When You Are Already Struggling: The Hidden Cost of Healthcare Between Cultures
The pain had been building for hours.
I had come from a root canal treatment at my dentist, and the ordinary painkillers were not touching it. My dentist sent me to a public hospital for an injection of something stronger. My husband came with me. There was no language barrier. He could translate everything. This, I told myself, would be straightforward.
At the emergency room, the doctor looked at me and said I would need to take a pregnancy test before they could administer the painkiller.
I told them I was certain I was not pregnant. I told them I would sign a declaration. I told them my dentist could confirm the situation by phone. None of it made a difference. The answer remained no. Without the test, no injection.
I was furious. Not confused, not uncertain. Furious. The pain was significant. The solution was simple and available. And the condition being placed on my access to it felt deeply denigrating. Not to me personally, but to women as a category. As if the standard assumption was that a woman of a certain age could not be trusted to know her own body, could not make her own medical decisions, could not be treated as a competent adult without first urinating on a stick.
We left. We found another hospital, with the help of my dentist, who was willing to give me the injection without conditions. The whole process took hours longer than it needed to.
Lying there afterwards, the pain finally beginning to ease, I thought about what the visit had cost me. Not just the time, not just the additional discomfort of navigating two hospitals while already in significant pain. Something else. The particular exhaustion of having to fight for something straightforward in a system that operates by different rules from the ones I grew up with. In a country where I have lived for years. Where I know how things work. And where, on a day when I was already struggling, I still had to spend energy I did not have on cultural navigation I had not budgeted for.
The extra layer nobody tells you about
When you are well, navigating a healthcare system that works differently from the one you grew up with is manageable. You can research, prepare, ask questions, translate, bring someone who knows the system better than you do.
When you are unwell, it is something else entirely.
Being sick or in pain already strips away resources. Your cognitive capacity is reduced. Your emotional reserves are lower. Your ability to be patient, flexible, strategic. All of it is diminished. You are not at your best. And your best is exactly what navigating an unfamiliar system in a moment of vulnerability requires.
This is the hidden cost of healthcare between cultures that most people who write about living abroad do not address. Not the practical challenge of finding a good doctor or understanding an insurance system. Those are real, but they are solvable problems with practical solutions. This is something different. This is the cost of having your cultural radar on high alert precisely when you are least able to sustain it.
In Nepal, as in many countries, the medical system operates on assumptions and protocols that are entirely logical within their own cultural frame but can feel deeply confusing or even offensive when you encounter them through a different one. The relationship between doctor and patient is different from what I grew up with in Belgium. The communication style is different. The assumptions about what a patient needs to know, what they are capable of deciding, and how much explanation they are owed are different.
None of this is wrong. But when you are already in pain or frightened or worried that something is seriously the matter, understanding that a difference is cultural does not make it easier to absorb. Understanding and accepting are not the same thing. And accepting and feeling fine about it are not the same thing either.
If you want to understand more about why that cultural fluency becomes less available under pressure, this article explores the dynamic in depth.
When your values and the system's values do not align
The pregnancy test situation was not simply a cultural misunderstanding. It was a values conflict.
I come from a cultural background that places strong emphasis on individual autonomy in medical decision-making, on informed consent, on the patient's right to be treated as a competent adult who can assess their own situation. The protocol I encountered at the public hospital operated from a different set of assumptions, ones rooted in a different relationship between medical authority and patient, and a different set of default assumptions about women specifically.
I am not suggesting that one set of values is superior to the other in every respect. But I am saying that when your deeply held values come into direct conflict with the protocol of the system you are navigating, and you are doing this while already in pain and already depleted, the emotional cost is significant.
What made it particularly difficult was that I could not simply defer to the cultural frame I was in. This was not a situation where I could say, well, this is how things work here, and adjust my behaviour accordingly. This was a situation where adjusting my behaviour would have required me to act against my own values. To comply with something I believed was wrong. To accept a treatment that I experienced as denigrating in order to access care I needed.
That is a different kind of cultural navigation. Not the navigation of learning how things work and adapting to them. The navigation of deciding what you will and will not accept, even when the cost of not accepting it is high.
Women living between cultures encounter this kind of navigation more often than is generally acknowledged. Not always in healthcare. In workplaces, in schools, in social situations, in interactions with institutions. Moments where the cultural frame of the place where you live asks something of you that your own cultural values will not permit you to give. Moments where the adjustment required is not a softening of style but a compromise of something more fundamental.
Those moments are costly in a specific way. They take something from you that ordinary cultural adjustment does not.
What vulnerability reveals
I have lived in Nepal for many years. I know the country well. I have learned to read many of its social signals, to navigate many of its institutions, to adjust my behaviour in the ways that daily life here requires. On most days, I do this without thinking too carefully about it.
What the hospital visit showed me was how quickly that fluency can become unavailable when the conditions change.
Vulnerability does something specific to the capacity for cultural navigation. It takes the cognitive and emotional resources that navigation requires and redirects them toward the more immediate work of managing the situation you are in. There is less available for the interpretive work of understanding what is happening through the right cultural frame. Less available for the patience that navigating an unfamiliar system requires. Less available for the flexibility that allows you to adjust your response without losing yourself.
What is left, when those resources are reduced, is something more instinctive. More rooted in the values and assumptions you grew up with. The cultural self you were before the years of adaptation.
This is not a failure. It is simply what happens when the layers of learned cultural behaviour are stripped back by stress or pain or fear. The bedrock is still there, and the bedrock is the culture you were formed in. Not the culture you have learned to navigate, however fluently.
Understanding this has changed how I think about the moments when I react in ways that feel more Belgian than Nepali, more first-culture than adopted-culture. They are not evidence that the years of learning have been wasted. They are evidence of what remains most deeply mine, even after everything that has been added to it.
What this means for women living between cultures
If you have had an experience like this. A moment of vulnerability in which the cultural navigation felt like too much, in which the system you were in operated by rules that confused or upset or offended you, in which you were already depleted and the additional layer felt genuinely untenable. I want to say something clearly.
That experience is real. It is not oversensitivity. It is not a failure to integrate sufficiently. It is the predictable result of being a person formed by one cultural system, navigating another, at a moment when your resources for doing so were at their lowest.
The exhaustion you felt afterwards was not disproportionate. Cultural navigation is cognitively and emotionally costly on the best of days. On the days when you are already struggling, the cost is higher. And the cost of navigating a values conflict, as opposed to a simple cultural difference, is higher still.
There is also something worth naming about the specific experience of navigating healthcare between cultures as a woman. Medical systems around the world carry within them assumptions about women's autonomy, competence, and credibility that vary enormously across cultural contexts. What is considered standard protocol in one system may feel deeply disrespectful in another. And when you are already in a position of vulnerability, already asking for help, those assumptions land differently than they would in a different context.
You are allowed to refuse. You are allowed to be angry. You are allowed to leave and find a different option, even when that takes more time and energy than you had available. Your values are yours to keep, even when the system you are in does not share them.
And afterwards, when the pain has eased and the situation has resolved, you are allowed to feel the exhaustion of what it took to get there. Not just the physical exhaustion. The particular exhaustion of having had to fight for something basic on a day when fighting was the last thing you had the capacity for.
That exhaustion deserves to be named. It is part of what living between cultures actually costs. And it is part of what this platform exists to say out loud.
The Life Stability dimension of this platform explores this cost in more depth, including what building something solid across cultural worlds actually looks like over time.
If you are carrying any of this, the free guide is a quiet place to begin.
A closing thought
I found the second hospital. I got the injection. The pain eased. I went home.
But I think about that waiting room sometimes. About the other women in it, with less knowledge of how to navigate the system, with less support, with fewer options available to them. About what that protocol asks of women every day. About the particular weight of having to advocate for yourself in a system that does not begin from the assumption that you are the right person to make decisions about your own body.
Living between cultures makes certain things visible that a single-culture life might not. This is one of them. Not comfortable to see. But worth seeing.
| Reflection questions
Have you had an experience of navigating healthcare, a bureaucratic system, or an institution between cultures at a moment when you were already depleted? What made the cultural navigation hardest in that moment? Is there a protocol or assumption in the medical or institutional system where you live that conflicts with your own values? How do you navigate that conflict in practice? When you are unwell or vulnerable in your adopted country, do you notice a difference in how you respond to cultural differences compared to when you are at your best? What comes forward? If you could say one thing to the medical professionals in your adopted country about what it is like to be a patient between cultures, what would it be? |
