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| 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 4]
 By Linda Keslar |
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But the challenges go far beyond funding. Training is a major problem, and while there are standards for training in medical schools, there’s a movement toward establishing mandatory requirements for cultural competence training, including as part of continuing professional education. Yet defining what skills are necessary and how they should be integrated into the curriculum remains an open question. Educational initiatives vary widely, says the MGH’s Betancourt, who is working to devise a more intensive cultural competence curriculum at the Harvard Medical School, where he is an assistant professor of medicine. Most cultural competence training amounts to brief sessions ranging from a few hours to a day—far too short, Betancourt says, to affect how health care is delivered. “Cultural competence should be embedded in our teaching, rather than addressed in a single, separate course,” he explains.
Another concern is that cultural competence efforts, designed to integrate diverse ethnic and racial groups into the health care system, could end up reinforcing stereotypes and isolating minority populations. But Garth Graham, deputy assistant secretary for the OMH, thinks the risk of doing too little outweighs the risk of doing too much. “Cultural competence should be about understanding,” he says. “It’s about learning more, not less, and integrating what you know about your patient and your patient’s background into clinical care.”
 Dossier
1. The Spirit Catches You and You Fall Down, by Anne Fadiman [Farrar, Straus and Giroux, 1997]. This account, of a child lost between two ways of healing despite heroic efforts by everyone involved, has become an icon of the cultural competence movement.
2. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, by the Institute of Medicine [The National Academies Press, 2002]. Landmark analysis of health care disparities affecting racial and ethnic minorities that found evidence of health care providers’ stereotyping and biases as contributing factors.
3. “Language Barriers to Health Care in the United States,” by Glenn Flores, The New England Journal of Medicine, July 20, 2006. Analysis of research revealing that hospital patients with limited English proficiency are at risk for poor and sometimes life-threatening care.
4. “Cultural Competence and Health Care Disparities: Key Perspectives and Trends,” by Joseph R. Betancourt et al., Health Affairs, March/April 2005. Discusses how cultural competence is emerging as an important strategy to address health care disparities in managed care, government and academia.
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Photographs by Erica Berger |
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