Cross-Cultural Mental Health: Insights from an Occupational Physician

Speaker A: 00:00:01

Welcome to beyond the Smile with me, Mary Layo, a podcast that discusses mental health and spiritual well being. If you like what you hear, please do remember to follow and share.

But before we jump in, there may be episodes that are particularly sensitive for some listeners. And if that applies, then I hope you'll join me whenever you feel ready and able. In today's episode, I'm talking to Dr.

David Aku, an occupational medicine specialist with over a decade of medical practice under his belt.

Now, David is based in Ghana, so I was interested to hear more about the cultural differences between countries such as Ghana and the UK when it comes to dealing with mental health challenges, and also to hear how David manages his own mental health. But to start off with, I asked David what led him to become an occupational physician and how did he get the nickname Triple D?

Let's join in the conversation. So, David, I'm really intrigued. Have you always set out to be a occupational physician? And why do some people call you Triple D?

Speaker B: 00:01:19

Okay, so I fell into occupational health. Literally fell into it. In medical school, you're not really taught about occupational health and safety. So what happened was I want.

I went on leave and I was trying to make money doing what we call lukum. And I happened to go to a hospital that was seeing to a mining site. And then I got to know, wow, this thing called occupational health and safety.

The interesting thing about it was I saw an opportunity to help more than one patient at a time. So when I was in the consulting room, you see one patient help them get better.

But with occupational health and safety, you get to impact so many people at once. And that's what really drew me to it. Really. Actually it was. It wasn't an intentional thing. It was. And I'm glad it happened.

I'm really glad it happened.

Speaker A: 00:02:12

And when you say you get to see like a group of people at one time, what do you mean?

Speaker B: 00:02:20

Okay, not to see a group of people at one time, but. So, for example, a worker comes in with a problem with their hearing, what we call noise induced hearing loss.

Then in occupational health, I would then go and investigate. Is there something about the workplace that is causing this worker to damage their hearing?

And then put in measures that would then protect all the other workers. And so the impact is quite wide.

Speaker A: 00:02:46

Yeah, right, yeah. So then why do they call you Triple D?

Speaker B: 00:02:53

So the presidential team of IOSH came up with that, that nickname and let.

Speaker A: 00:03:00

Me just stop you there. So IOSH is the institution of occupational safety and health.

Speaker B: 00:03:05

Yes, yes. Occupational Safety of Health.

So to rewind a bit, when you are a doctor in the patient health and safety world, you are expected to stay in the consulting room and you don't really have much influence on policy and strategy. And as you can tell, it's something I was very interested in being able to influence. So I went on a deep dive to improve my competence.

And because of that, I'm chartered with three international organizations.

So I'm a chartered member of iosh, Institution of Operational Safety and Health, iema, which is the Institute of Environmental Management and Assessment, and the Chartered Quality Institute.

And I'm also a fellow of three international organizations, so of Double irsm, that's the International Institute of Risk and Safety Management of IOSH as well, and iema, and therefore being triple chartered, Triple flute, they just said, let's call him Triple D. That's just what. That's the first point where it came from.

Speaker A: 00:04:10

Makes sense. Makes sense. Okay. All right. I'm tempted to call you Tricky D from now. I'll hold back. I'll hold back. So. So we've established that you are.

Well, you're based in Ghana and I'm in the uk and I know you've. I know you've had at least a few trips to the uk, so you're probably familiar, I perhaps in terms of maybe the differences in different areas.

So when it comes to mental health and how it's perceived in our respective regions, have you noticed any differences? And if so, what are they?

Speaker B: 00:04:52

So in the uk, I'm seeing that mental health is being accepted more another cause of a disability.

So where you would think of somebody having chronic low back pain or somebody with disability, somebody who has depression, clinical depression, would be seen as having a disability in the uk, from where, from what I see, from my viewpoint, Effy, this is not so much in Ghana, although the understanding of mental health issues is growing and this was helped by the COVID pandemic, because then people got to sit with their emotions and people got to sit their feelings and their thoughts. They had to slow down because before COVID everybody just moving around, nobody really started their feelings.

So the awareness of mental health issues is greater than here, but hasn't been accepted as a mainstream thing as much as the uk, in my opinion.

Speaker A: 00:05:51

Sure, sure, sure. And you know what, like what you've said kind of supports my perceptions of what I would have said as well.

So are there any common, I guess, stereotypes or even misconceptions about maybe people, workers in Ghana and mental health? What do you think are common stereotypes? Or misconceptions that may take place. I mean, you've kind of confirmed what I thought, which is good.

So I'm not off track, but I'm sure that, that there are some misconceptions or perceptions that people may have when it comes to Ghana and mental health that could be busted. So it would be good for you to share your thoughts on that.

Speaker B: 00:06:43

Okay. So one of the common stereotypes is concerning the mental health of men in Ghana.

It's seen as not strong for a man to express themselves emotionally and to, for example, cry. So we have this saying here that men don't cry. It doesn't matter if you just lost your father, your mother, your spouse, you expected to stay strong.

No. And just not react. So it's an issue because this results in men falling on unhealthy coping mechanisms. I will contrast it to women in Ghana.

So a woman in Ghana is allowed to cry, allowed to let off that emotion. And it has been scientifically proven that crying does help.

It actually does help you to release some of that negative emotions, actually good for your nervous system.

And therefore when men are unable to let this out, unable to sit down and talk about it, then we start to do things like drink or smoke or do other unhealthy coding mechanisms. I'll give a personal example.

When my dad died a few years ago, the expectation was that the very next day I come out, greets guests, I am doing, just seeing in public, doing stuff. But I've always been atypical, I've always been thinking, I've always been a self think, I think for myself.

So I put off my phones, I locked myself into in my house for about three days and I wept. I thought I'm sitting on the floor weeping and weeping because the pain was unimaginable.

It's pain I can't describe and I needed to let it out to heal properly so that years later I'm not left with unresolved issues. And because of these steps, I'm much better today. I mean, right now I've healed, I'm functioning well. So it's a problem.

In Ghana, men are not allowed to express our emotions.

Speaker A: 00:09:01

You know, I would say that it's similar or I would, it's probably even the same in the uk, but it's definitely a stereotype that's being challenged.

Because I think when there is that thing about being macho and being a man and you know, crying, being emotional is associated, you know, with women and being feminine. But I think that people recognizing that, no, it's a natural form of expression and letting things out, which is healthy.

So I think it's, generally speaking, especially in macho kind of cultures or sectors, it is something that is there, but I would say at the same time it is. It's being challenged in a way that's interesting to know.

Speaker B: 00:09:55

I didn't know was the same there.

Speaker A: 00:09:57

Yeah, it's like. Like you tend to hear that, you know, like exactly what you said, men don't cry. But people actually say, no, real men do cry.

You know, it takes a man, a real man, to actually be able to express himself and let go and make himself vulnerable. Yeah, it's not an easy thing to do. And I was gonna ask David.

So do you think that you went against the norms by locking yourself, you know, like for three days when you were expected to be, you know, like, showing face, you know, greeting, welcoming people, receiving people's, you know, well wishes during that really difficult time? Do you think you were. You did that because of your background as a.

As a doctor and knowing that actually the right thing for me to do is take time out for myself and grieve?

Speaker B: 00:11:00

Absolutely. I think you're right.

I never actually thought of it that way, but I think you're right because I knew instinctively, and it's not really instinct, it's probably because of my knowledge that if you don't deal with your emotions properly for the rest of your life, it's going to just keep on popping up and just keep on haunting you and keep on impairing you. And. Yeah, I never thought about it that way, but I think you're absolutely right. Yeah.

Speaker A: 00:11:26

And going back to, I guess, the differences in cultures, what can professionals in, like, Western countries like the uk what can professionals actually learn from approaches to mental health care in Ghana? And maybe even vice versa.

Speaker B: 00:11:47

Okay, so I'll start with probably what somebody in the UK can learn from Ghana. The. From what I've seen, and once again, I don't live in the uk. I visit it quite often, but I don't live there. And I've seen that in Ghana.

Our community of. I'm sorry, our culture of community really helps with mental health challenges.

So I've had friends who are going through challenges that would usually break a person, but then they fall back on this community. It could be family, it could be friends, it could be their close colleagues.

And people will take two hours, three hours of their life and provide you that support, provide you that shoulder to cry on, give you the encouragement. I see less of it in more developed countries.

And where you would, for example, have to rely on contacting a mental health worker, which is absolutely fantastic, but sometimes it's not always affordable or availability is not always possible.

So what I would say is a good thing we have that can help others is that development of a community you can fall back on when you're having a hard time.

Speaker A: 00:13:07

Sure, that makes sense.

And I think it makes sense because I have, obviously I have an African background that, you know, so it's something that I'm familiar with and I'm aware of.

And it's not just, I guess, the African culture, I would say it's like there's other regions, like the Middle east, they have that similar kind of community. They've got a strong network when it comes to supporting one another through difficult times. Yeah. So, like, actually, I don't know if you.

If there was something that you wanted to say about what, what professionals or what people can learn from a country or western country like the UK in, let's just say, West Africa, Is there anything that you think, oh, you know what, this is something that we could learn?

Speaker B: 00:14:06

So one, One of the things I've seen being done is something like your mental health first aid, where some, yeah, some organizations will have mental health first leaders.

It's one recognition that mental health challenges are recognized as something that is real and something that you need help for and sort of gives you a middle ground to seek help who can then help you to get higher help, for example. It would be great to see such a thing.

So in Ghana, we have a lot of workplaces that have first aid is for normal first aid, but for this concept of a mental health first, either who is trained to be able to give you that first aid in vetted codes for mental health and then show you where to get higher help. I think it would be a fantastic thing to add to our professional settings.

Speaker A: 00:15:04

Yeah, got you, got you.

And talking about the differences in terms of cultures, how, as a professional, when it comes to addressing mental health issues, how do you navigate between the complexities of traditions and culture or even religion in, for example, Ghana?

Because I know that when it comes to culture or religion, I don't know, you might have thoughts in terms of whether how big a factor that can be to how someone is dealing with it or struggling when you put your occupational health hat on and dealing with individuals, how much do those kind of issues or factors come into play and help or not help?

Speaker B: 00:16:07

Yeah, you're absolutely right. In Ghana, for example, a lot of issues from mental health to physical Health issues are seen as spiritual. Yeah, yeah.

Something, an external force is doing this to you. It can be challenging because you. Part of the process of getting somebody better is teaching them coping mechanisms.

And you can only learn coping mechanisms when you can recognize that you have power over what is happening to you. When you believe that the power, what's happening to you is external in totality, then you don't feel like you can.

You have the power to do anything about it.

That being said, it's also an opportunity because in Ghana, for example, once again, a lot of people tend to their religious leaders when they're having mental health challenges rather than going to a traditional psychologist or psychiatrist.

I feel that if I had my way, we would provide basic training to these people, these religious leaders, and use them as an avenue to help people with their mental health challenges. People will believe what they will believe, and I don't think it's our place to question their beliefs.

But then if these religious leaders are able to recognize that, no, this is a mental health problem. So let me start counseling in this, in this way. And when it gets to.

When it gets to a level that I cannot handle, let me refer to a mental health professional. I feel like we would then turn the conversation from, don't go to your church or your mosque when you're having a mental health issue.

Come to the psychologist. We'll turn that conversation around to be able to catch them where they're going and help them.

And in the end, everybody's happy, everybody's better and would achieve the same goal because we all want the same thing.

Speaker A: 00:18:11

Hmmm, do you know what's so, like, out of curiosity, is, is. Is that covered in your training, like when you went, you know, like when you were in medical school? Because it's such a big.

It has such a big place in, in society. In Ghana, does faith, religion. I don't know. Traditional practices, is that covered in the training?

Speaker B: 00:18:42

So. No, the training covers basically orthodox medicine. You get to know about this stuff from living in it, basically. Yeah, yeah, yeah.

And then interacting with patients, because you can have patients who would insist on leaving the hospital because they don't think you can help them. They think they need to go and pray or go and see their religious leader to cast out whatever evil spirits is making them depressed.

But as to if it's covered per se in our syllabus, definitely it's not. Yeah, it's strictly orthodox.

Speaker A: 00:19:22

Sure. And like, you've kind of touched on it a bit in terms of your own personal experience when it comes to managing your mental health.

But how do you personally prioritize and manage your own mental well being given the demands of your profession and what you do?

Speaker B: 00:19:47

Okay, so one of my top things to use is the Serenity Prayer. It's, ever since I learned that Serenity Prayer, it's, it's, it's been life changing.

What it does is it makes me categorize things that are happening into things I can control and things I cannot control. Once I realized.

Speaker A: 00:20:09

What did you say? What was, what did you call it?

Speaker B: 00:20:13

Serenity Prayer.

Speaker A: 00:20:14

Serenity Prayer.

Speaker B: 00:20:16

Okay, okay, okay, okay. I should stop assuming everybody's familiar with it. I apologize.

Speaker A: 00:20:25

Did I hear right?

Speaker B: 00:20:26

Yeah. So I'm pulling up the exact wording. I always, I always paraphrase it.

So somebody mentioned it to me a few years ago and I looked it up and I realized it made a world of a difference. Okay.

So the Serenity prayer says, God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

So it's about, if you can't change something, if it's out of your control, let it go, accept it, because worrying about it for six hours is not going to change, make a difference. So just let it go. But the things you can change, you put your effort and your soul and your heart into changing them.

And you often need the wisdom to know that this is something I can't, I can't change. And this is something I can't in any workplace because I've worked in a variety of workplaces.

You will come across challenges that you cannot control. And sometimes you simply need to say, this is out of my control. Let me focus on the things I can control. So it's helped a lot.

So if you have a patient who is dying and you've done everything humanly possible to save the patient, and the patient is still going to die because maybe it's end stage cancer, for example. You sometimes have to tell yourself that this is out of my control. I have to accept it.

Otherwise the mental health burden of the profession can weigh you down severely. It can break you.

You know, so you also, but you also, on the other hand, if it's something you can't change, then put my heart and my soul into changing.

Speaker A: 00:22:19

Sounds like. Yeah, wise, wise counsel. You were going to say, David, there was another thing.

Speaker B: 00:22:25

Yeah. So the other thing is, if it's not going to matter in five years, I don't spend more than five minutes thinking about it.

So it helps to tackle catastrophizing.

So let's say you get into a spot with a work with a colleague in your workplace and then it's all of a sudden seem like the world is ending and life is so bad. And this and this. What I do is I pause and I project.

Is this going to matter in five years if it's not, I give myself five minutes because I'm also careful not to bury what I'm feeling. I'm allowed to feel what I want to feel, go through the emotions, but just for five minutes and then I let it go.

Because in five years, if it will matter, you can't spend too much time on it now. So these two things have really, really, really helped.

Speaker A: 00:23:17

I think I'm going to adopt a couple of those, those, those tips there. Yeah, they sound like really good, practical, wise steps to adopt. Yeah.

Just to, you know, calibrate, you know, the situation and whether it really matters. And it's true, some things are out of your control. So why worry and expend effort on it when it's not going to make any difference?

Speaker B: 00:23:47

Exactly, exactly.

Speaker A: 00:23:49

So is there anything like you talked about that personal experience when your dad passed away. Is there anything that from a, like a.

That has personally challenged you, that helps you to actually understand and relate to people so that you're able to help them professionally, but also from a personal perspective?

Speaker B: 00:24:21

Yeah. So it is, it, it will come back down to my dad's death again. And his death, I think, completely changed my life. It's transformed who I am.

So his death, experiencing it because he died in the hospital that I was working in at the time and watching myself grieve, watching my mother, my sister grieve, having to break the news to them because I had to tell them that he was dead, it gave me an empathy that you can't teach. It's an empathy that there's no one can teach you that empathy until you have an experience like that.

Not saying we don't have empathy before, but my empathy got enhanced. I now feel patients pain or their relatives pain. I now relate to them in the way I did it before because I understand.

And for example, when I'm working to save a life, in the back of my mind, this life, if lost, is going to have such a ripple effect because I've seen the ripple effect and it gives you so much motivation to do your best for the person in front of you. So that moment in life one did teach me that empathy. It also showed me the importance of how you live Your life.

So at his funeral, met a lot of people who said he did this for them, he helped them in this way. And I realized this is what matters really. Leaving a good name, leaving a name that your death means something. That's how I took it anyway.

It's my personal opinion. So it made me really want to be a kind person, be a good person, help people whenever I have the opportunity to.

If you can say a kind word, to say, make somebody smile, you say it. If somebody has a struggle and you have the time and the space, you help them.

Because everything we are doing, all the hustling, all the money making, all the accolades and all the things we are doing when we die, it really doesn't matter. What matters is how we make people feel, how we help people. Their lives we touched and his death brought that to the forefront of my priority list.

And this is why you may see me volunteering here, volunteering there, and helping this person and mentoring that person and always trying to have a smile on my face or say kind words because life is really short and you really need to live it well. So it was a, it was a life changing moment for me.

Speaker A: 00:27:10

Sure. Like what you said is very, very true and reminded me that in the past few years I've attended quite a few funerals, unfortunately.

But it's during those services at those events that really is a time where I taken stock and you know, you listen to, you know, people's stories and you know about the person and it touches you and it makes you realize that, you know, one day we're all going to go, you know, it's just about when, you know, and when we do go, what do we want to be said about ourselves? You know, what really does matter?

It really does, it does shake you, but in a positive way because it really does allow you to take stock and to focus on the things that matter. And generally speaking, we don't always do that as people, you know. Yeah. Or we don't do it enough, perhaps.

Speaker B: 00:28:18

I agree with you.

Speaker A: 00:28:20

So there may be, there may be some advice or other advice that you would want to share and offer to someone who may be struggling with a mental health issue. If there's something that you have yet to say that you think might help them, what would it be?

Speaker B: 00:28:45

So the top two will be the ones I mentioned before. A third thing would be to take mini breaks and I'll just explain.

We, we usually what we'll do is to work hard for 3, 4, 5, 6 months and then take a one month leave for example, and then go back to the slaving again. Our battery tends to be below zero by the time you're taking that leave. And that leave barely refreshes that battery.

And then you go back to draining it again. What I've come to find is a more effective thing is to take some time off every week. Somebody once told me that everybody deserves a day off.

And it may not be a full day, it may be some hours, but once a week.

So you take time off and do something you enjoy, something that unburdens you, something that refreshes your battery so that when you're going to the new week, you have a fresher battery. And then when it's getting drained again, you refresh it. I find that it really does help to manage the stress that is life.

Cause life is stressful and the stress is not going anywhere, unfortunately. It's gets worse year after year.

And if we don't take care of ourselves consistently, we allow three, four, five weeks to go by and we haven't done anything for ourselves. We haven't refreshed our battery. Your mental health will suffer no matter who you are. It's not a matter of being weak or being not strong enough.

No, I consider myself pretty strong, but things break me when I don't allow myself to have adequate rest. We are all human and we all have a limit.

So in order not to test your limits, in order not to push yourself to the point where you will break down, I strongly advise take a little break once a week, schedule it in, make it a priority, and it can do wonders.

Speaker A: 00:30:55

And you know, I think what I would add to that, because I've definitely tried to do that.

One thing I would add is that you really have to make an effort to protect that time because it's so easy for things to get in the way and to steal that time, you know, and divert it elsewhere, you know, and it kind of defeats the purpose of what you're trying to do. So, yeah, really do protect your time so that you're able to do what you've just said.

If you could, like, if you could wave a magic wand for things to change when it comes to mental health in Ghana, let's just say within the next five years, what type of improvements or changes would you like to see take place?

Speaker B: 00:31:51

My magic wand would be used to make people share their experiences more. I will give an example. I went through stuff in my life.

Some I thought I was the only person in the world going through them until I started following some pages on Instagram. And then you are like, wow, people all over the world are going through the exact same thing. It makes you feel less alone.

It makes you feel less distressed. Like, you. You are, you are, you are. The world is no longer against you. You are just undergoing the normal human experience.

I want to see more people come together and discuss whether it's work issues or marital issues or whatever it is, because once we know that, oh, you're also going through it. Oh, you're also going through it. How did you get through that? Oh, I did this. And this and this.

It removes that isolation, that loneliness that the world is against you mentality. And it does a wonderful thing for your mental health because your challenge is no longer the dragon. It's a little kitten that's peering at you.

It's part of life. It's normal. So that is what I would want to see. I think it would really help the.

Speaker A: 00:33:13

Collective mental health, you know, 100% agree.

And I think one positive that I would say has come out from social media is giving that platform for people to share and be open and for people to be able to tap into that and realize that they're not alone when it comes to certain issues because they're hearing people, you know, talk about the things that they've gone through or they're going through. So I think with all the.

With all the issues that social media brings, there is that thing that also helps, which is, yeah, being able to share stories like you said, and talk about difficulties that people go through and for people to know that they're not alone in those. In those challenges.

On that note, David, I want to thank you for being such an open guest and sharing your stories, you know, from a personal level as well as from a professional level. Really appreciate your advice and for coming on.

Speaker B: 00:34:29

Thank you very much for having me. I enjoyed the conversation.

Speaker A: 00:34:33

Here's a spiritual wellness tip for you. Meditate On Proverbs, chapter 16, verse 24, which reads, Kind words are like honey, sweet to the soul and healthy for the body. Thanks for listening.

Do follow and join me again next time on beyond the Smile with Mary Lyndon.