If you have not read the previous posts on Cultural Competency, you are welcome to take a look! Today is the last in my 3-part series on Cultural Competency.

• Forget Diversity! It’s Cultural Competency that we Need
• Cultural Competency – How does it Help

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“It’s easy! All it takes is caring!” 

“All you have to do is be sensitive!”

“I don’t know why this is such a big deal! In our [insert company name] we treat everyone the same!” 

These are a few of the things a colleague and I have heard when we talk about cultural competency, specifically when we conduct workshops on cultural competency.

We always breathe deeply and slowly before we respond. 

As normal as those phrases may sound, they are exactly the sort of phrases that create barriers to achieving cultural competency.

• “It’s easy! All it takes is caring!” First off, let me say this: caring is good! Caring is essential. Caring is a great start. But, and this is a big but, it doesn’t give us what we need to communicate and function effectively across cultural boundaries. It’s a great and necessary first step but it is important to move beyond caring to offer culturally competent care and services. Here’s an example: For a long time I worked as a home care nurse. I would go to the homes of patients who had come out of the hospital but still needed nursing care. My patients ranged from new moms who were struggling postpartum, to oncology patients who were struggling with chemotherapy. The range of reasons for going to see patients was huge. The agency I worked with would always give me the “foreign” patients. It didn’t matter where they were from, it was assumed that because I had grown up overseas and then lived overseas as an adult with a lot of experience working across cultures that I would be the best one for the job. And sometimes I was, but not always. I remember a Japanese patient that I was caring for. I cared deeply for her, but I found it impossible to communicate. I felt loud and big in contrast to a woman who was quiet and small and lovely. One day with a shock I realized I would always put this patient at the end of the day, a time when I was busiest and had the least amount of time or energy. If I saw her then, I had a good excuse for a quick visit. I was not giving her good care. I was not communicating adequately and I didn’t know what was really going on with this patient. I cared – but caring wasn’t enough.

• “All you have to do is be sensitive!” This is similar to caring. Sensitivity does not a culturally competent person make. Sensitivity means that an individual or organization responds to cultural differences and attempts to take them into consideration in their line of work. But if I don’t know what those cultural differences are, how can I take them into consideration? If I am unaware of the beliefs, values, and behavior of those I work with or serve, then sensitivity won’t take me very far. Again an example: Western biomedicine places high value on something called evidence-based medicine. Evidence-based medicine is a way of taking the best scientific evidence and linking it with a physician’s clinical expertise to better treat patients. What evidence-based medicine doesn’t do is recognize dual causality – the idea that the mind and body interact with each other and patients from different cultures and backgrounds believe there is both a scientific and a spiritual reason for their disease or ailment. A doctor needs to know their patients well enough to know if they believe in dual causality in order to give them the best care possible. They need to know that their patient believes that both chemotherapy and snake oil will cure their cancer. One of the best examples of collision of cultures when it comes to medicine is in the book The Spirit Catches You and You Fall Down by Anne Fadiman. I write about it here and highly recommend reading the book.

• “I don’t know why this is such a big deal! In our [insert company name] we treat everyone the same!”  There is so much wrong with this I don’t know where to begin. First off, it’s a huge deal. We wear culture like our skin – we don’t even think about it until it is bruised or torn or burned. We don’t realize that everything we do is based on our cultural beliefs, until we encounter someone with behaviour and beliefs completely different from our own. And it’s all very well to say we treat everyone the same, but the reality is that they might not want to be treated the same. Their cultural norm could be completely different, whether it’s around greeting people or modesty or any other number of things.

So what are tools for the trade? We looked at some of these in the story about the FBI. Here are others that I think are excellent. I originally posted them in this piece: Tips for Working Cross-culturally in Healthcare Settings and Beyond. 

• Be aware of your cultural values and the beliefs you hold. This is a first and critical step to being able to effectively communicate across cultures. If you don’t understand the importance of culture — why you value what you do, how you make decisions, essentially how you live all of life, then it will be difficult for you to understand how culture affects others.

• Become a student of the culture and the community. Even if you’re an expert in a certain area it’s important to rethink your role and be willing to learn as a student.

• Recognize differences in narrative styles and practical behaviors across cultures. Be willing to research these differences and ask questions.

• Understand that  limited language proficiency (whether your’s or another’s) does not mean limited intellectual ability. People with limited language skills are usually capable of communicating clearly and effectively in their native language.

• Have a high tolerance of ambiguity.

• Seek help from bilingual/bicultural co-workers and individuals – find those who can help explain cultural nuances, the complexity of culture, dual causality and more.

• Know the role of interpreters and learn to use interpreters effectively.

• Allow the use of story-telling and props when speaking with others – we learn so much more in a story than in a list of facts. For healthcare providers, realize the symptoms are often in the story.

• Recognize the primary person you are working with may not be the decision maker in the family.

• Use empathy, curiosity, and respect as you work across cultural boundaries. Empathic listening, curious questioning, respectful observing.

• Learn to be capable of complexity.

• Be able to laugh at yourself and potential mistakes — if you don’t laugh you’ll find yourself crying way too much.

• Build bridges – just as a bridge connects two bodies of land together over a vast chasm or river, so it is with us. The chasm of cultural disconnect and misunderstanding can be bridged, but it takes humans to bridge it.

I’ve said it before, I’ll say it again and again and again. None of this is easy. It’s not easy to listen. It’s not easy to be reflective of our own cultural values and see where bias, both conscious and unconscious, is present. It takes time and effort. It means putting some, not all, but definitely some of our values temporarily to the side while we focus on what is important to those around us. But it can make a huge impact and change outcomes no matter what sphere we find ourselves.

“Building bridges means moving beyond my enclave of cultural comfort, moving to a place of cultural humility and willingness to learn” – Between Worlds, Essays on Culture and Belonging 

“Ignorance of cultural differences is one of the chief causes of misunderstanding in a world that is getting more and more interdependent on the one hand and increasingly torn with strife on the other.” – Fali Chothia

I would love to hear from you through the comments! What would you add to this list? 

Blogger’s note: Just this morning a friend of mine from Families in Global Transition wrote this piece: How to Build a Bridge for Mental Migration. I love how well it complements this series and wanted to link to it.