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Cultural Competency

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Bassem Azkul

on 27 October 2015

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Transcript of Cultural Competency

Mission Statement

Construct a medical and psychological assessment in a culturally sensitive fashion using negotiated approach in clinical care
Recognize and appropriately respond to verbal and non verbal communication
Form and maintain a therapeutic alliance

Work with family members, interpreters, other health care professionals,community and religious leaders, complementary medicine and folk healers
Examine our own beliefs and biases
Consider the culture dimension and the cultural shock when working cross-culturally

Age specific(Infants, children, adolescents, adults and older adults
Low income
Homeless persons
Migrants workers
Persons in specific occupations
Gays and lesbians
Persons with developmental disabilities
Persons with addiction problems
Persons who are incarcerated

What do you think caused your problem?
Why do you think it started when it did?
What do you think your sickness does to you?
How severe is your sickness? Do you think it will last a long time, or will it be better soon in your opinion?
What are the chief problems your sickness has caused for you?
What do you fear most about your sickness?
What kind of treatment do you think you should receive?
What are the most important results you hope to get from treatment?
Culture Shock

"People of different religions and cultures live side by side in almost every part of the world, and most of us have overlapping identities which unite us with very different groups. We can love what we are, without hating what – and who – we are not. We can thrive in our own tradition, even as we learn from others, and come to respect their teachings."
—Kofi Annan, Former Secretary-General of the United Nations
Eliciting an Explanatory Model
Old culture
New culture
this goes with knowledgs slide 18
A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.
Cultural Competence
CDC/NPIN, Adapted from Terry L. Cross et al,. 1989
Multiculturalism in the US
Selected at-risk groups
1-Society of Teachers of Family Medicine Task force on cross-cultural Experience Like, MD, Steiner, MD and Rubel PhD(Fam Med 1996;28:29 1-7)
2-Stuart, PhD and Lieberman, MD Bathe Prim Care Companion J Clin Psychiatry. 1999 April; 1(2): 35–38.
3-A Teaching Framework for Cross-cultural Health Care—Application in Family Practice Berlin, PhD and Fowkes, MD West J Med. 1983 December; 139(6): 934–938
4-Kleinman’s Explanatory Model of Illness: Cultural Competency: A Case-Based Approach to Training Health Professionals
Published Online: 27 APR 2009
5-CDC, National Prevention Information Network
6-National institute of Health
7-UNH website
8-American Nurse Association
Family Health Center, Concord Hospital
10.9% active refugee patients
Four Stages of
Competence Model

-How important is culture awareness?
-Do we really need to change the way we do things?
-Do we have biases towards certain groups?
-Are we aware of these biases?
-How can we be more open to groups holding a different set of values then ours?
18 y/o woman, with Bipolar disorder. Lithium was suggested as a treatment option.

A 76 y/o homeless man sleeps in his car, just moved from Connecticut, was offended when the homeless shelter idea was introduced.

How do you translate emotions and suffering when you face communication barriers?

Clinical Scenario
You are here!
Costume and Food
Personal identification
Language and
Values and
Thoughts and
You are still here!
NIH, Adapted from Terry L. Cross et al., 1989.
Group Discussion
Group Discussion
-came to the US 8/2009
-lives alone in Concord
-daughter in Manchester
-her mother is sick in her home country
-no tobacco or alcohol use
-family members forced to flee to Mozambique several years ago, then moved to Tanzania, then forced to return to Burundi
GK, is 69 y/o Burundi
refugee , comes to the clinic several times with different providers with extensive work up. She has complaints of:
-whole body aches
-stomach pain
-headache and constipation for several months
We used the Language Bank to assist in communication.
Background Information
Clinical Scenario
Where can you go from here:
Where can you go from here:
Elements of Culture
Reflection on Our Own Attitude
We call everyone who walks through door "patient!"
One size fits all "Gown"
The "Vital Signs"

It is common sense!
" Sounds like a plan"
Old culture
New culture
Culture Shock

Hospitalist and Family Physician
Concord Hospital
Cultural Competency
Bassem Azkul,MD

1- Define culture and cultural competence

2- Reflect on our attitudes and knowledge when
working with patients who come from non-prevailing cultures

3-Re-examine our approach as health care providers in cross-cultural situations
Acculturation, Based on Berry (1980)

Asian/Pacific Island-Americans
Native American/American Indians/Inuit
West Indian/Caribbean-Americans
Middle and near Eastern-Americans
Northern, southern, western, and eastern European-American
Different ethnic racial and
national back grounds
Professional groups
Political groups
People with addiction
Homeless groups
Incarcerated groups
Groups with certain Sexual orientation

24 counties involved worldwide
major resettlement countries include Canada, Australia, China, France, Germany, UK and US
In 2012 58, 000 refugees admitted to the US, 365 settled in New Hampshire
Refugee Settlement Program

Demographic change
NH-DHHS website
in 2005, one third of NH population was aged 50 years and older
This number is expected to increase as a result of the aging of the "Baby boomers"

NH-DHHS website
NH-DHHS website

The University of New Hampshire is the state’s public research university, providing comprehensive, high-quality undergraduate programs and graduate programs of distinction. Its primary purpose is learning: students collaborating with faculty in teaching, research, creative expression, and service. UNH has a national and international agenda and holds land-grant, sea-grant, and space-grant charters. From its main campus in Durham, its college in Manchester, and the UNH School of Law in Concord, the University serves New Hampshire and the region through continuing education, cooperative extension,
outreach, economic development activities, and applied research.
UNH is distinguished by its commitment to high quality undergraduate instruction, select excellence in graduate education, relatively small size, a location in a beautiful and

rich part of the seacoast of New England and a strong sense of responsibility for this special place, a commitment to serving the public good, and our emergence over the past decade as a significant research institution. The dedication of our faculty to the highest academic standards infuses all we do with the excitement of discovery.
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