, but I know Kang is one of the ingredients that they mix, uh, to kind of help, you know, with the pain and also, you know, they, they, um, I, I, I try to ask what happens when you get shot. Um, like, they'll say, I know I got shot, but I have to keep running with the cows, uh, until it gets to SEFA, you know, they, they don't consider the gunshot wound. It's technically like a soldier in the battlefield. Um, and that's why we, it's very difficult sometimes to correlate some of the pain that we fail to tissue structures. You know? So

Laura Rathbone: (47:53)
I have a good question for you then. So, so I have two ques well, I have loads of questions, but, um, my first que I have a question about the idea of the, the sort of, um, so the locus of control is something that we are talking about at the moment in, um, uh, sort of conversations, particularly around pain and pain care. Um, and this idea that people, um, with persistent and ongoing pain, uh, often show signs that they have externalized the locus of control for recovery to a healthcare clinic. And, um, what we are working on at the moment are how do we return the locus of control? How do we empower that person to feel autonomous about their own health and their own recovery, um, and their own ability to make choices in their life and, uh, in the, in the presence of pain or not, um, know what I'm, I'm wondering what that means to, to you as individuals, or as clinicians as philosophers, or in the wider sense of sort of the Kenyan cultural, uh, context of that. Um, because it sounds like within a traditional method, the locus of control for healing is also some how outside of the person, uh, I dunno if you've anything, what you guys think about that,

Dr Theresa Aoko Otieno: (49:19)
Uh, well, in terms of healing, uh, the locus of control, yes, I supernatural again, takes us back to the metaphysical philosophies that, uh, that which goes beyond human experience and, and cannot really be comprehended by the entire human mind. And while as well, pain can be supernatural, but also healing is supernatural and also attributed to supernatural forces. And, and that's why, uh, while biomedical, um, healing is popular, but also traditional healing is quite silent. It is still there in the communities. So people will go to seek this type of healing, uh, because one it's a chronic illness and the doctors are not able to find a solution towards it. So they believe there's a, there's an alternative. And the traditional healers just as Martin is saying, play a crucial role in this process. They are perceived to be able to go beyond what the doctors cannot see or hear or touch or smell traditional healers are perceived to have that ability to be able to go beyond that context. Then you'll also find that, uh, they'll then they'll stick this process because sometimes the health systems, they, they think are not adequate enough.

Otieno Martin Ong'Wen: (50:52)
Um, I'll chip in as, since I've lost her. Okay. Until she comes back. Um, yeah. Well, when it comes to the local of control, um, well, I don't, uh, what I, what I tend to look at it is it comes from all three perspective. It could be an anatomical, uh, you, you could be having like something in you that is affecting you, but then, uh, Kenyans have got like almost three things. There's the doctor, there's the religion. Um, so sometimes I pray with my patients in the clinic. You know, you let's say I prayer fast, uh, before we treat it's. Cause some of the patients initiate the prayer process and I, we pray together and I pray for them. I other, um, words that, you know, I'm telling God that they give me the, or rather they give the person the strength to heal before I get to put my hands on them or prescribe an exercise for them.

Otieno Martin Ong'Wen: (51:55)
So it, it is, um, it is religious. So there's, there's the, there's the religious aspect, there's the traditional aspect, cultural aspect. And then there's the pass on? There's the, there's the person in themselves. Cause sometimes I let, I usually try to ask questions, you know, what are some of the reasons as to why you've gotten through the place that you are? So some of them are like, it's because it is because of my doing. Um, and if it's, when they say it's because of my doing, then I, I have an opportunity to say that, Hey, you have, you have the strength and control for that. Um, and I can be, I can help you to get back to your previous thought process that, you know, uh, that made you be healthier as come to right now. So it, it is. And, and, and, and sometimes I let, uh, they feel that I, um, I got sick because I box lead from my religious practices.

Otieno Martin Ong'Wen: (53:04)
So then I'll say, yeah, what are some of the things? So I just try to ask them, what is it in your environment that you have control over and what is it in your environment that you do not, not have control over? So those are some of the things that, um, we try to see if we can merge them together to kind of like come up with a proper, proper healthcare outcome. Okay. Yeah. So, but then, um, I tend to use, um, the Bible. So I read the Bible so that I can have very good clinical examples for, for appropriate healthcare education. Okay. And sometimes I'll, I'll, um, I'll, you know, I'll talk to my Muslim brothers and sisters and ask them, what is it in Islam that has got encourages people to move more to exercise, you know? Uh, and then I'll, those are examples I'll use to my patients to kind of like feed in the concept that, Hey, exercise is good for you.

Otieno Martin Ong'Wen: (54:15)
It's healthy. And it's mentioned either in the Bible or in the Quran somewhere. And I use an example of, um, who, who in the Bible do you look up to? And then I'll give an example of this person needed to work from point a to point B, which is long distances and they eat healthy. And so I use, if, if you look at science, science says, you, you eat, eat a balance diet, right. Or exercise to get good health outcomes, or from a cultural perspective. We also have those behaviors that, um, uh, incorporate a healthy lifestyle dancing with one another in a wedding. Uh, you know, sometimes I ask some like some, let me give an example of one of these patients I ask, when was the last time you danced at a wedding? Cause dancing is considered something that is fashionable. So I'm like, oh, it's been a while.

Otieno Martin Ong'Wen: (55:16)
And then do you like dancing? Would you like to dance in the traditional art that, so then maybe we can use dancing or you doing dance practices to operate some sort of physical activity. So the, the, the, the locus of control, I don't, um, I don't give all the powers to my patient. I give bits of powers to culture, bits of powers to the social environments that they live in bits of power to of the religious practices and me being just, um, a guide or someone to help them see it from so that, so then, then I put in the scientific bits into it and I say, you know, um, maybe it's it's the back, but also it could, there's other things that could lead to why you feel the way you feel. So the focus, the locus of control to me is very multifactorial, you know?

Otieno Martin Ong'Wen: (56:23)
And, uh, I don't, I don't have it as you are the, you are the one responsible for your health. Maybe it's, maybe you are not the one responsible for your, and I also don't try to stop patients from doing, um, from going from getting traditional medicine, because there is something in traditional medicine that works. And all I try to say is make sure you are communicating to your doctor about the traditional practices that you are undertaking because sometimes like has gone life might not agree all the time. So applies to the different medicines that you're checking at the moment. So it's, uh, yeah, it's, it's, uh, it's a tricky, um, it's a tricky place to navigate and sometimes you have successes, sometimes you fail. Uh, yeah. So it's, uh, um, it's, it's not easy. I say,

Dr Theresa Aoko Otieno: (57:30)
Sorry, I lost, I, I, I got close somewhere there. Yeah. But, uh, just as to

Otieno Martin Ong'Wen: (57:36)
I, I got your part.

Dr Theresa Aoko Otieno: (57:38)
Thank you. Yeah. Going back to the locals of control you, traditional healing is sick because one there's, no, they there's a perception that the medical healing is insufficient. They, so in that case, it has lost its control over you and therefore traditional healers have control somehow. Cause they go beyond this financial, um, uh, aspects. They cover issues that the doctors can. So you find instances where your illness has become severe. Your illness is chronic and you know, uh, you, you are not getting precise. Uh, the, the, the duration of your illness has been quite prolonged. Then in this case, there's a different, uh, locus of control. And that is traditional options and alternative also, it's not just the traditional healer. It is the decision makers and the authority. Remember in traditional African communities, we are very collective. We are very socially integrated and, uh, your illness is not just you unless alone.

Dr Theresa Aoko Otieno: (58:50)
You know, I, I, I, I literally it's the philosophy I am because you are. And so it is kind of the responsibility as well of the traditional elders to give guidance. And so they are the ones who are going to advise next, you know, in the instances that biomedical, um, uh, opportunities and options have failed, then the, the, the, the community elders that is, that could be even your grandmother in, in our context or your grandfather, your father, you know, your uncles, your husband's relatives, or your, your, your wife's relatives are the ones who are not going to make the decision for you, that it is time to seek an alternative form of healing. And that is, that would be precisely go for traditional. So you find that the counseling and advice will not be that of the doctor, but of that, of the immediate relatives and community members.

Dr Theresa Aoko Otieno: (59:51)
Then you also find that this hi, um, with tradit, with the religious rights and rituals, it also occurs hubs and, uh, and, and, and religious science and symbols, some of which are, are, uh, are, are embedded so much in the traditional culture that this is a sign, or this type of illness is a sign or a symbol of this kind of ma Malays in the community, or, you know, in your homestead or in your, in your life, generally, how you are giving your life. So there will be symbols, or there will be, uh, rituals, or there will be special sites in which healing will be perceived to or car, which would be different from a hospital being admitted in, in a hospital or lying in a hospital bed. So you find that this symbol, if you are given, then, uh, its presence somehow will have an effect or will affect your process of healing. So the locals of control then is not just you as an individual is not just when in biomedical, it'll be you between you and the experts were involved in your case, but in the traditional African society to be between you and your immediate community. And, and, uh, and, and so the traditional healers at the end of the, you know, at the end of the circle, you actually determine what to, up for you.

Otieno Martin Ong'Wen: (01:01:24)
You, yeah. Um, let me just add one thing. So one of the things Laura that I've done is for the geriatric populations, they're very religious, so I'll, and those, those, so those who can ask of risk to come to their home, um, I'll, I'll say I'll have therapy after the prayer, because I knew me going after prayer, they're all and happy, and it gives me an opportunity to, Hey, you know, what did God say today? You're gonna walk to the end of the compound, you know, so I would use that to incorporate a physical intentional. So, but then the, the, you you've, you've, uh, you've, you've kind of like opened up an opportunity for healing by using, this is my belief. This is what I understand of, um, I need, I need, I need prayer. And the more, the, the more communal the prayer, the better.

Otieno Martin Ong'Wen: (01:02:28)
So I find patients at a hypo position are at a better position to actually provide, treat that it's scientific, but I try to usually correlate the science to some sort of cultural practice or religious practice, um, and patients believe as well. So, and, and I know that might not be possible in a lot of places because, um, it, it, it, it involves really getting to take time to understand the person or the passion in front of you to get to know, and having a keen interest on what do you actually, um, fancy? What do you try? What do you understand? And then how can I marry your understanding to science, to the social practices and, and cultures are different. Uh, we like, you know, they, and, and they all, you know, we, we speak for heal. We speak English, um, sometimes, but we have, uh, we may have similar similarities in cultural PR practices, but every, each and every culture is unique.

Otieno Martin Ong'Wen: (01:03:42)
And you have to have, I find that me getting to know bits of their culture helps me a lot in terms of clinical outcome. And it's a process to learn to understand. So, um, I will, of control is not, and as much as we are responsible for help, we, you know, we need help, you know, like human beings, we need one another to get to. Uh, and there's a, there's a, there's a saying that says, um, if you, if you want to, uh, if you want to go far, you work with others. You know, if you want to be the first walk alone, but if you want to go far, there, there needs, there needs to be others involved. And that's why I feel that healthcare now should incorporate each and every aspect of collaboration. And it doesn't matter whom you're collaborating with, whether it's the priests, cause some of the churches, if you have an obese priest, you probably have an obese congregation.

Otieno Martin Ong'Wen: (01:04:59)
It's, it's, it's it's if, if, if, if the it, and I'm, I'm, Terry's laughing, but it is, it is. If, if, if I can teach the, the, the, the religious leader that Hey movement is actually correlated to God and taking care of your body as a structure of God's doing, then you need to be an example to your congregation. And you find when the priest stops exercising, the whole congregation goes on the dog. If the priest is jogging, all of them, all of we go for a job. So I guess we need to, um, we need to factor in all those little pieces that contribute to us having proper healthcare systems. So

Dr Theresa Aoko Otieno: (01:05:52)
Martin just reminded me, uh, one of the, this discussions we, we used to have in, in school about, uh, St. Thomas Quin and his philosophy, or the trying to explain God. And one of the issues was God being there and moved mover, the, the, the one behind all movements, he only him cannot be move moved, but the, all the movement in the world is orchestrated by him. So actually, so when he is mentioned about, uh, movement, it's taken me back to some of those discussions he used to have. So yeah, you can actually talk about the, the move, if you had to get the congregations moving,

Laura Rathbone: (01:06:45)
I find it so beautiful the way you are both bringing together the sort of social aspect, um, of religion and culture into healthcare. I think it's something that, you know, being trained in the purely, uh, sort of biomedical approach and in a secular country with no concept, I have no concept of religion as a person, you know, not brought up with faith, never been to any faith teachings, never even really been to any, um, ceremonies other than sort of, you know, weddings and, and christenings. That don't make a lot of sense to me. Um, from my personal perspective, not, uh, to, to say that they don't make sense in the wider scope, but what I'm seeing here is that actually that is a real injustice on my behalf to the community around me, because how can I create messages and understand the perspective and show, you know, deep, meaningful empathy, if I don't fully understand the cultural context and religious context of that person, and, you know, to be able to make even to, to a great science into those messages, feels to me like an impossible task, because I don't have that knowledge.

Laura Rathbone: (01:08:10)
Um, and if we are thinking about pain care specifically, you know, there have been many times where patients have said that, and people who are living a life with pain, talk about their pain as a sin, or as a punishment as a being, um, part like a, a sort of transformational part of their religion. And it's very difficult for me to understand that. Um, and I think now, as we're understanding the bio psychosocial model, what we are doing really is by psycho. And if we are going to fully commit and fully embrace the social aspect of it, we need to incorporate education, religious and cultural education into that, so that we can fully under on maybe not even fully, but just take a step towards understanding the perspective of somebody else. Um, you know, living in a, in a multicultural multi-religious nation, um, you know, it's putting the social back in to the understanding of pain as a, as a social experience. Um, um, which I feel is what you, you are sort of talking about almost here, like would you say that in the sort of more rural communities or in your experience of working with, within the religious communities, that pain is a social experience?

Otieno Martin Ong'Wen: (01:09:30)
Yeah. Um, I would say, yeah, pain is largely, um, it is, it is very social and, um, considering, um, the environment in which of works, there is so much going on, um, in, in lives, different lives and they're so that they, they, they they're very different. So in, in Nairobi, somebody might be in pain, a lot of pain just because they probably lost the job. They try and find how do I pay my rent. Um, and that is the reason as to why they, they, they, they they're, they're getting, you know, their symptoms a lot more increase, um, as opposed to in the village. Um, I just, somebody might be in a lot of pain because their, for some reason, their cows are dying and they don't have control over their cows dying.

Otieno Martin Ong'Wen: (01:10:42)
So that is a contributing factor to why they feel the way they feel. And I can give an example of a patient, uh, who had high blood pressure, like really bad blood pressure until you could see the heart. Like you could see, you know, the chest, you know, BI, but she, the reason why she didn't want to come to the hospital was because she was afraid that her son is going to steal her eyes. So she, she was saying, if I leave my compound to go to the hospital and you guys, the last time I came here, you admitted me for three days. I found my rice missing after three days of laying in the hospital. So what is the next best thing to do is I stay home and got my rice, but she did not, she did not live long enough to got the rice, which I think it's, it was, uh, I'm doing in terms of not trying to explain to her, probably if we could have found somebody else who can take care of her granary so that she stays in hospital, knowing that horizon is safe, then that would've been a patient saved.

Otieno Martin Ong'Wen: (01:12:10)
But according to us, we, you are thinking that, Hey, you, you, you like, I'll, I'll say one of, um, one of my clinical mentors, um, once told me that patients don't come to the hospital because they have blood pressure of 200, over a hundred. They come to the hospital because they've stopped. They, something in their life that has been stopped that has got a social connotation to it. You know, patients who come to the clinic and say, I cannot play with my grandchildren. And that is the reason as to why they're in hospital. My hand is stopping me from, from playing with my grandchildren. They don't consider that a range of motion or, or a frozen shoulder problem. But here you are, you're telling them, this is, you know, it's frozen shoulder. This is how it, so they don't, they don't, there, there is a social component and it plays a very big role in how we've feel our symptoms.

Otieno Martin Ong'Wen: (01:13:19)
So, and we need to, we need to factor all those things and, you know, we cannot push all these things in questionnaires, but we can put them in conversations. We can, we can, we can, yeah, we can have a convers with my patient rather than having questionnaires with lots of checklists. I just, I talk to my patients in my, in my mind and probably, uh, I guess it takes time to really master some of the questio that need to be included in the questionnaire. But I guess just having dialogue with someone gives you an opportunity of figuring out how best to help them. And it could be, it could be from a social perspective, it could be from you need a certain injection to make those symptoms go away. But how do you explain to them that you need this injection without you knowing what is actually happening to them? You know, from a, a social perspective, a medical, but, and I'm not saying that we don't go teaching medical professionals only to be social human beings.

Otieno Martin Ong'Wen: (01:14:34)
They need to have an understanding of the anatomy, the physiology, the pathology of what's going on, but they also need to have an understanding that at the end of the day, we are human beings and reason as to why we experience things is because of our social environment. And that plays a very big role from, you know, pain that you felt, uh, when you were growing up. So somebody who grew up in the Islam, somebody who grew up in the city and I've had conversations with all these people and from their perspectives, I get of an understanding. This is how I can address, you know, somebody from this environment. And this is how I can address somebody from this environment. So, yeah.

Dr Theresa Aoko Otieno: (01:15:28)
Yes. And actually to add on the fact that pain is a very social, uh, phenomen know, um, going also back to existentialism the, the schools of thought of the existentialist and, uh, the likes of sat and all that, and who talk about life as a sum of their experiences and what they go through and not being able to, you know, kind of, uh, it's a defiance towards the, the very abstract conceptions about, um, individualism and also societies, but going more into, into, into real life experiences, whether you're an individual, um, as an individual or even as community, you know, as, as traditional African communities are very, uh, socially interrelated. And, uh, the philosophy of going to I am because you are still very much applicable such that pain is not just my own problem. It's also your problem. And that's why the community will find, try, find a way for you to heal.

Dr Theresa Aoko Otieno: (01:16:41)
But also you find that, um, it, it can be, uh, pain can be prolonged depending on how, uh, how involved the community is in your case or how distant they are from your issue, such certain, uh, very sensitive, uh, issues that bring pain, our issues to do it infertility or erectile dysfunction, for instance, you know, and, and, and, and the fact that you cannot bear children and, or the fact that, you know, you cannot serve children in, in, in an African community was not really welcomed. And it, it, it was attributed to those supernatural, um, uh, aspects you talked about previously with crafts taboos and all that. And, and, and, and so either the community found a solution like in my traditional, uh, low community, if you are BARR, then you as a wife will find your man or husband, uh, I mean, are your husband a, a, a woman so that she can give birth quite often, the first two who bring your husband was your sister, because his children are your children, her children are your children.

Dr Theresa Aoko Otieno: (01:18:06)
So you see, you are very much interconnected with those children because directly you are related to them by virtue of their mother. So, um, the closest relations would try solve that problem. If it was the man who could not serve children, then the, the, your brother-in-law could be invited at some point. And it's that you make it very obvious that it, your brother who made me pregnant know it is a way of covering up for your husband's ins. So you find that, um, whatever sort of illness that was, uh, affecting you had a social usual infertility had the social solution by involving immediate relatives. Also because the genes from this, uh, from, from your, your brother will still be the genes of that same family, other than getting, uh, siren children with someone else from a distance it's like bringing genes from another community to your community, and you don't know their, their tradition, you don't know their practices or the things that they've been doing.

Dr Theresa Aoko Otieno: (01:19:20)
You dunno their way of life. So to make it safe, your most immediate relations were the first solution to, uh, to your illness. So, um, then in that context, you find that, uh, uh, one pain is shared socially two. It is also, um, solved socially and three, uh, it, in as much as, yes, it's an individual experience. And there are certain instances where, uh, maybe infertility comes a lot with a lot. It comes around with a lot of, you know, labeling and stigmatization. And what have you still, the community found way of protecting you? Yeah.

Otieno Martin Ong'Wen: (01:20:11)
Yeah. Well guess just sorry. Guess how I treat my grandma's hip pain. Well, it's, I, I, I, I, grandma calls me and she says, Martin, you know, the first thing she says is I I've been having pains. Um, and these are the pains that I failed. So I tell her, well, Hey, guess what? I'll, uh, and she she'll ask, you know, to, for us to send drugs or send money for drugs, but then I'll say, Hey, grandma, how about I send you some money so that you go buy a fish from your favorite vendor. So then that means grandma needs to walk through the, to, to, to, to the market. And guess what, guess what happens in the rural areas? When you walk to the market, you, you socialize with other human beings. So, hi, grandma, how are you doing? But you are also getting physical activity, a movement that is going to probably solve hip pain without having somebody mobilizing your heat, for example.

Otieno Martin Ong'Wen: (01:21:10)
So that is all that is social. And then I'll call a high grammar. How are you doing now with the heat pain? Uh, yeah, I feel my, I feel way much better. So if, if we, um, if we, and, you know, the treatment of doesn't, it doesn't have to be, be very scientifically complicated to treat human beings. It can be as simple as kind gestures, you know? And, um, yeah. So, um, and yeah, maybe there's some of the things we, we are, we, we are talking about here could be related to how we are brought up, you know, from different cultures. And, you know, we are not saying that, um, we should behave like a particular culture, but at the end of the day, it's, uh, um, and grandma says, just be a good human being. And I like to, I like to, I like to say that a lot, you, you just need to, at the end of the day, care about another human with whatever they're explaining and whatever they're telling you as, as a clinician. So, yeah.

Dr Theresa Aoko Otieno: (01:22:24)
And, and also think this is part of what's missing the missing link between, uh, the modern medicine and traditional medicine is that there's no dialogue between these two partic uh, these two levels or these twos of knowledge. Both of them are EPIs epidemiological in their own rights. And both of them are, have a contribution to me. So interventions towards modern medicine, for instance, if you want to, to, to reduce maybe, or, or, or to introduce family planning in traditional, I mean, in rural setups, maybe you, you want to address malaria, you know, uh, frequency in, in, in, in villages, in rural settings, it's important to have dialogue with the rural communities because you find, yes, they're able to access malaria tablet, tablets, for example, but then they, they access it from the nearest vendor in, in, in the, from the nearest market center, from where they are, and maybe their access, uh, to this vendor is not accurately informed.

Dr Theresa Aoko Otieno: (01:23:34)
You know, when you, as doctors, your busy campaign in telling people to go to the hospital, and sometimes they don't even have the, and transport to reach the hospital, but this vendor is the closest person they're able to reach. So when you get to the community, it's important that traditional, um, I mean, um, modern medics or the medical professions get to have an interim. I dunno, it's what dialogue, so that they they're able to understand where this community is coming from. And the communities are also able to understand where are they also coming from in that case, if you are able to have dialogue with this community, and you find that they, they depend on this vendor for Malaysia tab, and you're able to sensitize this vendor on the, a, the way the, the, the accurate dosage, then these people will better respond to treatment. You know, so having this kind of dialogue with the communities on the ground to establish how, uh, both systems can be meaningful towards their, to the, the, their general health, whether, uh, physical, mental, you know, then there will be better solutions towards, uh, uh, uh, improving and is to healthcare.

Laura Rathbone: (01:25:09)
Yeah, I think that's a very good point. And I think that's, that's it. So when we are trying to deliver sort of cross-cultural healthcare messages, we have to be very informed about, about the culture we're going into. Um, you said something really beautiful there be between you, um, idea of community solutions to a social experience of pain. And then this, um, this is something that, you know, pain care from, from where I am, you know, sitting in, in Western Europe is, is something we are struggling with as a medical profession and as a healthcare profession. And I sometimes, as, you know, what, we hear a lot from people who are living with pain and trying to navigate the healthcare industry is that they feel really like isolated and not cared for. Um, and I wonder whether there is something about the medicalization of pain that is almost removing people from community solutions.

Laura Rathbone: (01:26:07)
We're now the, the medical community is so big that it spans the entire country or the entire part of Western Europe. We share a medical culture, a medical science, but actually what we're not doing is embedding that within the local community. And maybe what we're seeing is, is a lack of local community or a breakdown in community, uh, spirit, not knowing your neighbors, not having a shared, you know, a shared sort of geographical and social group, um, within local communities. And, and so actually the, the experience of pain, isn't a social experience. It's not a community there, there aren't community solutions, there's a medical, uh, solution, which is removed from the community. And so the person is having to leave their community in order to get the medical solution. Uh, and, uh, it there's something in the way you you're speaking that makes me think, yeah, maybe we maybe by centralizing our healthcare when it comes to pain and, and, and, you know, take medicalizing, it we're, we are losing that social care aspect, that social interrelatedness of how the sort of wider systemic, um, the sort of familial and sort of that person's systems, um, and how they care for each other and how they impact on each other and how it's interrelated.

Laura Rathbone: (01:27:42)
Yeah. Very beautiful. What you've said.

Otieno Martin Ong'Wen: (01:27:47)
Oh yeah.

Otieno Martin Ong'Wen: (01:27:50)
Yeah. I, I find, I find that, um, you know, patients who, um, are in better social environments get better quickly. Um, and it is, there's, there's a very big difference even in the rural communities. So from that have, um, so grandma, grandma is surrounded by lots, lots of grandkids, uh, you know, moms, uh, brothers and sisters who, who are within her reach. So, um, and, uh, she will, she'll, you know, getting access to healthcare is made easy for us that way, but also, uh, the environment provides, um, a healing phenomenon and, you know, even, even in just, uh, a good anatomical structure of how our bodies are designed, it, it, it, there's a lot that comes into play in terms of interrelationships of the system. And that, that is, we cannot, we cannot, um, treat patients if we are not considering environments in which they live in as well.

Otieno Martin Ong'Wen: (01:29:18)
So if the human body survives an environment where things need to work together, then what is, you know, what is the youth use of having different specialties in healthcare that does that don't communicate to one another. So, um, um, yeah, social environments and patients from very good social environments where they, you know, there's an understanding there's some level of education and there's a lot of people to seek advice and help from do way much better from even, even grandmas who didn't of a lot of babies or siblings. I'm not saying that we give back to a lot of, I'm not saying that we don't, we don't stop family planning, but I'm just saying we, um, we, we need to, uh, embrace the fact that human are social being, and we need to, uh, incorporate all aspects of social, uh, socialism in addressing the problems that we have, uh, an atomically and pathologically. So, um, those are, they can be simple solutions that can be very difficult solutions. I feel that if, um, if we work together, then it becomes simplified.

Dr Theresa Aoko Otieno: (01:30:51)
And, and also I think, uh, partly because partly why, uh, COVID 19 measures, uh, were not quite effective to some extent in, uh, urban areas, especially was because of so much emphasis on, you know, social distancing. And yet this is not a reality that we are used to, uh, our urban setups in, in fact, first, the way we socialize social distancing is not in been applicable in the first place. Secondly, the setup, uh, some of the setup areas, social distancing is a privilege for the reach, but when you went to the rural areas, really social distancing does not, did not, did not even apply. What's say if you go to the village, they, they think they think Corona is for people in Nairobi and urbans, but not for them, but, but then even traditional African communities had ways of dealing with infectious diseases. And if there was a pandemic, you would find that.

Dr Theresa Aoko Otieno: (01:32:04)
And, and, and there's an, there's a person affected the homesteads or the way in which our homesteads are formed. Uh, extended families live very much together, but then you'll find that maybe Laura's family and all her extended family members would self IOL in that homestead. So Laura will be taken maybe to grandma's house, but she'll stay there alone, except for maybe her husband or her sister who would attend to her, but then everybody else in that home state would stick within that compound. You know? So then you find that yes, even traditional communities had ways of dealing with infection, diseases. Some of these, uh, elements were timely missed in the way we handled COVID 19, you know, and we all, how the west has done it. And, you know, tried imposing the same rules in our context, which have not really applied yet. Our elders also had the same knowledge of how they could better handle our, our case.

Dr Theresa Aoko Otieno: (01:33:14)
So this had this led to a lot of stigmatization, and even the way coping 19 barrels have have taken place, the first barrel was very dramatic, chaotic, and scandalizing for the entire country, literally because it VE all barrel rights in the social setup, you know? And so that created a lot thing that was not there and stigma that was not there because of COVID-19. So you find that had there been a way in which, um, this, the, the, the, the expert committees handling this issue had involved to additional communities or setup, then they'll have better, uh, more hybrid, so better hybrid solutions. You find also issues, issues to do with contract tracing by when you come contract tracing was an issue. And because, uh, the government doesn't test and then goes away, but to see in this community that you're testing, everybody knows. So, and so, and so, and so, so if you don't go through that system of how they socially relate, then it'll be very difficult to trace the contacts of those people who came to test when they did not give activity information. However, if you, if you, if you went to the village, they all know each other, but if you just came and appear at a center and expected that everybody would be honest about their contacts, that will not necessarily be the case, which we actually, so, so you find that neglects in that social, cultural, uh, aspect also in a way impacts negatively on the interventions that are expected to yield higher results. Yeah.

Laura Rathbone: (01:35:19)
Yeah. Good question. Um, I think we're, we're coming to the end now. Um, so I just wanna say like, um, you know, this has been a beautiful conversation that I think, uh, the listeners can learn a huge amount, but I know just from a personal perspective, I learned a huge amount just from this conversation, and you've given me a great deal of seeds to think about and inspiration. So a huge thank you for your time and your generosity with your ideas and your thoughts and your, um, openness as well. Um, so thank you very much. Um, is there anything that anybody would like to say just before we finish?

Otieno Martin Ong'Wen: (01:36:02)
Yeah, I guess, uh, well, I just hope that, um, this information is useful to, um, that clinician who's been struggling, you know, trying to understand how best to help their patient. And also, uh, it, it becomes, um, kind of like a movement to bridge the gaps we have as clinicians on, uh, collaborations, you know, and, uh, we, we, we, we need to work together, um, on all aspects of, you know, factors that contribute to us human beings, having proper healthcare. Uh, so, and I know, you know, that that can be something very difficult to achieve or bringing all the, uh, different healthcare providers, as well as traditional and cultural, um, uh, persons with knowledge of how, uh, they, you know, they've, they've addressed some of society's problems in one room. It can, it can, it can, it can be a difficult and thrilling process. And I've tried it here. Um, I guess I'll still keep trying to, um, uh, get people together to discuss, you know, what are some of the best ways to really help, uh, people who are suffering, you know, so, yeah,

Dr Theresa Aoko Otieno: (01:37:34)
Yes. I want to say, uh, this has been quite, uh, interesting discussion Laura, and I'm happy. I'm always happy to put back into perspective, uh, all the philosophy I ever learned in school. And I, didn't actually now looking back at what I did in terms of counseling, uh, in clinical setups and, uh, my other experiences I see there's a lot I can still do, and there are ways in which I can still be relevant in that domain. And you have actually brought this to my attention. So I'll, I'll been out looking for such opportunity. And I'd also say there are, there are ways, ways in which, um, that this bridge can be gaped or this gap, sorry, this gap can be breached. Yes. And, uh, research is one of them in the relevant areas or in the relevant, um, uh, uh, areas we've been talking about relevant that would help elaborate more about this issue.

Dr Theresa Aoko Otieno: (01:38:38)
Uh, the training is very important for, in terms of curricular development, both from the Western and the African perspectives, if they could, uh, the training or the, the, that metrics go through could integrate. That would be very important, of course, sensitization and education, um, to communities, uh, especially on the level of traditional, uh, knowledge you have traditional midwives and, you know, the, the, the community has its own system of which can be, but also given the current global trends of modernity and the ways in which, um, things are constantly changing to going back to the philosophy of, uh, to that, uh, changes permanent. So even our societies need to adapt to, uh, the situations that come on and off, like the COVID pandemic has made us certainly make some adjustment. So it is important to continue with and awareness community as so

Laura Rathbone: (01:39:56)
Lovely. Okay. So, um, I wish you a beautiful evening, and I wish that, you know, hope that you continue to navigate this pandemic safely and do your brilliant work. So, um, for, uh, Martin, I know that people can find you on Twitter and Facebook, uh, under Kenyon physio. Um, if you want to get in touch with you there, is that something you're open to, or, uh, is there a way of people asking you a question or furthering the conversation?

Dr Theresa Aoko Otieno: (01:40:27)
Yes, yes. They can find me on LinkedIn is, uh, uh, a profile LinkedIn and Twitter, Twitter, but especially LinkedIn, just, uh, Tesa find you there.

Laura Rathbone: (01:40:39)
Thank you. And I will put the link, uh, on I'll put the links on the podcast and, uh, to both of your, uh, profiles so that people can continue this excellent conversation and we can continue to learn from each other. So I

Otieno Martin Ong'Wen: (01:40:54)
Dar was mom. Uh, she can say hi to the audience. I ill love her to say hi.

Speaker 5: (01:41:01)
Hi. Hi, everyone.

Laura Rathbone: (01:41:03)
Amazing

Speaker 5: (01:41:06)
To see you and

Laura Rathbone: (01:41:08)
To meet. Thank nice to meet you and are having a nice evening and thank you for all your time.

Speaker 5: (01:41:15)
Thank you. Thank you.

Otieno Martin Ong'Wen: (01:41:19)
I on

Speaker 5: (01:41:21)
Good. Thank you.

Laura Rathbone: (01:41:23)
I love this. Just warmed my heart. So, um, yeah, I wish you a beautiful evening, the rest of the evening, uh, uh, from here and I will speak to you all soon, so, bye. Bye,

Speaker 5: (01:41:41)
Bye.

Otieno Martin Ong'Wen: (01:41:42)
Okay, bye.

Laura Rathbone: (01:41:46)
A huge thank you for listening to this podcast, as well as the entire series. And I can't wait to bring you the next one in the series as well this year. Um, if you are interested in this topic and you wanna know more, then please consider exploring some of my other projects. There is, uh, paying geeks, which is, uh, available on paying geeks.community, which is an international reading group and discussion group, looking at different perspectives on how we understand this experience of pain. And I also run, uh, small clinical coaching groups for people who are wanting to explore how philosophy and culture and society and psychology, and although, uh, perspectives on the experience of pain can be integrated into the, their therapeutic practice. So to find out more about that, please go to www.laura.com. Thank you.