by Mamta Karani, Pharm.D., PGY1
Pharmacy Practice Resident, University of Maryland Medical Center
In
2008, I had the life-changing opportunity to volunteer at a medical mission
camp in Bidada, Kutchh, India. The Kutchhi people lived in a rural, desert area
and travelled over 100 kilometers to get medical care at the Bidada Sarvodaya
Trust Hospital. Health care practitioners and volunteers flew in from all over
the world to provide care for these patients. For some volunteers, this was
their fifth trip. For others, like me, this was our first.
During our trip, we had multiple opportunities to educate and
provide medical services to the Kutchhi people, a population with a different language and culture than ours. This experience
sparked my interest in teaching because I was assigned to teach these patients
about how to properly use the medicines that we were dispensing. Patients would
quietly wait in line while I read a piece of paper and filled medications in a
little plastic bag. I learned how to say “take it once a day” in Kutchhi and give
other simple instructions on the proper administration of the medications. However
when patients were prescribed over five medications to take on a daily basis, I
really had to reassess my methods to make sure they understood what I was
saying. In an attempt to help patients
remember, I learned how to write the
directions. After I’d given written
instructions, I would ask the patient to teach me regarding the proper administration. However, when checking the
patient’s understanding of the regimen, I'd often get a blank stare. I had
explained the directions and wrote
them out, why hadn’t the patient understood? I learned the language, collaborated with the
local people, and provide both verbal and written instructions. What went wrong?
When
addressing cultural differences and learning how best to effectively
communicate, knowledge is key and understanding the audience is vital.1 As in any teaching plan, we need to:
- prepare by performing strong background research
- actively teach, learn to adapt, keep an open mind, and be patient
- evaluate and make changes when necessary
What
is the preferred style of the communication for the audience? Are the
communication preferences similar or different from our own? In the United
States we tend to be low-context communicators — meaning we speak directly. In
some cultures, people prefer high-context communication which involves speaking
in conceptual terms to get a point across. In
general, high-context communicators find nonverbal messages and gestures equally
if not more important than what’s verbally stated. Building a good relationship contributes to the
effectiveness of communication over time; and indirect routes and creative
thinking are important. In the Navajo culture, for example, if I told a
patient that his/her poor blood sugar control might one day lead to a limb amputation
if he/she doesn’t take the prescribed medications, the patient may feel
insulted and disrespected. Rather, if I
created a story of how a person with high blood sugar required an amputation
after not receiving treatment, the patient would be more motivated to learn and
intuit the importance of adherence with treatment.
Does
the audience believe in individualism or in communitarianism? Do members feel
like they each are entitled to make their own decisions or are decisions driven
by society and/or family. Understanding
this concept is vital to gaining the respect and trust from the individual and
community.
What is the audience’s baseline knowledge? Are they well educated regarding health
issues? Have they ever attended school? What is their level of literacy? Can they
read? Learning the answers to these questions up front is really important to
making certain the audience can understand our take home messages. As I learned, this was one step I neglected to
research.
After having the baseline research, how can we overcome language and cultural barriers? Intercultural trainer, Kate Berardo, states we should:2
- Speak slowly and clearly. Even if the patient speaks some English, its hard to digest complex instructions. If using a translator, simplify your statements and questions — discuss one issue at a time.
- Ask for clarification. If someone asks questions, assess if you have answered the question and do not make assumptions.
- Frequently check for understanding. Engage the learner by asking open-ended questions to see if your message is coming across as intended.
- Avoid idioms. Idiomatic phrases and slang terms that are well understood in one culture, may not translate or make sense to someone in another culture. Avoid them. Provide examples of things they might be familiar instead. For example, when educating someone about diet, talk about foods that are commonly eaten in that culture. Teaching vegetarians to increase their protein intake by eating meat would be insensitive. Rather teaching vegetarians to increase their protein source by consuming more legumes and beans would be more effective.
- Be careful of medical jargon. Use simple terms. Although as practitioners we may be comfortable talking about hypertension, diabetes, condoms, etc, using these terms may confuse or even insult some patients. Consider using simple terms like high blood pressure, high blood sugar, and safe sex practices to get your message across.
- Be patient and attentive. They are trying to understand us as much as we are them.
References
1. Cross-cultural
communication strategies.
International Online Training Program on Intractable Conflict. Conflict Research Consortium, University of
Colorado. Accessed on: December 15, 2012
2. Berardo K.
10
Strategies for Overcoming Language Barriers. The Culturosity Group, LLC. Accessed on:
December 15, 2012
3. LeBaron M.
Communication
Tools for Understanding Cultural Differences. Beyond Intractability. Accessed on:
December 15, 2012
4. HubPages.
Identifying
and Overcomign Communcation Barriers.
Accessed on: December 15, 2012
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