CR #2: Can we be all-knowing of one’s culture?

Before reading this week’s reading, I was familiar with the concept of cultural humility but never cared to distinguish it from cultural competence. Tervalon and Murray-Garcia describe cultural competence through a scenario where a nurse assumed she understood a patient’s pain because she “knew” about their culture. She treated a patient based on a stereotype that she had learned in her past when in reality, pain level is based on the individual and not their culture. Cultural competence is to know about one’s culture, however, the real question is, can we be all-knowing of one’s culture? More so, Tervalon and Murray-Garcia explain that “cultural competence in clinical practice most reflects not a lack of knowledge but rather the need for a change in practitioners’ self-awareness and change in their attitudes.” (Tervalon and Murray-Garcia). There is no end-point in cultural competence for there is always more to learn, however, it’s the ignorance of not wanting to learn or the self-belief that we already learned enough.

This inquiry brings about the concept of cultural humility which is defined as incorporating “a lifelong commitment to self-evaluation and critique, to redressing the power imbalances in the physician-patient dynamic, and to developing mutually beneficial and non paternalistic partnerships with the communities on behalf of individuals and defined populations” (Tervalon and Murray-Garcia. With cultural humility, it allows a person to humble themselves and come to the realization that they will continually learn about one’s culture. Additionally, recognizing that the structural and hierarchical inequalities and taking action on those imbalances are also important concepts to cultural humility. One of the main power dynamics that this addresses is the physician-patient dynamic being that many care providers often assume that they fully know and understand their patients. Often times, patients feel as though they are looked down upon or not having their voices be heard because of mistreatment by their provider which is usually lead by this patriarchal power imbalance. Many institutions choose to recognize these issues. For example, the clinic that I am working at decided to do a training on cultural humility for all of the providers working at the clinic. All institutions need to take accountability for the practices that they put in place and work toward a better environment.

Another reading this week in the New York Times shows that power imbalances that many individuals have experienced. Verghese, the author of this article did an amazing job with thick descriptions and painted a vivid picture during his time serving in a refuge site after the destruction of Hurricane Katrina. He writes in such detail that you are able to clearly picture it in your head, for example he describes clearly his patient as a “man in his 70s with gray hair and beard came in looking fit and vigorous” (Verghese, 2005). Along with other description by Verghese, I think these are great examples of how our field notes can be written. One of the great ways he used direct quotes to show the power imbalances was while he was caring for the same patient. His patient described a scenario in which he was waiting to be rescued and said, “Doc, they treat refugees in other countries better than they treated us” (Verghese, 2005). This is something that is really powerful and putting in a direct quote shows the raw emotion that this patient might be feelings. From this quote I understand that the patient is feeling frustrated and abandoned.

Some of the strategies that I hope to use during my service learning at the Ritter Center are writing detailed descriptions of the clients and the staff. Often I can easily describe the mood or vibe of a situation or a vibe that is created by another person. I think I could easily pause, take-in, and observe everything that is surrounding me. I am usually a people watcher and I love to observe behaviors and how people think and function. However, it might be a bit hard for me to listen to people and interpret what the meaning is. I think the hardest tool for me to use would be direct quotes because in a food pantry people want to get their food and leave. Many people don’t want to have a conversation nor do they trust to speak to someone even if it’s a surface conversation. However, I believe that I can easily listen to conversations that are happening around me and I know I can learn a lot by a situation with just a simple sentence or reaction.