Labor Repose

Labor Repose
LaborPayne during her 6th homebirth (9th baby) at age 44

Saturday, October 3, 2009

What is Cultural Competency?

I attended a conference yesterday (what a shock right! Everyone must think I have a hidden trust fund to attend all these conferences, when really I'm just resourceful and I live in a metropolitan area that has lots of conferences to choose from). The topic was cultural competency. I attended because, 1. I think cultural incompetence feeds greatly into health disparities which greatly impacts the health of African-Americans and Latinos, and 2. I guest lecture on the topic and felt the need for more info, and 3. it was free to nursing students of the school I attend where I'm working on my masters.

What a lovely conference! It was hosted by INMED whose focus is international medical missions, so the focus was more on healthcare professionals dealing with clientele from other countries of origin, but as we all know there are plenty of American subcultures that are misunderstood by the majority of healthcare providers, whether those subcultures are characterized by race, class, religion, region, language linguistics, language dialect, health literacy levels or any other number of factors. The conference did an fairly nice job of pointing to the fact that healthcare is a 'foreign culture' unto itself.
(I have long been an ardent supporter of this philosophy. Healthcare has its own language, its own mode of dress, its own customs, power systems, etc. Since it is populated mostly by educated caucasians, their norms have become the norms of the this 'foreign culture' we call healthcare. So even caucasians entering the healthcare system to some extent have to step into this culture in the 'patient' role. Everyone else has that to contend with putting on the patient role plus whatever cultural divides exist, known and unknown.)

The sessions were on such topics as, 'Health thru the lens of culture,' Health beliefs and traditional health practices,' 'Health disparities in relation to cultural identity,' Defining culture and cultural competency,' and much more. Fabulous topics all. The most practical information was Kleinman's Questions which are 8 questions this researcher came up with for pulling out the health beliefs (or illness narrative as one speaker so eloquently put it) of the healthcare consumer- so if you learn to incorporate these questions into your history taking, it doesn't matter if the patient is from the same or a different culture than your own. Almost every speaker quoted Kleinman's Questions so google it for yourself to find out what they are. I'm incorporating them into my history taking lab for my students.

At lunch I approached a table of older caucasian gentlemen. (This is how I challenge myself now, to sit at a table of folks I don't know and suspect that I don't have much in common with.) After polite introductions we launched into an animated discussion on what cultural competency looks like in our individual practices. There was a surgeon (I think he was a cardiologist, but he never said), a homehealth case manager/manager who was a nurse, a home health physical therapist, and me, a nurse educator. The surgeon made the (for me) shocking but typical statement that it was enough that he was kind and polite to everyone he saw, that was his idea of cultural competence. I reminded him that he could very politely offend the hell out of someone by not understanding the customs or health beliefs of their given culture. As we talked more the nurse manager gave many excellent examples of how he ammended his care to the cultural needs of the client, but the surgeon really didn't get it. I told him I could 'blow his mind' with some examples of things he didn't know about his African-American client's health beliefs that he probably wasn't taking into account when he treated them. "Name me three," he challenged me. Only three? Sure.
  1. Your African-American clients don't trust the healthcare system, and by extension don't fully trust you.
  2. You are not the final authority for your African-American clients, you are at best a second tier authority on health and wellbeing.
  3. Most if not all your African-American clients indulge in folk medicine practices that you are unaware of.
I don't know if nurse manager and I convinced surgeon of anything, but we gave him some food for thought. This is why I always try to sit with strangers over a meal. Good rousing conversation always is a possibility. There's nothing I love more than thrashing around ideas with good conversationalists. I also remind myself that as an African-American woman, my voice and my story is seldom heard, and others need the benefit of my healthcare narrative and perspective.

All in all a fabulous conference and time well spent.

Have you looked up Kleinman's Questions yet?

4 comments:

Kathy said...

1. Your African-American clients don't trust the healthcare system, and by extension don't fully trust you.
2. You are not the final authority for your African-American clients, you are at best a second tier authority on health and wellbeing.
3. Most if not all your African-American clients indulge in folk medicine practices that you are unaware of.


This sounds like most birth junkies and/or natural-birth advocates I know. :-) Myself included.

Laborpayne said...

Kathy,
You're right. These certain apply don't they?

Laborpayne said...

Kathy,
You're right. These certain apply don't they?

Diana J. said...

Just did the Googling homework, and WOW! Those questions are awesome! All healthcare professionals should ask THOSE questions instead of the questions they normally ask. What good thoughts!

Thanks for posting! :)