Friday, August 10, 2012

Cross-Cultural Communication


Last week I attended an End-of-Life Nursing Conference (ELNEC) and heard several excellent presentations regarding care for patients who are in the final stages of life.  One of the sessions dealt with cultural considerations.  I have posted blogs before on matters of cross cultural communication. Sometimes it has been in regard to interfaith dialogue, sometimes it has been on matters of immigration. The crucial fact to consider is that more and more we are living in a pluralistic society and communication across cultures is becoming more and more important.

During that ELNEC session on Cultural Considerations, we were given a model for cross cultural communication. I thought it was a good model that could actually apply to other fields than just healthcare. The model is taken from an article in The Western Journal of Medicine (1983), “A teaching Framework for Cross-cultural Health Care," by Elois Berlin and William Fowlkes. (You can read the entire article here). 

Berlin and Fowlkes use the acronym L-E-A-R-N to outline their model:

     L  -Listen with empathy and understanding for the patient’s perceptions of the problem
     E  -Explain your perceptions of the problem
     A  -Acknowledge and discuss differences and similarities
     R  -Recommend treatment
     N -Negotiate agreement

The starting point in cross cultural communication should be to realize that there are differences between cultures in terms of customs, values, interests, needs and priorities. We in the dominant culture should never assume that our way of seeing things is the best, especially for someone who is coming from a different culture.  For true communication to take place, we must indeed listen and try to understand the other’s perspective. 

In matters of healthcare there may be a treatment that the healthcare provider sees as beneficial, but there may be some aspect of the treatment that is misunderstood by (or even offensive to) someone coming from a different background. It is crucial for the healthcare provider to understand where the patient is coming from in order to explain why a particular treatment is recommended. It is also important to realize that our way may work just as well if it can be accommodated to their cultural practices or preferences.

I can see this as an important model for any cross-cultural interaction. Today more than ever we need to let down our barriers and defenses and truly listen to those from other backgrounds living among us. I can also see this model being beneficial when we are talking in terms of politics, lifestyles, and community action. Might we use this model in the so-called "culture wars" in the U.S. that we see referred to so often in the media? We must at some point lay down the polarization that comes when people insist that their way is best and no other way is acceptable.



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Wednesday, August 8, 2012

Wednesdays with Dorothy: The Life Story Project

(This is part of a series. For Table of Contents go here)
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The telephone rang early one evening.

“Charlie, was that you that tried to call me just now?”

The voice on the other end of the line was that of my friend, Dorothy Burdette. “No, it wasn’t me, Dorothy.”

“Well – a while ago the phone rang and I couldn’t get to it right away, so by the time I got to the telephone they had hung up, and I just wondered if it was you, Charlie.  How’ve you been doin’?”

“I’m fine, Dorothy, how are you?”

“I’ve been doin’ pretty good, but you won’t believe what happened to me today, Charlie.”

Dorothy then began to recount some of the highlights of her day.  By the time we were through chatting, we had arranged a time and a day to meet together for lunch. I thanked Dorothy for keeping in touch. It was her usual way of beginning a phone conversation, on the idea that perhaps a call she missed might have been me. I don’t know if this was just her way of finding an excuse to call, or if it was her way of easing into a conversation, or if a missed phone call just reminded her of her desire to talk to someone. I always found it amusing, and it was a technique that worked well for her.

Dorothy had been living on her own in her little apartment for years. When I drove up to her three unit brown brick apartment house, she was sitting on the front porch waiting. We went inside for a few minutes. She had a small “shotgun style” apartment with a font room that served as her bedroom and living room.  Straight back from there was a small pantry that had a couple of cabinets and a table where she could sit and eat. The room then opened on to a small kitchen. She always kept he apartment meticulously neat and tidy.

The Joys of Coffee and Shopping

After we decided where to go for lunch, I knew that our visit would end with a trip to the supermarket so that Dorothy could pick up some grocery items. Her shopping would always include packs of toilet paper, boxes of crackers, and some bags of candy, though she also loved to keep fresh fruit on her table. Coffee was another necessity. She treasured her morning ritual of awaking to make a pot of coffee which she would savor either at her small kitchen table or in her chair on the front porch. Once she told me about a church social she had been invited to, describing all kinds of great food and friends gathered round, then ended her account of the night with a despondent expression saying, “And they didn’t even have no coffee!”

Shopping was a great joy for Dorothy, having spent so many years in an institution and being unable to go out on her own to shop for anything.  She was now in her elderly years and relied heavily upon friends who could drive her to places she needed to go. In her early days of independent living, however, she walked to several places in her neighborhood to do her shopping. She told me once, with remarkable candor, about one of her early shopping experiences at the little neighborhood grocery store named Milton’s.

“I was doin’ some of my shopping at Milton’s Grocery and I saw some air freshener that I wanted. I didn’t know if I had enough money for it so I thought I was goin' to be smart and get out of there without payin' for it. I put it in my bosom before I got up to the checkout counter with my groceries. Mrs. Milton was ringing up my bill and she said, ‘Dorothy, what’s that you’ve got in your dress?’

“I said, ‘I ain’t got nothing in my dress,’ but she kept on and said she knew I had something I was hidin’ so I finally took it out and when I looked at it, it wasn’t even air freshener! It was one of them things put in a bird cage! I didn’t have no use for that anyway.”

So Dorothy learned early that you must pay for what you get, and to look more closely to distinguish between air freshener and cuttlefish bones.  Fortunately, Mr. and Mrs. Milton who operated their little grocery were members of the community, knew Dorothy well, and they could all laugh about it with no hard feelings.

Initiating the Life Story Project

On this particular day, after going out to lunch I took Dorothy to do some shopping at Publix. Publix Grocery was on the other side of town and it was a rare treat for Dorothy to walk its isles. She might find something unusual to go with her coffee. It was on a day like this that I posed the question to her about writing down her life story.

“Dorothy, I often hear you talk about your life growing up in Sylacauga and then at Partlow State School.  How would you feel about taking some time to sit and talk about your life so I could record it on tape? Then we could get it written down on paper.”

“Oh, yes!” was her immediate reply, “You can come by anytime you want to and I would be glad to tell you all about it!”

So that was how we set out to record Dorothy Faye Burdette’s life story. Next week I’ll share about the first time we sat together with a tape recorder and Ms. Burdette told of her beginnings, and of a life of poverty, sorrow and abuse which eventually unfolded into something she could celebrate.


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Monday, August 6, 2012

Monday Music: Aerial Boundaries


When my wife and I had been dating for about three months, I bought her the 1984 Windham Hill Sampler. To this day, it is one of my favorite recordings. I am sure one of the reasons for my fondness toward it is that we listened to it during those early days of courtship, but it is also full of great music. One of my favorite tracks on that album is “Aerial Boundaries,” by the late Michael Hedges. Hedges was a true genius at his craft. His first two albums, Breakfast in the Fields, and Aerial Boundaries were ground-breaking events in acoustic guitar music. Hedges used various alternate tunings for his songs, and a number of techniques including slap harmonics to achieve his unique style.

Here is Michael Hedges' Aerial Boundaries:







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