Twelve Essays on Culture and Healthcare
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- CULTURAL COMPETENCY
Cultural competency is one of the difficult coinages that are easier to be realized than explained, because it points at a package of understanding regarding the nuances of one’s own culture and of the other prevailing cultures around, besides the ability to apply that understanding in real-life situations where one has to deal with a multicultural base of clients. In other words, cultural competency stands as something that empowers one “to deservingly respond with respect and empathy to people of all cultures” (Campbell, 1995).
Undoubtedly, one has to go through a constant learning process to achieve this quality and has to apply the learned ideas to enhance and maintain cultural competency. However, the professionals in the healthcare sector need to take care about additional factors too, as they mostly deal with patients, who are already sensitive with their problem. Thus, cultural competency from their perspective becomes an integral part of their “service-learning” that includes issues like languages, traditional practices, social values, and religious or community sentiments that prevail in the communities they mostly serve.
Each culture is much like a symphony of a group of people that has been developed through years – the prime job of a healthcare professional is to have a solid homework on such symphonies, which they would deal in their profession. As for example, a patient from a particular community may need to be addressed in relation to their parents or spouse; now this would not pose any problem to the healthcare professional who is aware of this custom. The basic idea would be to get maximum possible accurate information from the patients to utilize them towards their benefit, besides ensuring smooth flow in the process of service. For that matter, it’s not only the verbal communication, but also the non-verbal communication can come in handy, like body language, eye contact, spacing, or even silence.
- Cultures, Disability, and Illness
Understanding of foreign cultures greatly helps in rehabilitation services, as there are plethora of clues hidden in each culture, which come in handy to exchange satisfaction with the patients. In a country like America, which beholds a conglomeration of various communities, the need to know about various cultures is even higher, as things here at times might turn complex due to the presence of sub-cultures, like in the case of Chinese people, who are the inheritors of one of the oldest civilizations that has evolved through thousands of years and gradually has given birth to several sub cultures.
There are other communities too, like Indians, where the beliefs, customs and traditions greatly vary according to the subdivisions among communities or regions.
Thus it is understandable that if healthcare professionals don’t know about how a particular community perceives disability or illness, s/he will surely face lot of problems in providing the necessary service to the patients belonging to that community. As for example, people from Chinese origin still consider disability as a “punishment for the disabled person’s parental or past-life sins” (Liu, 2001). Accordingly there can be an ambience of shame and guilt in the family of the patients, which should be taken into consideration, if the healthcare professional wants his/her patients receiving proper attention and care from their family. Even the patient himself might feel low in esteem, and that should also be taken tackled.
Hidden situations like these can always block the processes of treatment, where the patient or his/her family member can become the victim of fear, shame, hostility etc., due to lack of knowledge about a specific disability or illness (Liu, 2001).
The difference in approaches towards illness or disability makes it difficult to apply a common method of counseling, or even convincing the patients or their families regarding the efficacy of the methods of treatment. As for example, Eastern system of healing “focuses on the cause of illness”, while Westerners mostly “focuses on the solution of the disease” (Chung, 1996). Therefore, it is highly desirable that healthcare professionals learn about such serious differences among cultures for the sake of serving efficiently and effectively to their patients irrespective of their origin.
- Cultural Competence and Access to Care
Since cultural competence is a package of knowledge about various cultures and their implications in healthcare service, it is literally a challenge to the healthcare professionals to make every patient irrespective of their cultural origin interpreting their messages the way they want, besides responding to the treatment the way they want. This calls for their readiness to deal “pluralism” effectively, as researcher and educator Dr. Martin E. Marty would use it to cover all possible diversities in the society that stem out of various cultures.
Successful dealing with pluralism by the healthcare professionals would definitely provide more access to healthcare to the citizens belonging to a multicultural country like America, where everyone has the right to live healthy life and has access to the resources to maintain such a philosophy. While the citizens too have a role in adapting to the situations, healthcare professionals have even more responsibility to “condition” them by attending to their specific needs.
Therefore, apart from leaning about various cultures and their impact on healthcare to the people, there are other ways too, which can help the caregivers to rise above the barriers of culture and achieve the desired outcome.
According to Dr. Marty, the following three ways can be helpful to the caregivers towards successfully attending patients from all cultural bases:
- Focusing on the patient: This is bound to convince the patient that the caregiver is totally concerned about his/her well being and consequently s/he would start responding more to the instructions of the caregiver, even if it is not fully backed by the acquired perception of the patient.
- Framing the issues of patient diversity: The deep routed beliefs should not be dealt with leniency if they pose as roadblocks to the much-needed treatment. For that matter, both secular and pragmatic approaches towards ethical issues should be merged with universal viewpoint of the issue.
- Dealing with patient diversity: Caregivers should be sympathetic to the spiritual standing of the patient, and it is justifiable to partially address them for the sake of best possible response from the patients, when that spiritual appetite or religious practice is not interfering with the process of treatment (Marty, 1997).
- Death Rituals
One of the interesting ways to understand the degree of differences among cultures regarding the life and death is to learn about the differences in death rituals among various cultures.
Death rituals are considered even more sacred than any other rituals in any communities, as it virtually reflects the summary of a community’s belief regarding life and death. While Buddhists or Hindus consider life on earth is a mere sojourn, ancient Egyptians would consider human existence is permanent; consequently they had a god of mummies too, named Anubis! (Anubis, 1987)
However, sub cultures within a major culture are also seen to be acting differently; as for example, the Parsees of India, a predominantly Hindu region, would leave the dead body at the rooftop of synagogue (their church) to feed the vultures, while Hindus would cremate the dead body and place the ash to a river. Communities in Chuchee (Northern Siberia, Russia) would cremate the dead body too, but with a completely different belief – as they would do so to prevent the dead person’s soul from entering his/her old house again!
Mexicans, however, would celebrate in commemoration of the deceased – they have even special days in the calendar for that – on the first and second November. The most common death ritual around the globe involves burial and mourning.
The concept of death ritual clearly indicates about the various concepts regarding life and death and even life after death, which are bound to influence the living ones and subsequently their concept on disease or disability. These concepts thus can be treated as foundations of pluralism in the healthcare sector, where it deals with life and accordingly can convince anyone with their language of healing – this idea alone can clear all the roadblocks brought forth by pluralism in the healthcare sector.
- Rituals, Healing and Folk Medicine
The seeds of culture bloom through various practices of the communities like rituals and healing practice. This is nothing new, but what is new in the current global order of pluralistic society is the question of converging various ideas that are now cohabiting in a newfound conglomerated society in countries like United States, where cultural diversity has been a constant factor and today it has become a distinctive collage of cultures each having distinctive identities reflected through their practices. This situation certainly commands a thorough review, as the question of serving all members of the all communities under one philosophical umbrella has become extremely important under the present circumstance.
Accordingly, healthcare sector, one of the major wings of the society has to have a clear-cut philosophy on how to manage its vastly expanded sphere with the constant addition of the package of unconventional medicine from various ethnic cultures like China or India.
The first and foremost condition of that philosophy should be to create a mindset of accommodating what is good for healthcare from a purely clinical point of view and not to be driven by the enthusiasm of science and technology and discard anything that has been in practice through years. There should not be any warring attitude from the allopathic camp towards alternative medicine, because various research findings clearly show that a huge number of highly educated members of the society favor alternative medicine (Hufford, 1997).
The new physicians should understand that allopathic medicine is relatively a child before some of the alternative medicine or folk medicine and thus is yet to establish itself to the psyche of various communities about its efficacy. Here comes the clinical importance of learning about cultural differences – that how a member of a particular community perceives about healing mechanism and how to get a best possible response from that person without damaging his/her cultural belief on the concept of healing.
While that is just one part of the scene, the other part for a new physician should be in quest of finding the best possible solutions from the platform of folk medicine and exploit them towards the benefit of the community. While the effectiveness of acupuncture, yoga or meditation has already been recognized; there lies an ocean of other healing practices like herbal or dietary techniques. No one can deny the fact that it is the efficacy of such folk medicines have helped them to create a niche even in a cross-cultural setting of America.
Thus it would always be better for a new physician to realize the fact that there is no practical barrier between allopathic and alternative medicine, so long clinical testing approves their application.
- Ethnicity, Culture and Eating
One of the most important facets of any culture is that it influences the lifestyles of its members in a great way, of which eating habit tops the list. Though it is said that eating habits are formed on the basis of the availability of the food resources of a region, but it is the cultural script that finally determines the food habit of its members.
It is thus understood, physicians in a country like America, which has so many cultures on its soil, would find it difficult to create a common dietary prescription for their patients, even if the patients suffer from same kind of disease. Thus it calls for a vast study in this area to find and create an inventory of dietary elements that can fit into a patient’s prescription without hampering his/her eating habit.
However, that does not deter the physician to prohibit the harmful elements of one’s eating habit, that stem out of custom, tradition or religious instruction. For that matter the physician should go at length with logic to convince the patient to follow the prescription. And the endeavor here should extend itself to involve the family members in the proceedings too – as families may resist any alteration in the custom or tradition they follow. This might look like a daunting task as there are millions of people under one or the other culture with distinctive eating habits. However, the silver lining in the issue is that while the availability of various food could help people to maintain their traditional eating habits, it would also be helpful for the physician to customize the dietary instruction for the patients.
The pluralistic society has started helping the physicians too, as the interaction among various cultures is culminating into cultural exchange, of which the various delicacies are taking a leading part. While Chinese Noodles or Indian yogurt have become a common item on the plates of many, American burgers are not lagging behind to position itself either. Now it is left for the physicians to do the balancing job between tradition and practical need of the patients, as the “awareness of specific cultural meal patterns, patient’s dietary preferences and disease patterns” (Terry, 1994)) becomes the real guidebook for the physicians.
- Building Your Practice for Diverse Populations
To create a niche in the healthcare sector in today’s America, a physician needs to be equipped both in medical and social knowledge. While the former is attainable through a systematic process and induced techniques of learning, the accumulation of the later depends mostly on the attitude and approach of an aspiring physician towards the subject, which at first instance might look like a mountain of diverse elements.
However, if the aspirant takes one stride at a time with a clear conscience of serving better to the patients irrespective of their religious or ethnic background, one would gradually form a habit of gathering information about any culture that a patient may carry with him/her.
Here the basic philosophy of healthcare can guide the aspirant, as Schwartz suggests, “much os what medicine does is designed to make people live more comfortably within their own, usually unanalyzed, cultural requirements” (Schwartz, 1994).
One of the primary ways of building a base in a multicultural platform is to focus intently on the patient to find out the following:
- The life-view of the patient
- Perception about well-being
- Elements embedded into the lifestyle
- Possible ways to come to an agreement regarding ways of healing.
This approach would surely help the physician to find the clues about the patient’s cultural base and its influence on him/her, and accordingly the physician would be able to work out a viable plan for the patient.
Apart from this approach, constant study on various cultures and their influence over people would greatly help the physician to tie all clues quickly, besides helping him/her to build a good rapport with the patient. The ideal bookshelf of the physician thus should contain references regarding customs of various cultures that can either be instrumental or detrimental towards treatment of the patients, besides an inventory on ethical issues that deserve to be handled with care.
- Health Care Disparity
Healthcare disparity is a common phenomenon amid a multicultural society prevailing in America, where people carry various concepts and practices regarding healthcare, ranging from primitive to state-of-the-art approach towards healing processes. Accordingly, the members of different communities are driven by various mindsets about the process of treatment, and thus it is the job of the physician to guide the patients towards the system s/he finds fit for them.
However, a physician’s favored system of treatment should be free from the bias of his/her own cultural preferences, and must be guided by the solid reasoning established through clinical practice confined within the laid down parameters of ethics. This is the most sensitive zone for a physician where many pitfalls wait for him/her. With the increase of complexity in the definition of healthcare, the ethical connotation of some of its practices too have become complex – for example it might still be difficult for a physician belonging to Catholic or Jewish faith to be willing to withdraw life support (Christakis, 19995), as it might seem difficult for any physician to accept hymenoplasty and labiaplsty as “treatments” to a health problem.
There may be plethora of issues like above, where healthcare disparity could come into play, where they may have a solid backing of any religion or tradition. As for example, some communities of Sudan still believe that female genital mutilation (FGM) is a holy practice, though it has severe negative impact on Sudanese woman. Thus, a physician should be guided by the knowledge that healthcare disparity stems out of several factors like Cultural practices, ignorance or economic conditions. Armed with this knowledge and free from the influence of own cultural background, modern physicians should cast a fresh look on the evolved community of humans.
9.Ethics and Diversity
To keep a calm head among divergent opinions on ethics can easily be earmarked as the prime quality of a modern physician amid the multicultural setting of America. On one hand there is the knowledge bank of do-s and don’t-s guide them, while social situations force them to go against their perception. While there are instances of one force prevailing over the other, it is always desirable to maintain the guidelines of medical ethics by a physician. However, with the significant development in the technology the scope of medical science has become extended to an unbelievable height, which in turn has opened new horizons of business in the name of healthcare.
As for example, cosmetic surgery has recorded a bumper growth, which works only towards beautifying the humans. In the process, it includes various surgeries, which at times can even blur the connotations of ethics, and even legal boundaries, if taken into serious consideration. Hymenoplasty or labiaplasty resembles female genital mutilation (FGM), which is legally prohibited in America and many other countries. Yet hymenoplasty or labiaplasty has become a fad among young generation (Kobrin, 2007). It shows how the power of market can regulate or tweak the guidebook of ethics. It is amid this state of affairs, physicians has to walk tight if s/he wants to maintain a clear stance amid the multicultural setting, where not only awareness about what can antagonize a particular community is no more sufficient to safeguard him/her, and thus the physician needs to be constantly alert ethical issues to keep him/her at distance from committing a social blunder.
- Oregon Vs Ashcroft
The human society is still equally divided over the question of whether to it would be a help or a brutal act to end the life of someone terminally ill. This question fuels a terrible dilemma among the doctors, where Hippocratic oath and the practical sense clash with each other. This issue thus attracted legal intervention and gradually seems to remain unresolved till date from the perspective of human perception of humanity.
On 6 November 2001, Attorney General John Ashcroft issued a directive that stated “a doctor could lose his or her federal registration to prescribe controlled substances if that registration is used to prescribed federally controlled substances for assisted suicide” (International, 2001).
Subsequently it attracted court proceedings, at the end of which the Court gave its verdict that “Controlled Substances Act (CSA) does not allow the Attorney General to prohibit doctors from prescribing federally controlled drugs for physician-assisted suicide in a state where the state law permits physician-assisted suicide”.
While the court cleared the issue in favor of euthanasia, popularly known as physician-assisted suicide, the dilemma still persists, because nobody could read what is there in the mind of the patient, not it could be ascertained that someone loses his/her mind with the loss of its faculties of expression. From this point of view, legalizing assisted suicide looks like a risky proposition, as its implication might extend itself to infanticide, according to the observations of the lawyers like Wesley J. Smith, who cites the instance of physician-assisted suicide done in Oregon, “even after a psychiatrist reported that she didn’t know what she was asking for and that her daughter was the driving force behind the request” (Smith, 2006).
This shows that there is a scope of misusing the legal corridor of euthanasia, though in the extreme painful cases it can be a solution. Physicians thus need extreme alertness before stepping into a situation involving euthanasia; though it is purely the circumstance that could decide on whether the heart or the brain would call have the final say.
- Religions and Health Care
Religion is one of the driving engines of any culture and it imbibes its nuances in the core of the perceptions of its subscribers. It is still one of the potent forces that can move humans towards any degree of destruction of development and thus a healthcare professional should always keep about the power and influence of any religion over the minds of its members. The physician should accept the fact mostly to gather his/her calm that religion would intervene the process of treatment more often than not and s/he should be equipped to handle that intervention effectively.
There is no dearth of instances where religion seriously intervened the even the general well-being of humans. The practice of female genital mutilation (FGM) in some part of Sudan can be one of many such examples, where researchers have proved with empirical data that humans are subjected to inhuman tortures throughout their lives in the name of religion (Thabet and Thabet, 2003).
Apart from such serious instances, religion influences human lifestyles too, where it determines the eating, clothing or other habits associated with daily lives of millions. Now things turn further complicated if a society contains people from many religions, as is the case of America, where people belonging to many religions reside together, with the freedom to practice their religion. This circumstance brings healthcare professionals before a group of patients with diverse life-views and world-views. This in turn might interrupt the process of treatment, and every physician should be ready to have more than one plans to keep the process on the track – that may include counseling, or an alternate way of treatment, whatever.
Focus on the patients, respect for their religions and general awareness about other habits stemming out of religion might be instrumental for a physician to handle the situation, but the primary steps to attain them should be to maintain their calm amid tough demands of their profession and apply themselves to achieve a positive outcome.
- Patient Interview and Treatment
This is perhaps the most important zone for both the patient and the physician before entering into the process of treatment. It is through the interview and discussion with the patient a physician can create his/her primary roadmap towards achieving benefit for the patient. Such interviews form an integral part of the whole operation, and in the modern times, as researchers like Rebecca and Thomson observe, “doctors are now encouraged to involve patients in treatment decisions”, where they would “recognize patients as experts with a unique knowledge of their own health and their preferences for treatments” (Charles et al., 1999).
This clearly seems to be a good method to focus on the problem with more inputs, besides gaining confidence of the patients. This method also can clear the differences of perceptions regarding treatment processes between the physician and the patient, where the patient may be driven by his/her culture of religion.
Moreover, a candid interaction between the physician and the patient can wipe out the sense of insecurity in a patient and instead can effective condition him/her to seek benefit of the medical practice. Alongside, a little working intimacy with the patient could fetch some of the intimate details of the patient too – which might prove instrumental in the actual treatment. Overall, the idea should be to gather as much information about the patient and utilize them towards the benefit of him/her. For that matter, the physician too needs to form a mindset like understanding the patients’ preferences and exploit them as much as possible to achieve the desired outcome.
Therefore, modern physicians need to develop interpersonal skills besides being equipped with knowledge on various cultures to develop rapport with the patients, which would not only help the patients, but also would be instrumental for the physician to rise in confidence and skill with each passing day.
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