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Module 1: Culture and the Volunteer

“The increasing population growth of racial and ethnic communities and linguistic groups, each with its own cultural traits and health profiles, presents a challenge to the health care delivery service industry in this country. The provider and the patient each bring their individual learned patterns of language and culture to the health care experience which must be transcended to achieve equal access and quality health care.”(1)

“Cultural differences” are often thought of as something that one must deal with only when one travels abroad.  But you only need to look around you to find serious cultural differences among groups or individuals right here at home.  As a volunteer seeking to close the disparities gap in health care in North America, it is very important to understand the way that culture and health care can interact so that you can be prepared to provide the best help possible.  Domestic cultural competency has become the focus of a significant body of research and literature in the past two decades, as health care providers and advocacy groups alike have come to realize its importance in the effectiveness of providing care.(2)

An Example of Cultural Differences in the U.S.

Kielich and Miller documented a case in which “a culturally competent physician who had been taking care of a Native American family for about five years noticed that the wife was depressed. The wife slowly revealed that she had been sexually assaulted by her uncle when she was young. The doctor started her on psychotherapy and antidepressants, which helped but did not resolve the underlying problems. After consulting with a Native American medicine man, who then met with the family, the physician and the patient learned that the woman had acquired a bad spirit from the incest. A traditional purification ceremony was performed that released the woman of the spirit and her depression.”(3)  To the traditional Western medical perspective, the notion of a “spirit” affecting anything comes across as unbelievable: the usual perspective tends to deal in empirical facts and physical entities, not metaphysical concepts.(4)  However that is precisely the problem in this situation: because of the woman’s belief in her own cultural norms, what we may perceive as an illusory notion is, for her, every bit as much of an empirical reality as a virus is from the medical perspective.  Therefore, a culturally competent care provider (like the physician in this story) must recognize that the cultural beliefs of a patient must be taken into account in order to provide him or her with the best possible treatment.  If the physician had not done this in the example, the woman may never have recovered from her condition.

The Potential Effects of Cultural Differences

As this example illustrates quite clearly, cultural differences can affect many aspects of how care providers and care receivers perceive each other and the care-giving process, including:

• Foundational beliefs each one has about health, healing, and wellness
• How illness, disease, and their causes are perceived
• The behaviors and attitudes of each party and how they are perceived

The services provided by the volunteer may also be limited by cultural differences, as the volunteer perceives the world through his or her own set of values and beliefs and oftentimes has difficulty thinking from a patient’s perspective.(5)

A Simple Model

The LEARN model is a widely accepted and very basic heuristic from which we can start thinking about cultural competency and how best to achieve it in practice.

• Listen with sympathy and understanding to the patient’s perception of the problem
• Explain your perception of the problem simply and patiently
• Acknowledge and discuss the differences and similarities of the two perceptions
• Recommend a plan while remembering the patient’s cultural parameters
• Negotiate an agreement that respects the patient’s cultural framework while still providing for them the kind of plan they need(6)(7)

Some parts of this model clearly apply to doctors, not volunteers (non-medically-trained volunteers should never make diagnoses, for example), but it is a good framework through which we can think about how best to communicate with others who may have radically cultural beliefs from your own.  For an extensive list of web resources and quick-training guides that deal with specific populations and situations, we recommend that you visit the US Department of Health and Human Services HRHS Cultural Competence Resources page at http://www.hrsa.gov/culturalcompetence/.(8)  This page includes highly-specific links that can be very helpful if there are specific demographic characteristics of the population you wish to serve.

Go To Module 2: Language Barriers >>

Footnotes

Cultural Competency For Chapter Volunteers

• Table of Contents
• Module 1
• Module 2
• Module 3
• Module 4
• Module 5
• Module 6