Intercultural awareness. A tool for the health professional
- patient relatioship
Eduardo Garbey Savigne
Licenciado en Lengua Inglesa. Profesor Auxiliar
Asesor del Vice-rector de Investigaciones
Vicerrectoría Docente. ISCM-H.
Ciudad de La Habana, Cuba
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.
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.
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
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.
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).
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.
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.
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.
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.
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
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.
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