Intercultural awareness. A tool for the health professional - patient relatioship

Autor: Lic. Eduardo Garbey Savigne

Licenciado en Lengua Inglesa. Profesor Auxiliar
Asesor del Vice-rector de Investigaciones
Vicerrectoría Docente.
ISCM-H. Ciudad de La Habana, Cuba




La sensibilidad intercultural ha sido en estos últimos años un elemento importante en las relaciones con personas de otros países. En la relación entre profesionales cubanos de la salud y pacientes de otros países esto es un elemento primordial para comprender las actitudes y posiciones tomadas en ocasiones. No solo hablar el idioma extranjero, en este caso el ingles, permite desarrollar un correcto entendimiento de las expectativas del paciente en su intercambio con el profesional de la salud. Entender su cultura y ser flexibles es la CLAVE.



Dr. MT. Lopez García, a Cuban medical doctor in a Caribbean English-speaking country is in her consultation office just checking how a middle-class old senior citizen whom she has never met before feels.
She gets very close to the patient, pats his shoulder and tells him with a very soft and tender voice:
OK, Grandpa, What has brought you to the clinic today?
The old senior citizen's reaction is to get far from Dr. Lopez and to leave the room without further explanation.
Some time later, a complaint letter was received at the clinic stating the doctor's improper behavior. The old senior patient declared to have been treated too informally, without much respect, and the line of respect had been violated.
Was this the intention of the Cuban doctor?
Surely it wasn't, but she forgot certain rules when dealing with foreign patients. She just transferred her daily and routine actions while in Cuba to a foreign environment.

The situation, which has been described here, is not simply from the use of traditional healing practice that, most Cubans face when carrying out their internationalist missions in English-speaking countries.

To avoid situations as the one mentioned, the author of this paper has provided some thoughts on the importance of cross-cultural awareness when providing health services to other people from a different cultural background.



To provide the Cuban health professional with enough information to cope with the different situations they face when fulfilling their missions abroad is our main aim. When a Cuban medical doctor or a nurse arrives in a foreign country, he or she brings his or her culture, habits, attitudes and ways of thinking. Therefore, it is vital that they should also be trained in intercultural awareness and be able to tolerate and deal with the different situations he or she might find.
To tolerate means to be flexible and able to understand other peoples' points of view, to understand that there is no a single answer to every situation.
Health care is a social process in which each part, I mean health professionals and patients bring a lot of expectations and beliefs to the meeting. This is also shaped by the different practices they have been used to. Their meeting is a sort of a negotiation where an oral exchange plus a good clinical management will bring the diagnoses and then the medical doctor will decide what to do. That will require the patient shall be willing to cooperate and comply with the treatment and the whole proceedings.
When the health professional and the patient share the same views and practices, this health care process is easier to follow. The problem is when there is a difference in culture, attitudes and beliefs. Then, the negotiation will not get the results expected in the shortest term. When the patient shares the same culture, his behavior is smoother and he cooperates more. But if they share different cultures, then the exchange might be ineffective.
Then it is the health professional's task to try to understand the intellectual, cultural and emotional constraints when communicating and dealing with a patient. The medical doctor or nurse should convey trust and safety through their actions and interventions. These professionals should know what their tones of voice, gestures and non-verbal communication actions must reflect, depending on the patient they are assisting, avoiding the extremes of reactions. Therefore, it is the author's opinion, that health professionals must be culturally aware.
To be culturally aware is to understand those aspects of the human condition that differentiate individuals and groups. These differences, therefore, sometimes affect communication. Communication can not only be achieved through the use of the language. The speaker when communicating should also convey sociocultural meaning. He or she must have what is known as sociocultural competence. This is especially emphasized in our view of sociocultural competence because we consider that "one should be opened to new ideas and yet be embedded in one's own culture ( Pakir, 1999)
It is then assumed that any Cuban health professional working abroad will face three main problems or issues:
One is the lack or command of a foreign language. This makes all health service encounters frustrating and often unrewarding for everyone and the help for the problem in no way meets the need. The second one is the social class or amount of money the patient might have. Usually, most medical doctors are middle or high class and patients expect them to behave as such and the sort of management these patients expect is mostly formal and not a too close and open relationship.
The third problem is the health, social service the foreign country has implemented. Cuban health professionals come from a free-of-charge universal and single public health system, which is not common in the world. That's why the attitude towards public health system is not a narrow view as it has been established in other countries. Public health for Cubans mean not only the public services for health such as water treatment, water disposals, sewage systems or garbage collection, it will also include primary care for promotion and prevention of health, the implemented family doctor scheme and the services provided in hospitals, research and health institutions.
Going back on our earlier point on foreign language, let us briefly refer to the ability of speaking a foreign language.
Not having a good command of a foreign language is one of the greatest handicaps any professional working with foreigners might have. It is not logical that any medical or health personnel working abroad does not speak rather well even one foreign language. It is our opinion that a good and proper health service is provided if the health personnel can speak, at least, one international foreign language with a good command and another with some command of it, specially in the field related to medical-nursing assistance.
How would you expect a patient to trust the health professional if he or she is not able to communicate properly with him? And, how would a nurse reassure or praise a patient if she can't even say something in a lingua franca?
Nevertheless, the fact of speaking a foreign language is not the only aspect for establishing a proper communication with the patient. An adequate cultural awareness is also needed. Paraphrasing what Garbey & Enriquez wrote, "The unknown or misunderstanding of a performance, an answer, a question or even a word might ruin the success of a nursing care".
It has been recognized that English is an international language and also a multinational language used in different parts of the world and learned in these contexts. Therefore, it is undoubtedly, that it has been involved in the process of globalization and internationalization (Pakir, Ann 1999).
As a world language English is rapidly developing into what Pakir (1999) has defined as GLOCAL language, which means that is global but maintains local roots and identities.
This notion of GLOCAL language gives new insights to the learning of English as a foreign language and stresses the need of promoting intercultural awareness. This is the reason why, the focus of our attention is precisely on the sociocultural dimension of communicative competence.
Traditionally, professional training courses have paid little or no attention to the sociocultural component, perhaps because it has been incorrectly assumed that a good command of the foreign language directly leads to the understanding of the foreign culture and the sociocultural values that the linguistic forms carry. However, in recent years, this aspect has received considerable attention and terms such as intercultural communication, cross-cultural communication and cultural literacy have come into play.



Culture is necessary to an effective understanding of language and language is necessary to an effective understanding of culture. We strongly emphasize that people should recognize that cultural diversity exists and as professionals linked to the health sector it is our own task to train our learners to be flexible and demonstrate respect for people as unique individuals and respect for the unfamiliar.
Besides, it is important to make them aware of the fact that language serves both global and local needs, which indicates in Pakir's words that one should be " globally appropriate and culturally relevant".
A deliberate search for the meaning behind patient responses enables the health professional to plan and provide safe and individualized patient care. Language differences between the medical doctor and the patient compound cultural differences between them and can keep the professional from getting at the patient's point of view.



  1. Binon Jean & Marie T Claes. Intercultural communication and Negotiation in a Business Environment. Denmark: Aalborg University Press 1995
  2. Enriquez O'Farill I, et. al. 1995 El desarrollo de la competencia sociocultural en estudiantes de lengua inglesa. Paper presented at Expolingua Habana'95 Cuba.
  3. Hammerly, Hector. 1982. Synthesis in Second Language Teaching . Second Language Publications. U.S.A.
  4. Garbey, Eduardo & Enriquez O'Farril I. La comunicación intercultural en el proceso de negociación. Paper presented in Expolingua Habana' 96, Cuba.
  5. Pakir Ann. English as a GLOCAL language: Implications for English language Teaching Worldwide. 33rd IATEFL Conference. Edinburgh, 1999.
  6. Patrick Maxine, Medical Surgical Nursing. Second Edition. J.B. Lippincott, 1991, USA
  7. Raja T. Nasr. 1972. Contextual and Cultural Orientation. Teaching and Learning English, pp. 152-156
  8. Seelye, Ned. 1984. Teaching Culture. Canada.
  9. Tavares Roseanne and Ildney Cavalcanty. 1996. Developing Cultural Awareness in EFL Classrooms. English Teaching Forum, 34, 3-4 pp. 18-23.


Última actualización: 16 de Mayo del 2002
Copyright © 2001 Facultad de Ciencias Médicas "Cmdte. Manuel Fajardo"
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