Religion and Culture
KUMC CLINICAL CULTURE AND
DIVERSITY SERIES
UNIVERSITY OF KANSAS
APRIL 21, 2015
Objectives
1.
2.
3.
4.
5.
What is culture?
What is cultural competence
Where does religion come in?
What are some important things to think about?
What are some important things to do?
What is culture?
 a : the integrated pattern of human knowledge, belief,
and behavior that depends upon the capacity for learning
and transmitting knowledge to succeeding generations
 b : the customary beliefs, social forms, and material traits
of a racial, religious, or social group; also : the
characteristic features of everyday existence shared by
people in a place or time <popular culture> <southern
culture>
 c : the set of values, conventions or social practices
associated with a particular field, activity, or societal
characteristic <studying the effect of computers on print
culture> <changing the culture of materialism will take
time — Peggy O'Mara>
Defining “culture”
 Everything we do in our normal,
day-to-day life that feel so natural
that we forget them
2-x-2 differences
 In groups of 2 for 5 minutes: identify as many
characteristics or experiences you have in common
and which are different?
2-x-2 differences
 In groups of 2 for 5 minutes: identify as many
characteristics or experiences you have in common
and which are different?
 In Larger group:
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What was easy to talk about?
What surprised you?
What was hard to talk about?
Belief Structure: Religion
Religion typically does three things:
It confirms to us the role of “the gods” (pc-speak: the
‘elemental forces at work in the universe’) and helps
us understand how the universe and nature work
(ontology).
2. It provides important stories that help us understand
how to live as individuals and communities
(morality).
3. It provides rituals (such as prayer and worship)
intended to ask the gods to intervene on our behalf,
including in matters of health and well-being (hope).
1.
Western Two-Tiered Cosmology
Religion &
Personal
beliefs
Excluded
Middle
Non-western cosmologies
often assert that there is a
parallel universe peopled
by spirits
Science &
Fact
Seee http://rationalrevolution.net/articles/history_of_the_separation_of_chu.htmi).
General Animistic Cosmology
Remote-inaccessible
Deity/deities
Living Dead
Spirits
(Known Dead Persons) (Long forgotten Dead)
Angels/demons
Intermediaries:
Realm of humanity
and physical things
Keith Eitel, Missiology
In the “excluded
middle” it is believed
that spirits intervene
in humanity’s normal
experiences.
Designated
intermediaries
(shamans, traditional
healers) must
appease these forces
to heal/sustain life.
Cultural Competence Definition
 Cultural Competence – Definition
A set of congruent behaviors, practices,
attitudes and policies that come together
in a system or agency or among
professionals, enabling effective work to be
done in cross-cultural situations
Cultural Competence Definition
 Cultural Competence – What it isn’t:
 An in-depth study of a number of common cultures you
may encounter in practice, their characteristics, cultural
health practices and beliefs and how to best approach them
 “Culturalism”
 Assuming that, because we know about cultural beliefs
and practices, we are fully-prepared to intervene.
 Knowledge without self-discovery may lead to even more
bias, stereotyping and discrimination.
Patient Safety and Healthcare Quality:
what can go wrong in LEP populations
 Among 1,083 adverse incident reports from
six Joint Commission-accredited hospitals for
English speaking vs. LEP (Limited English
Patients) over 7 months in 2005:
 A greater percentage of LEP patients (49%)
experienced physical harm versus Englishspeaking patients (30%).
 LEP patients also experienced higher levels
of physical harm ranging from moderate
temporary harm to death, 47% and 24%
respectively.
Divi C, Koss RG, Schmaltz SP, Loeb JM. Language proficiency and adverse
events in US hospitals: a pilot study. Int J Qual Health Care. Apr
2007;19(2):60-67
The Cultural Competence Continuum
Cultural Destructiveness
“See the difference; stomp it out.”
Using one’s power to eliminate the culture of another.
Examples
 Genocide or Ethnocide
 Exclusion Laws
 Shun/Avoid certain curriculum topics
 “We know it when we see it”
“When we redistrict we can get rid of THAT neighborhood!”
“If we could get rid of the special needs students, our scores
would improve.”
Cultural Blindness
“See the difference; act like you don’t.”
Acting as if cultural differences do not matter or as if there are not
differences among/between cultures.
Examples
 Discomfort in noting difference
 Beliefs/actions that assume world is fair and achievement is based on merit
“Our school does not need to focus on multicultural education- we have no
diversity.”
“Everyone learns the same.”
“We have nothing against their religion, we just don’t know anything about it so
we ignore it, because we don’t want to offend.”
“I’m not prejudiced. I don’t see color in my students.”
Cultural Proficiency
“See the difference; respond positively. Engage and
adapt.”
Esteem culture; knowing how to learn about organizational culture;
interacting effectively in a variety of cultural groups.
 Five essential elements:
1. Assessing culture
2. Valuing Diversity
3. Managing the Dynamics of Difference
4. Adapting to Diversity
5. Institutionalizing Cultural Knowledge
Examples
 Interdependence
 Personal change and transformation
 Developing alliances with groups other than one’s own
Cultural Proficiency
“See the difference; respond positively. Engage and
adapt.”
Esteem culture; knowing how to learn about organizational culture;
interacting effectively in a variety of cultural groups.
Does it matter what you think about the
Excluded Middle?
 We each have beliefs about ‘what is out there’.
 If we believe that what we think is “true” and the
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other person is “uneducated” (or other label)
unconscious biases are communicated (feeling).
It may be useful to think about what we might say or
do if they ask.
I don’t know is an OK response.
“I believe this and so should you” probably is not.
Our role is as “professional helpers” and that
requires being respectful, genuine and beneficent.
 “Primum non nocere”
Kleinman’s Nine Questions
 One assessment tool for clinicians to better
understand patients
 Developed by Arthur Kleinman, MD, MA, a
physician and anthropologist
 “Culture, Illness and Care: Clinical Lessons from
Anthropologic and Cross-Cultural Research,”
Annals of Internal Medicine, 1978
Reference:
http://depts.washington.edu/fammed/predoc/clerkship/resources/cultKlein
Kleinman’s Questions
1. What do you think has caused your problem?
2. Why do you think it started when it did?
3. What does your sickness do to you; how does it
work?
4. How severe is your sickness?
5. Will it have a short or long duration?
6. What kind of treatment should you receive?
7. What are the most important results you hope
to receive from this treatment?
8. What are the chief problems your sickness has
caused you?
9. What you do you fear about your sickness?
Story of Bhutanese refugee community
 150,000 (20% of Bhutan’s population), Nepali-
speaking majority language
 1989: Minority ruling-elite outlawed Nepali language
and dress
 1990-94 Dissent quashed, lands-finances seized,
rape-torture-murder, followed by mass exodus and
18 years in Nepali refugee camps

Gross National Happiness and ethnic cleansing: read Thapa
2011 http://www.wavemag.com.np/issue/article3775.html
Story of Bhutanese Refugee community
 UNHCR unable to secure repatriation
 US agrees to give asylum to 60,000 by Dec.
2013 (~50,000 have arrived)
 3 months of re-settlement assistance
 8 months of Medicaid then medical indigence if
un-employed (exceptions for families with
children and some medically disabled)
Learn to anticipate the un-expected
Source: Doug Hall, “The Cat and the Toaster”
Lessons learned by 1 provider
1.
2.
3.
4.
5.
Every person is different/thinks differently:
generalizations don’t help
I am the one who needs to learn the most
Relationships and mutual understanding takes
time to develop.
Every community and person has a path that is
unique, and worthy to celebrate
It will not “just happen”: it is important to be
intentional, “learning to learn well”
Getting there is half the fun…
A grid to think about your growth
Attitude
Community
System
Partners
Knowledge
Your
practice
Skills
Clinical
Behavior