Cultural Competence Cultural Brokering Health Care

Why is Cultural Competence so high on the Health Care business priority list?  Is it just a move by some politically correct agenda or is there truly any real benefit? Exploring an example of Cultural Competence at work may help:

A cultural enclave in Texas called the Rio Grande Valley boasts one of the largest Hispanic Communities as it is located so close to the border with Mexico[1].  Health Care Workers are on higher demand if they are bilingual with Spanish as a second language.  This, of course, makes sense because despite the high likelihood of a patient knowing English, when a person is ill, all things familiar become a necessary buoy for mental, emotional, and, consequently, physical health.  Language becomes one such comforting familiarity.  Beyond this, knowledge of the culture of the region can help health care workers in their administration of services. 

For instance, The Hispanic Community of the Rio Grande Valley is largely Catholic in their religious practice.   A patient with a serious infection wound up in the ICU.  Bilingual nurses and orderlies were able to bridge the communication gap between doctors and the patient’s family.  During visiting hours, the grandmother of the patient administers holy water she scooped up from the local Church onto the patient’s IV site, forehead, and in a general mist upon the patient as the grandmother prays.  The patient;s situation gets inexplicably worse, since no one is aware of the grandmother’s activity—the holy water she has gathered is from the basin at the entry of her church where all parishioners dip their hands upon entry. Contaminants in this standing water are profuse and, although harmless to the average parishioner, are harmful to a patient in ICU.  Thankfully a culturally competent lab technician notices new bacterial growths on recent samples and on a hunch sends a request that the patient be monitored during visiting hours. A nurse catches on to what has been going on, and respectfully explains how the holy water in use may not be the best approach for the patient without discouraging prayer and faith.  The explanation is given in Spanish and with deference to what motivated the behavior.  The grandmother was encouraged that her prayers and visits are wonderfully supportive activities for her grandchild, and was asked to perhaps request a fresher sample of water from her priest, a visit from her priest directly, or prayers without the water application.  Such a culturally responsive explanation was heeded, and the patient’s healing speed along.

As the above example has shown, cultural competence can be helpful and may even be indispensible for the proper administration of health care.  Cultural competence is defined by the National Center for Cultural Competence at Georgetown University as:

“Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. ‘Culture’ refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. ‘Competence’ implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.”

 How much of a need is this? Any time differing cultures mix, a more rounded approach must be found to reconcile needs. It may be difficult, at first, to realize how much communication influences perception and thought—but consider the differences between people who share the same language: different fields of study and profession and generation.  Communication marks clear lines of distinction of thought and speech from slang to technical terminology and what are thought to be appropriate responses.  Imagine the difference between linguistic cultures! 

Like disparities within a culture, bridges can be forged here in every respective area in which paths cross between persons with different languages. This is an effort known as Cultural Brokering.  Specifically defined, Cultural Brokering is the “…bridging, linking or mediating between groups or persons of different cultural backgrounds to effect change”[2]

Of immediate concern to any member of society is Health Care and Cultural Brokers can be in high demand. A culturally diverse society can only benefit from responding more appropriately to all populations within the reach of Health Care Services.  Efficient Cultural Brokering becomes a notable goal for health practitioners because it is marked by informed responses to patients that are inevitably influenced by language and culture[3].  Equal dispensation of Health Care Services must meet these challenges with CULTURALLY COMPETANT Health Care workers.  A Cultural Broker can specifically help with developed skills to understand,

(1) values, beliefs and practices associated with illness, health, wellness, and well-being of cultural groups

(2) traditional or indigenous health care networks within diverse communities

(3) medical, health care, and mental health care systems (assessment, diagnostic protocols, and treatment).

For the general Health Care worker, exposure to differing languages and cultural practices builds experience and knowledge for multicultural encounters.  Such efforts breeds Culturally Competent Health Care Professionals who are respectful of and responsive to the health beliefs, practices and response to cultural and linguistic needs of diverse patients can help bring about positive health outcomes[4]. Continuing Education programs with special attention to differing populations’ needs and communication tendencies can be a beginning to more effective treatment for persons of all cultures.

[1] Healthy Valley Magazine

Georgetown Public Policy Institute

[3] Georgetown University. National Center for Cultural Competence

[4] Office of Minority Health