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Working Abroad in Ghana: Cultural Considerations in Radiologic Science
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Editorial
Working Abroad in Ghana: Cultural 
Considerations in Radiologic Science
Benard Ohene Botwe, MSc Lawrence Arthur, MSc
William K Antwi, PhD
Many countries are experiencing a shortage of Gesturesradiologic science professionals, prompting Medical imaging conversations in Ghana can be an increasing number of foreign technolo- challenging because of the diversity of languages in gists to move to those countries. Some tech- the country; although the official language is English, 
nologists accept the challenge because they want to apply about 80 languages are spoken. This situation often 
their skills where the need is greatest. Financial reasons prompts the use of gestures to communicate. A gesture 
entice others, whereas still others are drawn by the oppor- is a definite physical movement that strengthens verbal 
tunity to learn or experience something new. Whatever communication or expresses a particular notion or sen-
3
the individual motivation for this migration, the result is timent.  Gestures primarily are made with the hands 
that a growing global need is being addressed.1 and arms but can include the head, shoulders, legs, and 
Working in a setting where the cultural aspects (eg, feet. Just as cultures differ, so too do the meanings of 
3
language, food, customs, traditions) are unfamiliar can certain gestures.  In Ghana, for example, using the left 
be challenging. Culture shapes how people think and hand, for gesturing or for anything else, is considered 
4,5
act, as well as how they interpret certain actions; it plays disrespectful, insulting, and highly provocative.  This 
a role in every situation, including when patients receive norm has roots in Ghana’s cultural and religious history. 
medical care. Radiologic technologists who strive to The left hand is thought of as the “unclean” or “toilet” 
learn about the people they serve experience fewer hand. A technologist should use his or her right hand to 
clashes and conflicts inherent in cross-cultural com-
2 take the request forms or other material from patients munication.  In addition, adopting patient interaction and when handing anything to patients. In addition, 
practices that consider the prevailing cultural norms the left hand should not be used to direct patients 
results in more patient cooperation and satisfaction dur- (eg, to sit, lie, stand, or follow) or to wave to them.4,6 
ing imaging examinations. For example, if a technologist needs a patient to lie 
This article discusses some of the patient interaction on the examination table, he or she can communi-
practices preferred in Ghana. However, because Ghana cate the request by saying it or by gesturing with the 
is a multicultural society, the norms described in this right hand. Alternatively, both hands can be used to 
article are by no means indemic to the entire country. direct patients, but never only the left. However, in 
Foreign technologists likely will encounter varying circumstances where the left hand must be used, the 
patient practices and preferences, depending on the area statement, “sorry for left,” must accompany the action 
of the country in which they work. or gesture.
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Editorial
Botwe, Antwi, Arthur
Greetings of the word is required during formal and informal con-
Greetings are acts of courtesy in Ghana that show versations.6 In some parts of the country, tribes even say 
acknowledgement, respect, and concern for others. To it before they insult or swear at someone. When attend-
ignore a greeting or fail to greet someone is a serious ing to patients, technologists should use please often 
insult. Patients expect to be greeted verbally, with a during the conversation. For example, the technologist 
good morning or good afternoon, and with their title. If would say, “Please, have you drunk water for the ultra-
a patient is a professor, for example, the word professor sound procedure?” Similarly, if asking the patient why 
should be used as a prefix to the name. If a patient’s title he or she arrived late to the appointment, the technolo-
is not known, use mister or madam. It is discourteous gist should say, “Please, why did you come late?”
to speak to or refer to a patient without using his or her 
title, especially when he or she is older than the person Beliefs
speaking. In order of preference, a verbal expression of Superstition is belief in the supernatural, or in 
greeting is preferred over a handshake, and a handshake customs, rites, and rituals that are not based in logic.9 
is preferred over a head nod.6 Some Ghanaians will In Ghana, cultural beliefs can greatly influence a 
snap their middle fingers with those of the person they patient’s willingness to receive health care. For exam-
are shaking hands with, which produces a sound. It is ple, an 18-year-old patient presented at the radiology 
acceptable for a technologist to snap the patient’s finger department with a condition that required the use of 
back during a handshake greeting. In addition, the cor- intravenous contrast. The patient refused the procedure 
rect order for greeting a group of people is from right to because she was not allowed to receive a needle injec-
left, regardless of the age, gender, or status of the people tion without consulting the family deity. She cancelled 
being greeted, and this order must be respected.5 her appointment, consulted the deity, then came back 
Eye Contact and consented to the procedure. Because situations like this are common, technologists who work in Ghana 
Evidence suggests that eye contact influences social 
cognitive functions and plays a critical function in must understand how to navigate their patients’ beliefs 10,11
regulating face-to-face communication.7 The increased to be effective in their jobs.
social interaction among people of diverse cultural set- A belief in supernatural elements, such as soul eaters 
tings is revealing cultural differences in the use of eye and bewitchment, also is common in Ghana, and many 
contact. Some cultures value direct eye contact during people wear talismans around their waists, ankles, 
conversations, while others, like some Ghanaians, do knees, or abdomens to protect them from attacks by 
12,13
not.6,8 Toastmasters International’s claim that “failure these dangerous elements.  Although a technologist 
to meet another person’s gaze when speaking implies will explain that these items need to be removed before 
disinterest, lack of confidence, insincerity, or chicanery” the examination to prevent artifacts on the images, 
runs contrary to the norm in Ghana, where a lack of eye some patients will be reluctant to remove them. These 
contact during communication is a sign of respect, and patients must be allowed to decide whether to heed 
direct eye contact is viewed as rude and threatening.3 the instruction; however, if they refuse, the procedure 
When attending to a patient, a technologist should use should not continue.
intermittent eye contact. This approach demonstrates 
professional genuineness and that the focus of his or her Consent
attention is on the patient. However, communicating Some cultural beliefs and norms in some areas of 
with the face predominantly turned down or turned Ghana limit women’s use of health care services.14 One 
away from the patient is a sign of rudeness. such norm is that men are the head of the household 
and hold ultimate decision-making power, even regard-
Please ing their wives’ health care.10 In some ethnic groups, for 
Globally, the word please is considered a polite, but example, a wife must obtain her husband’s consent for a 
optional, way to ask for something. In Ghana, the use radiography examination, and when a provider speaks 
RADIOLOGIC TECHNOLOGY, September/October 2018, Volume 90, Number 1    95
Editorial
Working Abroad in Ghana: Cultural Considerations in Radiologic Science
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ƒ keeping eye contact to a minimum when com- 10. Antwi WK. Child protection in Ghana: exploring the percep-
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 using the word please when addressing them or University; 2016.ƒ
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