Lessons in Cultural Differences

Chance Wayne: We’ve come back to the sea.

Princess: What sea?

Chance: The Gulf.

Princess: The Gulf?

Chance: The Gulf of misunderstanding between me and you …

                              Tennessee Williams, Sweet Bird of Youth



A group of Afghan Army medics recently quizzed a colleague of mine by asking him to give priority to the following vehicle processions: a wedding party, a funeral convoy, the presidential escort team, and an ambulance traveling with a casualty. The Afghans wanted to know who the American thought was most important and most deserved the right of way should they be encountered on the road. My colleague responded quickly that the ambulance was the first priority, with the presidential vehicle likely second, the funeral procession third, and the wedding party least important.

The Afghans were aghast. They argued that a wedding is the most important event of a person’s life, and that it was only right and correct and fitting that the wedding procession deserved priority over all other groups. The vehicles carrying the dead and the deceased’s relatives would be the second priority, as the funeral signifies that a person is going to meet Allah (apparently the most important moment in a person’s death). The Afghans rated the presidential convoy as the third most important since they carried the leader of the nation. The ambulance, they insisted, was certainly the least important of the processions. The person inside was injured already, they argued. The victim’s fate was more in the hands of God than those of the paramedics and the physicians the casualty might see if newlyweds and dead people didn’t completely block access to local medical care. The Afghans seemed to believe that clearing a path to the nearest hospital would do little to improve the injured person’s chance of survival.

After I heard this story, I began to think strategically on how we could improve emergency medical care in Afghanistan. My first thought was that we should paint and decorate all ambulances to resemble a bride’s vehicle. And maybe we could add edifices to the Afghan hospitals so they would have the outward appearance of one of the ornate wedding halls that are omnipresent and very popular here for nuptials celebrations. A longer term goal would be to ease the sexual repression and frustration that add so much social (and physical) imperative to the wedding (and the wedding night).

All of my thoughts, however, and all of my strategy might very well prove foreign to the many Afghans. After all, we would not agree that even a blushing bride should wait out a rushing ambulance if they arrived simultaneously at an intersection. The Afghans would likely be stunned to hear that I have devout Catholic friends who no doubt would call a halt to a wedding reception to recite a short prayer for the injured should they even hear a distant siren wailing. The difference in how Americans and Afghans think sometimes is quite startling. Hypothetical scenarios such as the aforementioned vividly illustrate the contrast.

I think Americans and our Afghan colleagues can bridge differences as we work together to improve the lot of the average person here, but contrasting sociocultural attitudes, beliefs and priorities often makes the work difficult. Recently a group of Afghan Army colonels were discussing with their American colleagues a proposed system of casualty evacuation from a battle site. The Americans assumed that serious casualties would be transported for care first, followed by the less seriously wounded, and then the dead.

The Afghans colonels were silent at the beginning of the discussion, and very polite to consider the American plan; but then they abruptly inserted themselves into dialogue when, from their perspective, the American proposal proved itself to be prima facie ridiculous. The wounded, they stated, are important. But the dead, they insisted, are more important. Of course the dead soldiers would be evacuated first from the battle site, the Afghans insisted, and returned to their homes or another appropriate location for the quick ceremony and burial that the Islamic tradition dictates.

I’m not sure how you argue against the Afghan colonels on this point. It’s not easy to argue against what someone else accepts as faith, as faith is not always beholden to intellectual reason. I probably could not convince a proponent of intelligent design that there is nothing notable at all in the construction of the human pharynx where our food and air can mix; and that either element can create a disturbance quite easily by taking the inappropriate route further south into our bodies. Or that a woman’s canals for defecating and birthing are perilously close together. There’s nothing objectively intelligent at all in these and other anatomical “designs” of the human body.

Biological evolution can certainly explain their current construction. But to the intelligent designer who refuses to believe the theory of evolution, faith is more important than objective fact. In fact, faith itself often sets the framework for what can and cannot be accepted as fact.

Motivating the Afghans to create what we, the Americans, feel is an appropriate healthcare system will remain a frustrating endeavor until we accept the fact that the Afghans don’t always believe and value what we believe and value; nor are many of them especially eager to adopt our cultural attitudes and ways. The American expectations here might be the major source of confusion and frustration, even though we often consider the response of our Afghan colleagues as the most challenging issue.

I’m no expert in cross-cultural dialogue and learning, but I’ve seen enough during my year in Afghanistan to realize that this place is different – very different – from what I regard as normal and functional. We need to recognize and address these differences if we expect our work to be successful.

But back to the wounded Afghan soldier who sees a dead buddy evacuated before he gets transport for treatment of his internal bleeding: My advice to him is to feign death to ensure quicker evacuation.