When the World Comes to You

It was over a year ago when Elizabeth Jones contacted me. She had been reading and interacting with Communicating Across Boundaries for a while at that point, always affirming and entering into discussion in meaningful ways. I am delighted to have Elizabeth guest post today! Elizabeth watched the world come to her through her work as a chaplain in a busy, diverse, city hospital. 

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world, globe

Caring, Capable and Conscientious

Caring, capable and conscientious. That’s what I wrote on the fliers several years ago, advertising piano lessons I could teach from my home when my children were small. When I turned 40 and my mother died after several years of uncertain health, I went to seminary with the money I received from her small estate. As I formulated my new, chaplain’s resume, I turned to the same phrase—caring, capable and conscientious.

I enjoyed chaplain internship! I dug right into learning about different faith traditions. This was a natural progression for me, in learning more of how to accompany diverse people in crisis, critical care, trauma and end of life. It sounds rather odd, talking about my years of intensive learning and stressful internship in this way, but I very much appreciated every experience I had: both in the classroom, as well as on the floors and units of the hospitals and care centers.

I no longer serve as a chaplain, since I am now a small church pastor in the Chicago suburbs. But for almost ten years, in several hospitals and extended care centers in and around Chicago, I dealt with patients, their loved ones, and health care staff—on a regular, and sometimes daily, basis.

I appreciate Marilyn’s kind invitation to write a guest post. This blog ordinarily talks about the wide world, and how Marilyn and her friends and acquaintances navigate this world and cross visible and invisible boundaries and borders. Instead, I had the world come to me, in the hospital.

All three of the hospitals where I served were in the middle of multicultural areas, a crossroad of the multicultural communities of Chicago and the surrounding area. One of these hospitals has the distinction of sitting in one of the most diverse ZIP codes in the country. (The U.S. Census Bureau says so.) I never knew who was going to be in that next room I entered, or what situation I was going to encounter next.

People—when they become patients—are so often stripped of everything they have, everything they are. Especially in critical care, this hospitalization experience can be depersonalized. As a chaplain, I tried to bring some personal, pastoral care into each room I entered.

I have a big, friendly smile. It happens naturally. When I’d knock and enter a room, announcing myself as a chaplain, my smile would often automatically turn on. (It still does.) I’ve had people of all different faiths and all kinds of nationalities thank me for my smile and my genuine manner. “Your smile lights up the room. I really needed that,” one older woman told me.

I have sat with an aged senior in Cardiac Care, holding her hand with the chipping nail polish, as her life softly ebbed away. She was a nursing home patient and had no other relatives. I remember an Asian family in critical care, as their loved one had just died—complete silence and intense sadness greeted me as I came into the room. I entered the packed ICU cubicle—wall to wall with a Pentecostal Latino family, who wanted me to pray their brother (and uncle) across the River Jordan. (The waves of grief were palpable…I vividly remember.) And the couple who had just delivered a stillborn, full-term baby. Their first. The husband looked so lost, so alone. My heart still goes out to them both as I see them in my memory.

It wasn’t all end of life. I remember being asked to pray the Rosary with a Filipino family around their ill auntie, lying in the hospital bed. Then, talking haltingly in my schoolroom German with a grumpy old man who just spoke Russian—and Yiddish! (He was disgruntled that few could understand him. But with my cheerful efforts, I believe I made a difference.) The situation with an older Muslim patient, and the 20-something relative wearing hijab and very conservative dress; she earnestly asked me to pray. Of course I did! (And, I talked with her for a good long while afterward, since her loved one in the bed was non-verbal.)

Happy occasions happened, too. Often I would see patients get better, and get released. Also, I loved seeing all the babies. Bless the babies, and their families, as well.

Caring. Capable. Conscientious — The words continued to guide me as I tried my best to be warm and nurturing. I would strive to help, to serve, to come alongside of whoever needed me, or paged me, or stopped me in the hall. Just as I do now, in the suburb where my church is located. Multicultural Morton Grove, Illinois.

Again, the world is coming to me. I hope always to have my heart and arms open wide.

How has the world come to you? Please share your stories through the comments! 

More about the author:

ElizajonesElizabeth has been involved:

– as a pastor at St. Luke’s Christian Community Church, Morton Grove, Illinois

– in various ministry and prayer-related activities

– as a commissioned member in the Federation of Christian Ministries

She holds a Master of Divinity degree from Garrett-Evangelical Theological Seminary and a Certificate in Alcohol and Drug Counseling in Illinois (IAODAPCA). You can find her blogging at matterofprayerblog.wordpress.com

Cultural Competency – Tools for the Trade

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.

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Building Bridges city

“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.

Cultural Competency – How Does it Help?

police

Four years ago, the FBI (Federal Bureau of Investigation) conducted a raid on a mosque in Miami, Florida. What could have been a disastrous, public relations nightmare for both the Muslim community and the FBI was carried out so well and so carefully that most of us had no idea the raid took place. I wrote about it then, but I bring it up again now.

I believe this story has good insight into how cultural competency helps in any area of work.

I am not one to praise the FBI or government in general, but it is important to give credit and recognition where it is deserved. I was amazed with the thoughtfulness and cultural awareness with which the raid was carried out. All the evidence points to actions that took into account the larger Muslim community and efforts that were taken to inform and involve this community.

First: The story goes that the activity of the imams had been watched for some time so when the decision was made to arrest and question these men, the FBI consulted with a cultural broker about the best time to carry out the raid. It is a large and active mosque with prayers going on five times a day and activities in between. It was decided that a Saturday morning at 6am would be the ideal time. This ensured the fewest number of people and the least amount of chaos.

Second: The officers took off their shoes before going into the mosque. They took the effort, despite the obvious seriousness of the situation, to display sensitivity that this was a place of worship and it was important to abide by the rules of the mosque.

Third: They spoke to the imams in Pashto, through an interpreter. It was their native language so there was no ambiguity about the arrest and no miscommunication because of limited English. The Pashto was clear and precise.

Fourth: They did not interrupt morning prayers, but waited until the prayers had finished before they entered the mosque.

Last:  Before the media had any idea that this had occurred, the spokesperson for the FBI contacted leaders in the Muslim community. The neighborhood surrounding the mosque is heavily populated with Muslims and, while an arrest of a religious leader within any religious community would be difficult, given the current attitudes toward Muslims this is one of most difficult and potentially explosive things that can happen. They wanted the community to have an opportunity to frame a response before a media frenzy began inciting fear,  indicting all Muslims as well as spouting assumptions that everyone in this community was involved in suspicious activities linked to terrorism.

In a climate of police violence, FBI gaffes, and abuse of power by people in the role of law enforcement, the FBI used principles of cultural competency in carrying out this raid. Just days before the operation many of the officers had attended a training program that gave tools on working in a culturally sensitive way with Arab and Muslim communities.

What did the FBI do right?

They asked and they listened! Sometimes it’s as simple as just asking. They asked a cultural broker because they knew they were interacting with a culture and community they knew little about. But if we ask, we must also be willing to listen to the answer, to not impose what we think we know on a situation.

They adjusted their behavior. Not only did they ask and listen, but they adjusted their behavior based on what they learned.

They understood the importance of language and didn’t take any chances with misunderstanding. Cultural competency always takes language into consideration.

They respected the larger Muslim community. Respect is imperative in culturally competent interactions. We don’t have to agree with people, we don’t have to believe what they believe or adhere to their values, but respect is important. The people involved in this operation understood that these Imams did not represent the broader Muslim community. They didn’t stereotype and see a single story, instead they focused on the problem and actions of a couple of individuals. “The problem with stereotypes,” says Chimamanda Adichie “is not that they are untrue, but that they are incomplete.”

Cultural competency can change outcomes, can make a terrible situation a bit easier on a community. Whether it be health care, education, law enforcement, counseling, social work, faith, or any other area, taking into account the cultural beliefs and values of a community gives us better outcomes. 

As you think about the way the FBI handled this situation, how do you think your work place handles sensitive situations? Do they practice cultural competency through asking, listening, adjusting, understanding the importance of language, and respect? 

There’s another question I ask myself — and that is this: What lessons could law enforcement in Ferguson, Missouri learn from the way another law enforcement agency handled a difficult situation? 

Photo Credit: http://pixabay.com/en/police-search-block-security-171454/

Forget Diversity! It’s Cultural Competency that We Need.

cultural competency

I live in a diverse neighborhood in a diverse area. Every day I ride the subway with people of many different backgrounds and ethnicities. I go to work and sit next to a man from Malawi and have friendships and work with women from Haiti, Jamaica, Costa Rica, Senegal, Portugal, Cameroon, and Roxbury – and that’s just naming a few.

But so what? Just because there is diversity in my life doesn’t mean I know how to navigate diversity. It doesn’t mean I exercise cultural humility in my interactions. It doesn’t mean that I don’t make mistakes and show my prejudice, sometimes well dressed and well hidden, other times more overt.

It’s not enough to recognize, and be sensitive toward, diversity. We need to learn how to navigate diversity.

In the 2012 census, census officials in the United States said that by the end of the decade “no single racial or ethnic group will dominate the majority of children under 18.” By the end of three decades, the same will hold true for the population at large.

More and more, the United States is seeing communities change from predominantly white, to a veritable ‘salad bowl’ of color. A place where people from many ethnic and racial backgrounds live, work, play, and fight together.

I’m tired of hearing about diversity. As long as we just talk diversity, nothing will change. Because diversity just means ‘difference.’

This is what the dictionary says when defining diversity:

  • the quality or state of having many different forms, types, ideas, etc.
  • the state of having people who are different races or who have different cultures in a group or organization

When it comes to a health care organization, a school, even a church, that definition is singularly unhelpful. Because all it gives you is the what – not the how. It gives you nothing about the good and the hard of a diverse population of people living, working, playing, and fighting together.

I think we need to stop talking ‘diversity’ and start talking about ‘navigating diversity.’ One of the ways to do this is by learning what it is to be culturally competent — learning how to function effectively across cultural differences.

As I think about the many tragedies that have affected the United States in the past few months, I am struck by the fact that no one has been talking about the importance of learning how to function effectively in the midst of difference – whether that difference be racial, socioeconomic, cultural, or physical.  And that is just naming a couple of areas where we see diversity in our communities.

We can talk all day long about diversity, but if we don’t have tools on how to navigate this diversity, than the talk is empty and nothing will ever change.

So for a moment, I want to talk about cultural competency. A disclaimer here – when it comes to cultural competence I am most familiar with how this plays out in the world of health care. This is where I see difference and inability to navigate difference played out regularly. So the way I approach this is from that perspective.  I want to talk about what it is, why we need it, and some tools for how to move forward in this area.  I hope to do this in the next few blog posts so I would love it if you tracked with me.

Cultural competency is a field of study, a series of behavioral changes, and a strategy for working with and serving diverse populations. The term was born in the field of mental health but didn’t make its way into medical literature until the early 1990s. The words and ideas behind cultural competency began to get more recognition in 2002 when the Institute of Medicine published a report (now a book) called Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. This report highlighted extensive areas where racial and ethnic minorities receive lower quality health care, even when their income and insurance status were the same. Among several recommendations given at the end of the study was the need for systematic cultural competency trainings.

There are several different definitions for cultural competency.

A colleague and I use prefer this one, partly because it is simple and short:

A learning process that enables individuals and organizations to respect, value — and function effectively in the midst of — cultural difference.

The definition accurately portrays cultural competency as something that is ongoing, something that has to be learned and practiced. Cultural competency is a continuum and needs to be seen in stages. 

Why do we need it?

We need cultural competency because there are overwhelming disparities in almost any area we could mention. In health care, everything from access to pain medication to being offered treatment for cancer shows overwhelming differences in quality of care. For example, in one study minority patients were more likely to be under-medicated for pain than white patients (65% vs. 50%), and more likely to have severity of pain underestimated by caregivers. Another study in the area of mental health indicated that 44% of White English speakers to 27.8% of Blacks received treatment after a diagnosis of depression. These disparities are well-documented in the book I cited above.

In an extensive survey conducted by the U.S. Department of Education’s Office for Civil Rights showed that racial disparities are well documented and pervasive in various areas of education. Here are some of the key findings from this survey:*

  • Access to preschool. About 40% of public school districts do not offer preschool, and where it is available, it is mostly part-day only. Of the school districts that operate public preschool programs, barely half are available to all students within the district.
  • Suspension of preschool children. Black students represent 18% of preschool enrollment but 42% of students suspended once, and 48% of the students suspended more than once.
  • Access to advanced courses. Eighty-one percent (81%) of Asian-American high school students and 71% of white high school students attend high schools where the full range of math and science courses are offered (Algebra I, geometry, Algebra II, calculus, biology, chemistry, physics). However, less than half of American Indian and Native-Alaskan high school students have access to the full range of math and science courses in their high school. Black students (57%), Latino students (67%), students with disabilities (63%), and English language learner students (65%) also have less access to the full range of courses.
  • Access to college counselors. Nationwide, one in five high schools lacks a school counselor; in Florida and Minnesota, more than two in five students lack access to a school counselor.
  • Retention of English learners in high school. English learners make up 5% of high school enrollment but 11% of high school students held back each year.

We need cultural competency in health care because it is one of the ways we can provide quality care. We need cultural competency in education because our schools have students of all colors, backgrounds, and religious beliefs. Cultural competency is one way to serve these diverse students and their families. Learning doesn’t take place in a vacuum and the student’s family and culture are critically important to their education. We need cultural competency in law enforcement because those in the field often encounter the challenges of interpreting and understanding the behavior and attitudes of those who are culturally and linguistically different than they are.

Talking about navigating effectively through difference is far more difficult than talking about being sensitive to, or appreciating difference. Navigating or functioning effectively in the midst of diversity is hard work. It is a learning process. It takes tremendous humility – recognizing that the way you view the world is not the only way. It takes guts. It takes a sense of humor. It takes willingness to say sorry, to admit we are wrong. It takes negotiation and communication.

In the next couple of blog posts I hope to discuss a fraction of how I think cultural competency can help us to work, serve, and form friendships more effectively as well as some tools that increase people’s ability to navigate across cultural differences.  In the mean time, what do you think? Do you talk about cultural competency in your area of work? Why or why not? 

*http://www.ed.gov/news/press-releases/expansive-survey-americas-public-schools-reveals-troubling-racial-disparities

Photo Credit: http://pixabay.com/en/photo-montage-faces-photo-album-556806/ word art by Marilyn R. Gardner

“I Was a Stranger”

 

strangerWhat is our first reaction, our spontaneous response, when we meet the stranger? 

“Who let’s these people in here anyway?” asked the man. He was agitated and shaking his head, in complete dismay. “I mean” he paused “The woman who served me coffee the other day was Moroccan!” His voice raised in incredulity at the end of this declaration. The man was a casual friend of ours and he was speaking to my husband on a chance meeting at a convenience store nearby.

My husband took a second then responded calmly “Who let your people in here?”

Brilliant.

But our friend didn’t hesitate and was not to be silenced. “My people came on the Boat!” he said with authority and pride. He did not have to specify “which” boat. Depending where you live, this conversation is not uncommon. It is not nearly as rare as I would wish it to be.

The French philosopher Zvetan Tdorov puts this response well when he says that “our first spontaneous reaction in regards to the stranger is to imagine him as inferior, since he is different from us”.  If one could see the unfiltered version when any one of us confronts difference in the form of a stranger, they may see this response.

Daily in our world we encounter the stranger.

Some times the encounters are interesting, intriguing, fun, joyful. Other times encounters are troubling, assaulting us with faces, smells, clothes, and accents that exacerbate the differences we feel and make us uncomfortable. Sometimes those feelings of discomfort spill over into anger or judgment.

And now I speak to the Christian who is reading — the one who believes that the gospel message is for all people. Hear this: the way we confront difference, the way we treat the stranger, reflects what we believe. If we consider the stranger to be inferior because he or she is different then we’d best ask ourselves ‘why’, best examine our motivation and our heart.

“For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in,naked, and you clothed Me; I was sick, and you visited Me; I was in prison, and you came to Me.”*

The stranger – that one who is foreign, not one of us, unknown.  From Genesis to Hebrews to James we have clear instruction and wisdom on how to treat the stranger. The words of Jesus call us to feed the hungry, bring drink to the thirsty, clothe the naked, visit the sick, come to the prisoner. The writer of Hebrews asks us to show ‘hospitality to strangers for by it some have entertained angels’. Hospitality holds a high premium in Middle Eastern culture, both now and in Old Testament times. The verse below is not ambiguous in its command:

‘When a foreigner resides among you in your land, do not mistreat them. The foreigner residing among you must be treated as your native-born. Love them as yourself, for you were foreigners in Egypt. I am the Lord your God.’

We are told to “love” the stranger. Not just tolerate, not pass by, not ignore – but to love.

International students, immigrants, refugees – they all fall under the category of the ‘stranger’. The journeys that brought them to the United States are as varied as the tapestry of experiences they come with.

Take international students as an example. Figures vary, but the United States has over 800,000 international students that arrive every fall for the academic year. Statistics on international students show that 80% of them never set foot in and American home. Never. Former world leaders who were international students at one time include Benazir Bhutto, Fidel Castro, and King Abdullah of Jordan. The state department maintains a list of current world leaders who at one time participated in American academic programs. The list includes almost 300 former or current leaders.

I have to ask myself – were they ever invited into the home of an American? Was hospitality extended to them during their tenure as students? Or did they come to this country and leave, without so much as a cup of coffee in the home of someone from the United States?

Who is the stranger in our midst? Who is the stranger in your midst? 

And how do we respond to that stranger?

Can we ask ourselves this question and be honest in our responses? What is our first spontaneous reaction in regard to a stranger? What is our response to difference?

Do we consider some worthy of our hospitality and others unworthy? Some superior because they are attractive, or white, or clean, or smart, or beautiful? Do we love only those with whom we agree, because we believe the same things on faith and God? Do we believe those who look like us are somehow more worthy of God’s love and of ours?  Do we love because of obligation or duty which is really no love at all? Do we believe we are more lovable because of who we are and how we live?

Or do we love because first we were loved?

It is the Advent season and daily we are reminded of the Incarnation – God become man. If there was ever one to meet the stranger it was Jesus, the God-Man. Leaving all that was rightfully his, he came into our midst and encountered a world that didn’t know what to do with a Messiah. He engaged the stranger and found out their story, he entered into their story, and by entering their story – their lives were never the same.

So this advent, can we look at the stranger and imagine him as equal? Can we embrace the stranger with an invitation to dinner offering a side helping of genuine hospitality and pumpkin pie? Can we put aside our discomfort with difference, and see what might happen? Can we bring the stranger home?

What will our response be in regard to the stranger? 

*Matthew 25:35

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