In all professions, but especially in the realm of health care, intercultural communication is paramount to developing a good relationship and an optimal outcome for the patient. If a patient is uncomfortable with their health care provider, or has reason to believe that they are being judged negatively by the doctor or nurse, they may be hesitant to disclose all information that is necessary for their recovery. The importance of communication skills becomes even more crucial when the health care provider is in a situation in which he or she is dealing with a member of a culture different from their own.
The examples of Dr. Paul Farmer, the multiple health care providers at the Addis Ababa Fistula Clinic in A Walk to Beautiful, and the examples I found in my own research on health clinics in Appalachia provide many salient illustrations of good cross-cultural communication. As all of these examples illustrate, it is important for a health care provider to be empathetic, nonjudgmental, and open to their patient’s needs, whatever their culture of origin may be.
In the 2009 book, Mountains Beyond Mountains, which details Dr. Paul Farmer’s work with indigent patients in Haiti, the reader can witness many examples of the special gift Dr. Farmer had for connecting with his patients. While other Americans, namely the soldiers who were dispatched to the conflict in Haiti in the early 2000’s, tended to ascribe every health-related behavior of the Haitians to “voodoo” beliefs (Kidder 6), Dr. Farmer refused to stoop to this level, and instead related to all of his local patients at the clinic on a friendly, equal basis. One example of outstanding intercultural communication on Dr. Farmer’s part occurs when he is interacting with a Haitian nurse. As Kidder describes the scene, “Farmer smiles at her, making the Haitian hand slap, the back of one hand into the palm of another” (25). The examples that Farmer provides highlight the importance of learning local customs and etiquette when working as a health care provider in a different cultural zone. Even small gestures, such as a local form of a hand slap, can go a long way towards making a patient feel respected and at ease with a foreign health care practitioner.
In the 2007 PBS documentary, A Walk to Beautiful, we learn of the heartbreaking stories of several Ethiopian women who suffer from uterine fistula. As a result of their condition, these women are often ostracized and cruelly marginalized by members of their own rural villages and even their own family members. The British doctors at the Addis Ababa Fistula Clinic treat these women with extra care and compassion when they arrive at the clinic, often having traveled for hundreds or thousands of miles from rural villages in Ethiopia. Amazingly, as the documentary describes, when rural Ethiopian women seek treatment for their fistula at their own national clinics, they are often turned away because they have a bad smell, or because of urban prejudice against rural villagers. These local prejudices, as well as the conditions which these women have had to face in their own society, must be very difficult for a Western-based physician to comprehend. However, the health care providers at the Addis Ababa Fistula Clinic go out of their way to make the women feel welcome and well cared for, regardless of their poverty and rural status. One of the physicians even expresses pride in her ability to provide these women with “a new life” (Smith, n/a).
As I live in West Virginia, I performed outside research on the intercultural communication difficulties that non-Appalachian health providers often face when they service rural clinics that have been established in the Appalachian region. Often, Appalachians have been raised to be self-sufficient, to distrust outsiders, and to be hesitant to share their problems with others. Thus, when a health care provider who is not of the Appalachian culture works in a health clinic, they can face significant barriers in the provision of health care. However, according to the research I performed, the best way to circumnavigate these barriers is to make an appeal to the strong sense of family loyalty that is abundant in Appalachian culture (Slusher 85). After all, if an individual is not in good health, they will not be in good shape to care for other family members.
As the examples of Dr. Paul Farmer, the physicians at the Addis Ababa Fistula Clinic, and health care providers in Appalachia illustrate, it is essential for all health care providers to gain a strong understanding of intercultural communication practices. Often, we will be called upon to provide care for individuals from cultures other than our own. Almost all cultures have strong beliefs about health and the maintenance thereof that are specific to their own milieu, and thus it is crucial to gain an understanding of these nuances prior to working at a clinic in another nation or cultural zone. In the healthcare provider-patient relationship, a sense of trust is essential for the best outcome for the patient, and the physician or nurse who is charged with the responsibility of care would do well to understand this concept. The best way to establish trust is to exhibit a basic understanding of the patient’s culture of origin, and to above all, behave with a sense of empathy and with compassion. When patients pick up on such cultural sensitivity, that alone can go a long way toward their recovery.