Cultural Competency and
Professionalism
Professional Ethics and Obligations
The Lebanese Code of Medical Ethics states:
• Article 27:
1. A Physician, when providing medical care to a patient, must treat him/her with
humanity, compassion and integrity, and take good care of, and give attention to, the
patient
2. If a Physician accepted to provide medical care to a patient, he/she must ensure his/her
continuing treatment, either himself/herself or in collaboration with a qualified person,
in a fully careful manner and with live conscience, according to the most recent
scientific findings the development of which should be followed-up by the Physician
‫الفصل الثاني‬- ‫واجبات األطباء نحو المرضى‬- ‫أحكام عامة‬
٢٧ ‫المادة‬:
1. ‫ وأن يحيطه بالعناية واالهتمام‬،‫على الطبيب خالل معالجة المريض أن يعامله بإنسانية ورا ٔٔفة واستقامة‬.
2. ‫موهل وذلك بكل دقة وضمير حي‬
ٔ ‫ يلتزم بتا ٔمين استمارر معالجته سواء بنفسه أم بالتعاون مع شخص‬،‫إذا قبل الطبيب بمعالجة مريض‬
‫ووفقا ألحدث المعطيات العلمية التي ينبغي أن يكون قد تابع تطورها‬.
1.
2.
Code of Medical Ethics. Law no. 240 dated October 22, 2012. Amending Law No. 288 of February 22, 1994. Translated from Arabic Retrieved on Feb 24
2016 https://www.aub.edu.lb/fm/shbpp/ethics/public/Documents/New-Code-of-Medical-Ethics-text-ENGLISH.pdf
http://www.lp.gov.lb/Temp/Files/ee758377-1b1f-42c1-8eea-beb627eafb59.pdf ٠٢‫تاريخ‬٢٨٨ ‫تعديل بعض أحكام القانون‬/٢٢/‫اآلداب الطبية‬١٩٩٤
Compassion
The sympathetic consciousness of others' distress together with a desire
to alleviate it
A compassionate doctor is a better doctor, because you will build trust and respect
with your patients, and they will work with you
Merriam-Webster dictionary. Taken from http://www.merriam-webster.com/dictionary/compassion on 2/1/16
Cultural Competency
Specific set of values and principles, along with behaviors, attitudes, policies, and
structures that enable a person to work effectively cross-culturally 1, 2
To be culturally competent one should, Have the capacity to:2
1.
2.
3.
4.
5.
value diversity
conduct self-assessment
manage the dynamics of difference
acquire and institutionalize cultural knowledge
adapt to diversity and the cultural contexts of communities they serve
This applies to ALL types of culture: Political, Social, Religious and Sexual, including
various types of culture within or between countries and societies
1. Cross, T., Bazron, B., Dennis, K., & Isaacs, M., (1989). Towards A Culturally Competent System of Care, Volume I. Washington, DC: Georgetown University Child Development
Center, CASSP Technical Assistance Center.
2. National Center for Cultural Competence. 1998
Why Do You Need Cultural Competency?
• Homosexuality is very common in the animal kingdom
• It has been observed in over 1,500 animal species including mammals, insects, crustaceans and
octopuses1
• It is difficult to get accurate data on how many people in the world are Gay, Lesbian, Bisexual or
Transgender
• In the 1940s and 50s, Alfred Kinsey conducted interviews of over 5,000 men and women in the US
and found that 8-10% of males and 2-6% of females practiced exclusively homosexual behaviors2
• More recent surveys from the US, Australia, UK, and Norway show that about 4% identify as Gay or
Lesbian, and 0.5% as Transgender3
• Of the 6 million people in Lebanon there are likely 270,000 – 600,000 people who identify as Gay,
Lesbian, Bisexual and Transgender
1. Homosexuality in the animal kingdom. University of Oslo, Norway. 24 Feb 2012. Taken from http://www.nhm.uio.no/besokoss/utstillinger/skiftende/againstnature/gayanimals.html on 2/13/16
2. . Data from Alfred Kinsey’s Studies. Kinsey Institute. Indiana University. 2016. Taken from http://www.kinseyinstitute.org/research/ak-data.html#homosexuality on 2/13/16
3. Gates, Gary J. How many people are lesbian, gay, bisexual and transgender. The Williams Institute, UCLA. April 2011.
Why Do You Need Cultural Competency?
• Heteronormativity exists in virtually all societies and is often unconscious
• If you want to deliver high quality health care you must be aware of your
own biases and address them
• Never allow your own biases to affect the quality of care you deliver
Transgender People in Lebanon
• Being transgender in Lebanon is a difficult life with many struggles
• In 2015, researchers surveyed Lebanese trans women and found:
– 90% reported being the victim of some form of violence
– 90% reported suffering from depression
– The only person who didn’t suffer from depression was the only one who had familial support
Kaplan, R., et al. Forms of Safety and Their Impact on Health: An Exploration of HIV/AIDS-Related Risk and Resilience Among Trans Women in Lebanon. Health
Care for Women International, 36:917–935, 2015.
Family Rejection
• No Lebanon specific data available
• In the US, 2012, homeless youth service organizations were surveyed:
– Over 40% of their clients identify as LGBT
Top five reasons why LGBT youth are homeless
or at risk of becoming homeless
% of respondents
0
10
20
30
40
50
46
Ran Away Because of Family Rejection of
Sexual Orientation
43
Forced Out By Parents Because of Sexual
Orientation or Gender Identity
32
Physical, Emotional, or Sexual Abuse
Financial or Emotional Neglect from Family
14
Durso, L.E., & Gates, G.J. (2012). Serving Our Youth: Findings from a National Survey of Service Providers Working with Lesbian, Gay, Bisexual, and
Transgender Youth who are Homeless or At Risk of Becoming Homeless. Los Angeles: The Williams Institute with True Colors Fund and The Palette Fund.
Lebanese Attitudes Toward LGBT People
• In 2015, researchers surveyed 1,200 randomly selected Lebanese people about their
attitudes and beliefs towards LGBT people, homosexuality, transsexuality, and other sexual
topics and found that1:
– 56% agreed that a person’s sexual behavior is private and shouldn’t be judged
– 55.7% agreed that any sexual act between consenting adults should be legal
• So far so good…..?
Nasr, N., Zeidan, T. “As long as they stay away”: Exploring Lebanese Attitudes Towards Sexualities and Gender Identities. 2015. Arab Foundation for Freedom and Equality.
Lebanese Attitudes Toward LGBT People
• The survey also showed:
– 60% said that a person could stop being homosexual
– 72% said homosexuality was a mental disorder or hormonal sickness
– 79% agreed that homosexuals should be taken in for treatment
– 76% said it would NOT “be beneficial for society to recognize homosexuality as normal”, with 51.5% of
them feeling “very strongly”
– Almost 90% believed that both men and women who possess homosexual feelings should do their best to
overcome them
– 61.7% disagreed that society should offer homosexuals some form of protection from discrimination
Nasr, N., Zeidan, T. “As long as they stay away”: Exploring Lebanese Attitudes Towards Sexualities and Gender Identities. 2015. Arab Foundation for Freedom and Equality.
Video courtesy of Assem Tawdi.
LGBT Discrimination Lebanon
• The Lebanese Penal Code, Article 534, states: “All sexual intercourses
contradicting to nature are punished from 3 months up to 1 year, additionally
to a penalty between 200 and 1,000,000 Lebanese Liras.”
– This law has been used to persecute, discriminate, and commit human rights violations
upon hundreds of gay and lesbian Lebanese citizens1
– These violations include forced anal exams, public humiliation, and harassment1
• Yet, the previously mentioned 2015 survey found that:
– 65% were opposed to the suggestion that homosexuals should be taken to prison2
– The authors noted that the results suggested that respondents were still in favor of some
kind of law against homosexuality, but not necessarily severe punishments2
1. Youth Coalition for Sexual and Reproductive Rights. Report to the United Nations Human Rights Council for the Universal Periodic Review of the Republic of Lebanon. On
Article 534 of the Lebanese Penal Code Correlated to Discrimination and Access to Comprehensive Sexual and Reproductive Health Services.
2. Nasr, N., Zeidan, T. “As long as they stay away”: Exploring Lebanese Attitudes Towards Sexualities and Gender Identities. 2015. Arab Foundation for Freedom and Equality.
It is getting better
Rulings by Lebanese judges Mounir Suleiman and Naji El Dahdah 2011 and 2014
Stated that homosexuality is NOT against nature
Youth Coalition for Sexual and Reproductive Rights. Report to the United Nations Human Rights Council for the Universal Periodic Review of the Republic of Lebanon. On
Article 534 of the Lebanese Penal Code Correlated to Discrimination and Access to Comprehensive Sexual and Reproductive Health Services.
Lebanese Attitudes Toward Trans People
• This same 2015 survey also revealed that1:
– 97% agreed with the idea of “two sexes only” when referring to gender
identity
– Over 80% described “men who dress as women,” and “women who dress as
men,” to be perverts
– 59% agreed that gender reassignment surgery is “morally wrong”
• Gender Affirming Surgery is permitted by the Lebanese Code of Medical Ethics
IF there is a “… decision of at least two specialist Physicians, with the consent of
the patient”2
1. Code of Medical Ethics. Law no. 240 dated October 22, 2012. Amending Law No. 288 of February 22, 1994. Translated from Arabic Retrieved on Feb 24 2016
https://www.aub.edu.lb/fm/shbpp/ethics/public/Documents/New-Code-of-Medical-Ethics-text-ENGLISH.pdf
2. Nasr, N., Zeidan, T. “As long as they stay away”: Exploring Lebanese Attitudes Towards Sexualities and Gender Identities. 2015. Arab Foundation for Freedom and Equality.
Coming Out Process
• Very stressful time in a LGBT person’s life
• “Refers to the process in which one acknowledges and accepts one’s own sexual
orientation. It also encompasses the process in which one discloses one’s sexual
orientation to others”1
– Can also refer to Transgender identities
• Always be sensitive and aware if your patient has
come out to their family
• Coming out is overall associated with better mental
and physical health outcomes2
Image taken from http://www.visaliatimesdelta.com/
1. American Psychological Association. The Guidelines for Psychological Practice with Lesbian, Gay, and Bisexual Clients, adopted by the APA Council of
Representatives, February 18-20, 2011.
2. Kosciw, J. G., Palmer, N. A., & Kull, R. M. (2015). Reflecting resiliency: Openness about sexual orientation and/or gender identity and its relationship to wellbeing and educational outcomes for LGBT students. American Journal of Community Psychology, 55(1), 167-178.
Preparation for Activity
• We encourage you to share your experiences and thoughts at the end, but you
certainly do not have to
• You can keep your worksheets or we can dispose of them. Regardless,
everything will be confidential
• First, let’s go through each aspect of the social identity profile to make sure
there’s no confusion
Social Identities
•
•
Natal / Biological Sex: The sex you were assigned at birth. Examples: male, female, intersex
Gender Identity: The gender YOU identify as. Examples: cis-male, cis-female, trans-male, trans-female, a
mixture, gender neutral
– Cis-gender is when you identify as your biological sex, while trans-gender is when you do not
•
Race and/or Ethnicity:
– Race: Genetically similar groups within the same species, often based on physical characteristics. Ex: Caucasian, Asian
– Ethnicity: Shared culture, language, customs, nationality, etc. Not biological. Ex: Arab, Korean, Native American, English
– In reality it is very hard to accurately define race and ethnicity, so it is more important to decide what you identify as
•
Sexual Orientation: The characteristics of whom you are attracted to
– Heterosexual: attracted to members of the opposite sex / gender identity
– Homosexual: attracted to members of the same sex / gender identity
– Bisexual: attracted to members of both sexes / gender identities
•
Religion / Faith / Spirituality:
– If you belong or identify with a Religious or Faith group
– Spirituality tends to describe beliefs that are at one’s core with relation to the nature of existence. They can be
complementary to religion or separate. Ex: Reincarnation, belief in the afterlife
•
•
•
Social Class / Socioeconomic Status: Your social class in society, typically related to wealth and status
Body Size / Type / Appearance: One’s physical appearance including height, weight, body shape, skin color,
hair pattern, etc.
Other: Anything else not listed. Ex: dietary preferences, political affiliation, social activism