Cultural sensitivity in clinical practice

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Monday, March 3, 2014


IT WAS the wee hours past midnight. I was awakened by the alarming siren of the ambulance that seemed permeable even among the thickest of the layers of wall separating my quarters to the emergency-triage room.

I knew then it was a sign telling me to rise from a privileged slumber that I was so deprived with just like any doctor, nurse or midwife rendering an on-call duty way past office hours.

Already in scrub suit, I hurriedly headed the receiving area to check the patient needing healthcare.

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It was a pregnant woman in her early 20s and she was enduring probably the worst pain any woman could bear -- labor pains.

After some preliminary assessments, I realized she was speaking in a language beyond my comprehension: she was a Maranaw.

Adding to the challenge, she had not brought her prenatal record, could only speak few Tagalog words and was brought by her “platoon” of “watchers,” who were all her relatives but had conflicting stories as far as the medical and obstetrical history of the patient was concerned.

These watchers have somehow flooded the waiting area and occupied all the seats despite the fact that at most, per patient was only allowed to have two watchers as health facility policy applies.

One of the staff who was with me got piqued over the idea that these watchers, who were clearly deviants to her eyes, had to wrestle with the reasons as to why they all had to invade the area to a significant extent of depriving the watchers of other potential patients.

Realizing that the patient was in the advanced stage of labor and would have delivered anytime soon, we quickly brought her to the delivery room table.

Our assessment of the patient was still on-going and after further probing, it was found that she has had a history of hypertension in pregnancy.

Our physical assessment also revealed that she had been using liniment oils thinking that it could at least soothe her aching labor pains.

The scent of this liniment oil was somehow offensive to one of the midwives on-duty that she started raising questions on the scientific bases of the said liniment oil.

To cut the story short, she fortunately delivered her baby under normal vaginal birth and had not developed any complications at all as of writing.

It is but inevitable that healthcare professionals encounter patients with diverse socio-cultural backgrounds in day-to-day clinical practice.

The reality holds that most often the patients coming to the health facility do not just present different signs and symptoms but also manifest a broad range of cultural beliefs and practices that impact his or her health in general.

An extension of this reality is the fact that these cultural spectra can be a powerful force that either facilitates or hinders the access or delivery of quality health services by the service provider to the clients or patients.

In short, a potential barrier is formed once differences are encountered on the grounds of withheld cultural beliefs and practices.

You may think of this barrier like an imaginary wall that separates the healthcare professional and patient in some psychic or cognitive plane of existence.

Worst, cultural ignorance causes a healthcare professional to be dysfunctional in the delivery of quality healthcare services.

As in my encounter, for instance, the initial reactions of the healthcare providers are just a minute testimony of my propositions: that healthcare providers may possess reservations in rendering health services to patients of foreign cultural origin.

The first staff in my story, for example, did not understand that in Muslim culture, strong family bond is a highlighted feature that members of the family support each other in times of need like hospitalizations and deliveries.

Secondly, differences may lie in cultural health practices and these must not be challenged but instead an alternative should be reached in a win-win solution.

To be such means not just to empathize with the patient but also to adjust to his or her needs including those that are culture-bound.

As in the case mentioned, the healthcare professional is obliged to use a neutral language -- Tagalog or English -- in order to communicate effectively with the Maranaw patient.

Respect for the cultural practices of patients is the key to cultural sensitivity and it sets the culturally competent healthcare professional different from the rest.

[Email: polo.medical.sociologist@gmail.com]

Published in the Sun.Star Cagayan de Oro newspaper on March 04, 2014.

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