“You cast a spell on my babies, Doctor. Surely my babies are going to die! Your envious, evil eye, it discloses the wickedness of your heart!” She pulled her twins tight against her chest. “You are an agent of the Devil,” she spewed.
I was stunned at the young Hispanic mother. We were just wrapping up a routine one-month newborn checkup. I found both babies to be vigorous, nourished, and each child wearing a charm bracelet. With an expression of exasperation, I asked the mother, “What did I do wrong? Why do you believe I cursed your babies?”
She fired a distrusting glance at me. “Doctors should know better! You gushed over how adorable are my newborns, and you probed their bodies. But nothing more!” With that the mother stormed out of the exam room.
I looked on in shock and disbelief at the cross-cultural meltdown that just transpired, and I am not alone. A recent survey of physicians who participated in the Healthy Families program found that 71 percent of providers believe that culture and language are important in the delivery of patient care. 51 percent believe that their patients did not adhere to medical treatments as a result of cultural or linguistic barriers.
The challenge of cross-culture and language barriers is a daily reality for us in healthcare. Fortunately in this instance, a nurse practitioner, Helena, also of Hispanic origin, came to my side. “Don’t you understand why the mother is upset?” She queried. “I am simply clueless,” I defended, “I was just providing a normal well-child check.”
Helena shook her head. “Did you complement the mother about her babies?” “Of course,” I responded, “I expressed how lovely they are.” “But did you touch them fondly?” Helena continued. “Touch them fondly? No, of course not.” I said. “I’m a doctor. It’s my job to examine them.”
Helena declared, “You have so little insight into our culture, Dr Comninellis. A touch of tenderness is necessary to communicate genuine affection. Without the touch, you are only expressing jealous envy. You are communicating that you wish the babies were your own or that they would die.”
Again I was shocked at her observation. “So how can I learn such intricacies about people of your culture?” I inquired. Helena’s response was more sympathetic. “You begin with a keen awareness that cultures are indeed powerful. You and this Hispanic women are from very different worlds.” I nodded in hearty agreement. “Next,” she continued, “you observe and seek to understand those differences. Allow extra time to ask Hispanic people their views about health. This will also build confidence and rapport between the two of you.”
“And then?” I persisted. “Then,” replied Helena, “you can adjust your care accordingly. For example, next time you provide a well-child check up, do not only complement the children but pat and stroke them tenderly in their mother’s presence. This will convey your genuine admiration and dispel any suspicions.”
Vietnamese, Afghans, Somalis, Nepalese, Haitians, Native Americans…Do you find it challenging to provide effective health care to patients who are culturally distinct? Apply the process of observing, understanding, and adjusting to cultural differences. Together, let’s progress beyond offering just quality healthcare and on toward providing culturally appropriate care.