 |
 |
|
| Archive : Winter 2007 |
LOST IN TRANSLATION:
It’s your first time in a U.S. hospital // You don’t speak the language // You can’t read the signs // How can you tell doctors the red welts on your back are the result of a healing ritual,
not a sign of abuse?
Care Across Cultures [page 2]
 By Linda Keslar
|
|
|
Many recommendations in the IOM report overlapped with the first set of national standards for cultural competence, issued a year earlier by the OMH. Some of the 14 guidelines which were in those Culturally and Linguistically Appropriate Services (CLAS) standards have been incorporated into federal mandates. For example, any medical facility that receives federal dollars must provide language assistance to patients who have limited English proficiency. Other initiatives, recommended though not yet required, include recruiting a diverse staff that mirrors the local population, and developing strategic plans for providing culturally and linguistically appropriate services. Beal terms the CLAS standards “a good starting point,” but thinks they are too vague—for example, one standard recommends that health care staffs undergo cultural competence training but does not provide specific advice about the content.
Meanwhile, racial and ethnic disparities in health care remain, and threaten to mushroom. U.S. minorities, who now constitute 33% of the population, could grow to account for more than 50% by 2050. Already, roughly 20% of the U.S. population speaks a language other than English at home, and a growing number has limited proficiency in English. Against this backdrop, implementing comprehensive cultural competence strategies is a mammoth task. “People are just beginning to understand that this is about more than addressing language barriers,” says Joseph Betancourt, director of the Disparities Solutions Center in the Institute for Health Policy and director of multicultural education at the Massachusetts General Hospital (MGH). “Cultural competence has moved from the margins to the mainstream, but we’re still in a learning mode.”
Much of that learning, as well as many answers to questions about cultural competence, is being formulated hospital by hospital, with solutions designed to address local conditions. In Dearborn, Mich., Oakwood Hospital & Medical Center serves an area in which people of Middle Eastern ancestry, including many recent immigrants, make up more than 40% of the population. To serve them, Oakwood has built a stable of medical interpreters conversant in Arab dialects and trains its practitioners to recognize issues that may arise in treating patients unfamiliar with American medical practices. The hospital, which is hiring an increasing number of doctors and nurses of Arabic descent, holds health outreach programs in local mosques and other community centers and serves such Middle Eastern foods as hummus and halal meats prepared according to Islamic law.
“Many of our patients come from a non-Western mentality,” says Rose Khalifa, clinical educator in transcultural services at Oakwood. “They don’t know how medicine is practiced here, so a lot of education must go on.” Learning happens on both sides of the bed as staff seek to understand and accommodate patient requests—for example, moving the bed of a dying man to face Mecca so that his soul will exit in the direction of the Muslim Holy Land, and discussing the man’s end-of-life options with his eldest son, who is responsible for making his father’s medical decisions, a common practice in Arab culture.
Khalifa, a nurse and practicing Muslim who is fluent in Arabic, may be called in to help, for example, when a Muslim woman in labor refuses to be examined by a male physician. In these and other situations in which language, religion and cultural beliefs erect barriers, she can sometimes influence a patient’s care. “There’s an inherent comfort zone when these patients see I’m from their community,” she says.
Often, immigrants arrive with significant health issues and are thrust into a medical system they don’t understand. “They may come from a third-world country with a serious lack of health education, poor diets, no exercise and heavy smoking—all major health risks,” says Bruce Nelson, director of community services at Glendale Adventist Medical Center, which serves an area in Southern California in which people of Armenian descent comprise almost a third of the population.
|
Next page | Pages: 1 2 3 4
Photographs by Erica Berger |
|
|
|
