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Considering the challenge of diversity

Posted: October 12, 2011

Yesterday morning was a treat – Board member Paul Levy led a discussion of Anne Fadiman’s inspirational book “The Spirit Catches You and You Fall Down”.  Paul had donated multiple copies of the book to JCHE and I gave them out to anyone on the staff who was interested in reading it.   The subtitle of the book is very descriptive, “A Hmong Child, Her American Doctors, and the Collision of Two Cultures.”  The book documents the story of a Hmong child with epilepsy—the doctors at a California hospital who treated her had a care model which was not well understood or accepted by her Hmong parents—and while there were efforts to bridge the cultural divide, they failed.  he child went into a long-term coma and remained in that state at the close of the book.

The staff that participated was from different departments and different professional backgrounds.  The conversation revolved around reflections on how cultural misunderstandings can occur so easily and be so frustrating for both parties.  We talked about the legal framework in which doctors must work—and the ways it constrains simply exercising good judgment. The book described this poignantly. The Hmong family did not follow the prescribed drug regimen because it was too complicated and it was not consistent with their more spiritual response to treating illness. The doctors reported the family’s lack of response as neglect and the child was placed in foster care. This resulted in a classic cultural impasse: the actions of a very loving family collided with the doctor’s need to avoid the risk of not reporting a situation that the state deemed as neglect. We all agreed upon the benefits of having group discussion on how to handle cultural impasses—as a way both to give the individual professional (doctor in this case) and the institution some reassurance about all options having been explored, all issues dealt with honestly.

We realized that this story is not just relevant for medical personnel, but rather is emblematic of the ways it is difficult but imperative to truly communicate—not exclusively through the ways you yourself like to give information, but rather after first trying to understand how the recipient best gets information.  Genuine inquiry is the urgent first step—and must be re-engaged at many points along the way.

We concluded with a hope that as professionals, we all embrace the chance for learning about different people—their unique styles and backgrounds and assumptions—and see diversity (cultural or otherwise) as an exciting challenge rather than a source of stress.

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Comment by Carol Fineblum | 10/13/2011

I tend to disagree. As a long lived diagnostician working with families diverse and oftentimes limited in their native tongue, I have noticed that the family must show an effort to accommodate to the changes in their lives--with willingness and expectation. Often, they want the advantage of living in a western democracy BUT at the same time want to retain only their own cultural traditions and standards. This retards progress and complicates remedy.