Our ability to communicate effectively and compassionately in a multicultural society is influenced by many factors. Our ability to be successful requires us to be diligent and to avoid biases and stereotyped assumptions that colour our perceptions and encumber our efforts. We need to stop assuming we know things that we do not know and must recognize how damaging our erroneous assumptions can be.
Cultural communication challenges do not simply include the crossroads of ethnicities, but also those of social classes, educational backgrounds, belief and value systems, and the human factors associated with language fluency and contextual language comprehension, among others. In order for us to communicate effectively, we need to recognize how we are influenced by our backgrounds and the biases that form our stereotypical perceptions of others. When meeting with patients, we may find it desirable to have a medically aware individual from the patient’s cultural background serve as a resource to enhance communication efforts. The goal is to facilitate clear communication, to build a collaborative basis for working together, and if we lose sight of this then someone might get hurt. The prize is patient safety and improved health outcomes.
Case Study: Recognizing opportunities when unexpected
I was caring for a child with sickle cell anaemia and osteomyelitis likely to require several weeks of hospitalization. The parents, who had recently emigrated from Haiti, were anxious and deeply worried about their daughter. The father was an academic; his wife was much less sophisticated, at least in an academic sense. French was their first language, and even though they both could speak some English, I wondered whether they truly understood the issues at hand. Context is important. I sensed that communication was going to be very challenging.
The family had settled into a closely-knit Haitian community, and I asked the father if there might be someone who could assist me in my efforts to communicate with them. One day the mother returned to the hospital with a man dressed in flowery clothing and wearing a headband that was sprouting two feathers. This man was a traiteur, a local faith healer in the Creole culture noted for combining prayer, the laying on of hands and the administration of herbal remedies as compliments to, or in place of, modern medicine.
I presumed, wrongly, that the traiteur, with his metaphysical beliefs, was going to try to convince the family that what I was saying, and what I wanted to do, was simply not true or meaningful, and that this might interfere with their daughter’s getting well. Turns out that this man, though deeply committed to his own therapeutic approaches, was reasonably knowledgeable about modern medicine and viewed his efforts and mine as complimentary. It was clear to me that the family admired and respected his opinions, so my strategy was to ally myself with him and to align our complimentary therapeutic approaches.
I arranged to meet privately with the traiteur and explained in relatively simple terms the nature of sickle cell disease and the osteomyelitis that this child had and what we were trying to accomplish. I expressed my views that by working together we likely would be successful. The only thing I asked him to do was to share with me the names of any herbal remedies he wished to prescribe. I needed reassurance that nothing “complimentary” might compromise the effectiveness of my science-based therapy.
Moving to and fro across cultural barriers – more permeable than I had imagined – was easy as we were both aligned on achieving the same prize. We were able to work successfully with this family to help them navigate this very challenging time.
My error was that I presumed I knew what actually I did not know. I had approached the initial meeting with the family and the traiteur from a confrontational, instead of a partnering, approach. I had lost sight of the prize because of my own unrecognized intellectual arrogance and biases.
Pause before you speak. Talk, but more important listen, not only to the words of others but also for the heartbeats of understanding, and keep your eyes on the prize!