Tag: Learning

On Cultural Competency & Cultural Humility

Published on by Marilyn31 Comments

I spoke to a class of graduate nursing students yesterday in the city of Worcester. The topic was on cultural competency and health care — a topic I’ve spoken on for many years. They were an amazing group of students; smart, engaged, thoughtful, and diverse.

When I began to do this work around 13 years ago I knew it all. I spoke with confidence and flair, I had all the ‘best’ examples and brought people into the conversation in a new way. But this work is like living cross-culturally; the more you learn, the more you realize you don’t know. The more you experience, the less you are sure of any absolutes. So now, I’m much less sure of outcomes, yet much more committed to the process.

If you define cultural competency at its most basic level, it is about learning to communicate and function effectively across cultural barriers, cultural differences. So no matter where you live in the world, it is something that is useful to learn. In our increasingly diverse societies, it is indeed a critical life skill. The difference however when it comes to cultural competency and health care is that the stakes are higher. Cultural competency, knowing how to function in the midst of cultural differences, can change an outcome, can be the difference between life and death, or life and permanent, irreversible damage and I am not being dramatic when I say that.

  • There is the 71-million dollar word resulting in an 18 year-old becoming a quadriplegic.
  • There is the story of Lia Lee; a Hmong child who ended up having severe brain damage, largely because the arrogance of western biomedicine and the ignorance of healthcare providers who did not take into account the family’s belief system.
  • There is the story of a Japanese mom who ‘didn’t sound worried’ over the phone so was not given an appointment for her small child. By the time she did get the appointment, it was too late and the child died.

There is an argument in the field of cultural competency on the word ‘competency’. I would argue that in every field there are certain competencies that need to be met. As a nurse, I was not allowed to do certain things until I had reached a certain level of competency. It didn’t mean I knew everything, it meant that I was at a point where I could function well and not be a danger to patients. The same is true for cultural competency – I believe that people can reach a level of competency and have tools to use when it comes to communicating effectively across cultural boundaries.

But critical to this field of study, to this skill set is the idea of cultural humility. This term was developed in 1998 by two physicians: Dr. Melanie Tervalon and Dr. Jann Murray-Garcia. They proposed that this was what the goal should be when it comes to looking at outcomes. They say this: “Cultural humility incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-physician dynamic, and to developing mutually beneficial and non paternalistic clinical and advocacy partnership with communities on behalf of individuals and defined populations.”

How does that work out in practice?

It means being a student of the patient, person, or the community — not an expert.

It means not equating limited language ability with limited intellectual ability.

It means admitting what you don’t know, and seeking to learn what you need to.

It means seeking out those who can function as cultural brokers, as cultural informants and asking them questions, learning from them.

It means knowing the importance of culture for all who we encounter.

It means being capable of complexity. 

It means learning the fine art of negotiation, and the finer art of putting what we think is best in the background, focusing instead on what the person or community thinks is best .

Most of all, it means knowing who you are, what your cultural beliefs and values are, and how they may come into conflict with those you are wanting to serve. We wear our culture like skin. we’re so used to it we don’t even think that what we do, how we think, how we govern, how our schools are set up, our infrastructure, our medical system, is all based on cultural beliefs and values. Until we recognize both the complexity and the pervasiveness of our cultural beliefs we cannot move forward in communicating effectively across cultural boundaries. Then, and only then can we move forward on this path.

I left the students yesterday with this quote: 

Most things that don’t make sense from the outside usually do make sense if understood from the inside…

It’s a life long journey, but so worth pursuing. 

Blogger’s Note: One book I would recommend that looks at cultural competency in the context of western medicine is The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures by Anne Fadiman. It is a profound look at culture, healthcare, and what can go wrong.

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For the Love of Libraries

Published on by Marilyn30 Comments
Boston Public Library bearing the inscription on the north side "THE COMMONWEALTH REQUIRES THE EDUCATION OF THE PEOPLE AS THE SAFEGUARD OF ORDER AND LIBERTY"
Boston Public Library bearing the inscription on the north side “THE COMMONWEALTH REQUIRES THE EDUCATION OF THE PEOPLE AS THE SAFEGUARD OF ORDER AND LIBERTY”

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It was my sister-in-law who taught me to love libraries. I can see her to this day, curled on the cushions in the children’s section of the Cairo American College Library. She had a toddler on her lap and a pre-schooler beside her and she was reading Miss Rumphius. I was glued to the scene. I wanted to be her. I wanted to sit curled up on those cushions with my kids reading library books forever. I don’t know why it took me so long to love libraries, but once I learned I never looked back.

Not surprisingly Miss Rumphius became one of my favorite children’s books. Years later, one of my close friends became the librarian of that section of the library. She found her niche among Miss Rumphius, Stargirl and many more excellent books for younger audiences.

Periodically I would receive notes from one of my kids “going to the library after school” – it wasn’t a place of punishment, it was a place and space of comfort.

In moving from Cairo this year, my daughter Annie had ‘Get a library card’ at the top of her to-do list. It was crossed off quickly.

So when Room for Debate in the New York Times asked the question “Do we still need libraries?” Scissors went through my heart.

What?

Who would even ask that stupid question?

Of course we need libraries. Libraries are necessary to a functional community. Libraries are reading places, meeting places, resting places, learning places, writing places, necessary spaces!

If you want to question the importance of libraries just talk to people who have lived for long periods of time in countries without a public library system. They’ll tell you what it’s like to long for that space, those shelves of books, that quiet. They’ll tell you how they begin their own forms of libraries through borrowing the books of friends, through developing small loaning libraries in a tiny room in a church, they’ll tell you how they bought the Kindle, NOT because they like electronic media, but because they love books and had a limited luggage allowance that had to include baby paraphernalia and other essentials, leaving some of the essential books behind.

I was told once that the biggest consumers of the New York Public Library system are immigrants. I believe it. For when you’ve lived without, you don’t take for granted a system like libraries.

So why is it even a question?

Because libraries, though free to us, are not free. They take upkeep, good staff, an incoming supply of books. They may be public, but they are not free. And judging from the various perspectives in the Room for Debate article, libraries have had to reconsider their function. They have had to address the need and importance of computer and internet access, speak into the digital world of e-books. In many ways they have had to be reinvented.

Luis Herrera, city librarian of San Francisco says this: “Libraries are more relevant than ever. They are a place for personal growth and reinvention, a place for help in navigating the information age, a gathering place for civic and cultural engagement and a trusted place for preserving culture. While the technology for accessing library materials has changed and will continue to change, our mission – to inform, to share and to gather – will not.”

It is Matthew Battle, author of Library: An Unquiet History, who worded it best in Room for Debate:

“In their long history, libraries have been models for the world and models of the world; they’ve offered stimulation and contemplation, opportunities for togetherness as well as a kind of civic solitude. They’ve acted as gathering points for lively minds and as sites of seclusion and solace. For making knowledge and sharing change, we still need such places — and some of those, surely, we will continue to call ‘the library.'”

So what do you think? What is your experience in and with libraries? And do we still need them? Discuss!

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A Long Journey; A Journey of Faith

Published on by Marilyn20 Comments

When you become a mom you don’t have the luxury of seeing a future film about the twists and turns your life is going to take. You don’t know what joys, trials and tragedies may be awaiting you. You become a mom on faith.

Faith that you will weather the sun and rain that is a part of raising a child.

Faith that you will have strength for the long haul. 

Faith that you will have the grace it takes to love a child more than you love yourself.

In faith we get pregnant. In faith we give birth. In faith we cry tears of joy as we look at our newborn, awed by tiny hands and feet, puckered mouth, and newborn wrinkles. In faith we adopt. In faith we see our child for the first time at an orphanage or foster home, and from eyes to heart we know this is our child, given to us at this moment for this time. In faith we find out that something is not normal with our child, in faith we move forward learning all we can about children with Down Syndrome, or Muscular Dystrophy or Autism. It’s a journey, a journey of faith.

And there are moments when you see results of your faith. First steps, first word, first prayer, first day of school, completion of kindergarten, healing from a first heart ache or broken friendship, healing from a first wound, graduation…the list is endless.

It’s a long journey; A journey of faith.

Yesterday I saw a result: I received a text from my youngest saying “It’s all good!” – he had completed all the course work required and is graduating from high school. Next Wednesday he’ll pick up his cap and gown at four in the afternoon and go over final steps of the program. We will be there, celebrating with proud grandparents who will quietly cheer as their 17th grandchild graduates.

As youngest of five kids Jonathan came into the world with instant family and no need for play groups. He was adaptable and flexible, rarely displaying a temper and willing to go with whatever was happening. He is one of those kids that is comfortable to be around, even in adolescence. (Well. Mostly.) We can sit for hours discussing life topics, things that matter.

I’ve written before about Jonathan and academics. It’s been a long journey. He is smart, loves reading and is a critical thinker. But. He doesn’t fit with the main stream learning process that demands sitting at a desk, fitting in with the status quo, and writing one hundred ‘P’s’ across the paper in cursive to show you have it “right”. Wow. Good for us. We have a bunch of kids in this country who can write ‘P’s’.

And until this year, Jonathan did not have teachers that encouraged. He had teachers who were type A personalities whose teaching careers seemed defined by the results their students achieved. He has had teachers who follow the book to  the minute details and struggle to find room for the “Jonathans” in their classroom. He has had teachers who are more concerned about standardized tests than true learning. He was a statistic, caught in a bad system.

Until this fall. And this fall, by faith, we were able to move him into an extension program where he was surrounded by teachers who love teaching and love the students. He is now affirmed for who he is, not who they want him to be. He has excelled as he has inhaled Dostoevsky and Mark Twain, Kerouac and Nietzsche. It has not been easy and he has worked hard.

We celebrate the results of his work as he graduates a year early. This child who didn’t want to go to college (ever) is now excited about learning and looking into colleges and universities. He has applied to do a gap year in Oxford at an advanced studies program. He boasts a reference letter from one teacher that had me in tears with her affirmation of him as a student, of him as a person.

We become parents with no guarantees. Whether biologically birthing or adopting, parenthood is a journey of faith. Today I get to celebrate. Tomorrow I may have to cry. But that’s what this is: A long journey, a journey of faith.