By Christiaan Von Woerden
After a year of observing and assisting medical interns in dealing with children and thinking about my role as a pediatrician in Cape Town, (formally called Cape of Good Hope), I am invited to organize a two-day solution focused workshop around medical history taking in children and their parents. I am thrilled.
Born Dutch and trained as a medical specialist in the Netherlands, I felt uplifted after becoming adept at solution focused brief therapy and its use in medical practice. I wanted to become involved in the innovative medical education system of South Africa and I am curious how solution focused practice aligns with other local aims to improving service delivery. The group consists of four very experienced nurses, one physiotherapist, one general practitioner, one pediatrician and a child psychiatrist.
After some warming-up exercises in which the group explores their preferred future for the workshop, I launch the question that I have found most helpful in starting conversations with children and their parents: “What is your best hope for today?” The participants gaze at me somewhat disapprovingly and explain that there is no hope in this country anymore; even 20 years of democracy have not restored the racial segregation of the years of apartheid. Instead of hope, there is only survival.
When I wonder what other question could reveal the story of the patient instead, four nurses answer: what are your expectations for today! While trying not to show my disappointment about the impossible hope question, I receive this alternative suggestion with a smile. After all, I am still relatively new here, and may not know how to perform solution focused practice in the South African context. Two weeks later, we convene for the second session.
I ask the participants what they considered new or interesting during the first day of our workshop. A nurse, who has taught history taking to medical students since 1975, sinks in deep thoughts. Then she looks up, and explains how the workshop didn’t teach her anything new but endorsed her vast experience in medical history taking. She adds that she would like to develop language for hope in South African society, “because we also need to talk about hope, like you can talk about hope in the Netherlands”, she adds. This allows me to share that hope was neither a common starting point for me, when having medical conversations with colleagues in Dutch hospitals, we are geared towards helping clients then eliciting their hope. The nurse and I decide to go for it together. Very hopeful.