Language Of Healing Not Universal

June 3, 2005
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GRAND RAPIDS — Chicken soup is the cure for the common cold. Or is it echinacea? It depends on where the patient comes from.

In recent years, the health-care system in West Michigan has been learning to deal with a growing number of patients who speak different languages, come from different cultures, and have widely varying views on the concept of health care. And, as providers help patients navigate the complicated health-care system, it becomes clear that cross-cultural communication means much more than speaking the same language.

“Every year, we’re losing about 100,000 patients to early death because of miscommunication, misunderstanding, not being aware of their cultural needs. Now, we can’t cut out the whole figure, but we can reduce it to about 20,000,” said Dr. Gottfried Oosterwal, director of the Center for Intercultural Relations and an expert in cross-cultural communication. Oosterwal spoke last month at a Spectrum Health educational seminar entitled “Cultural Competence in the Workplace.” His message was simple: Understanding a variety of languages and cultures leads to healthier patients and stronger health-care systems.

However, teaching an organization to understand the cultures it serves is not an overnight process. Oosterwal suggested that health-care providers set up diversity committees to provide ongoing instruction in cultural differences. But before people can understand other cultures, Oosterwal pointed out, they must understand their own. The first step he takes people through is a deconstruction of their own culture. In understanding how one’s own preconceived notions work, an individual can more easily view the world from another perspective.

That is absolutely essential for cross-cultural understanding, said Michelle Scott, a registered nurse and president of Voices For Health Inc., a Grand Rapids-based firm specializing in language and culture solutions. Scott warned that when organizations teach cultural awareness by focusing on common tendencies among different groups of people, they can unintentionally encourage stereotyping.

“You can’t predict behavior by culture,” she said. “In the medical field, we’re very fond of our checklists. If we have to diagnose something, mentally we’re going through a decision tree. ‘Cough? Yes or no. Runny nose? Yes or no. Congestion? Yes or no.’

“I think when we have these ‘All You Need To Know About Hispanics’ — or Vietnamese or Muslims or whatever — we’re so much in that process that we go, ‘OK. Vietnamese? Yes. Woman? Yes.’ And then we kind of make this checklist that we think is going to guide our practice. It just doesn’t work that easily.”

Instead, Scott said, the process of communicating across language and cultural barriers is an intricate coordination of efforts between the patient, the doctor and, when necessary, a medical interpreter.

“It’s a lifelong learning process,” she said. “It starts with having an openness to all cultures. You have to walk into that room with that Muslim patient and set some of your assumptions aside. You have to walk into that room with that Hispanic patient and set some of your assumptions aside. You have to treat them as an individual and try to meet their needs.”

Learning to bridge the gap between cultures is not simply an exercise in humanitarianism. It’s a question of “the hard dollar,” according to Oosterwal.

Take the example of Lee Memorial Hospital in Dowagiac. The hospital was dealing with a dangerously low occupancy rate of 42 percent and facing the possibility of closing its doors. Administrators were struggling with ideas to reinvigorate the hospital. They suggested bringing in more highly trained, qualified specialists. Oosterwal suggested that the staff brush up on its cultural competence.

He arranged an intensive three-week training session, focusing largely on the area’s sizable Latino community. After the training period, Oosterwal said, the staff knew that a pregnant Mexican woman needed cold foods — and that “cold” has nothing to do with temperature, but instead with a cultural system of food ranking. Nurses understood that an ill Guatemalan man in the intensive care unit required the company of his family. They brought in mattresses so the relatives could be by his side. Before long, Lee Memorial became known as the pre-eminent hospital in the area serving the Latino population.

“One Spanish-speaking person tells another, ‘That hospital, they’re buena gente — they’re good people,” Oosterwal said. “So they don’t go to Berrien County Hospital. They don’t go to Hartford. They don’t even go to Spectrum. All of them go to Lee Memorial.”

The occupancy rate jumped from 42 percent to 72 percent.

The hospital discovered that simple measures to better serve its patient base could result in drastically increased revenue.    

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