When I was sixteen years old, my mother forced me to take Vietnamese reading and writing classes at the local temple. “How could you forget your own language?” she would always chastise while on the verge of tears. I never understood why she was upset; English had always come easily to me and was the much more sensible language to use as a natural born citizen in an American school. The Vietnamese classes didn’t last long before I stopped attending.
Three years later, I accompanied my grandmother to a hospital for an MRI appointment. I was to wait with the technician in another room until after the imaging took place. “Where are you going?” she cried in Vietnamese, clutching my arm, “what are they going to do now? Don’t leave!” Not knowing how to reply in Vietnamese, I clumsily patted her hand, kissed her cheek, and told her everything would be okay in a language she didn’t understand. I’ll never forget the pain of being unable to answer because of a language barrier built from my own cultural incompetence. What is the importance of cultural competence, of knowing your family’s native tongue, of knowing a patient’s language?
As a future physician, I hope to never leave a patient frightened or uncertain of his or her outcome. A patient should never have to endure the figurative and literal isolation my grandmother experienced. As such, I took Vietnamese lessons through college and, after becoming a proficient speaker, acted as a translator for my grandmother through her rehabilitation period. I was even able to lend my translations to a local hospital through a recording that could be played for Vietnamese patients. Now at UTMB, I intend to enroll in a Medical Spanish course in order to improve my Spanish.
Today, this lesson and the need for bilingual health has become increasingly relevant; Spanish is now the second most common language spoken in my hometown, Houston, followed by Vietnamese. In order to have constructive dialogue with patients, physicians must rise to the modern society’s demand for cultural proficiency.
Physicians, however, are not the only ones who need to be culturally competent in order to deliver quality health care. Health care policy-makers must be aware of cultural boundaries before establishing laws that affect multi-cultural populations.
Through college, I was a casework intern for the Texas Chairman of Health and Human services and a researcher for Dr. William Winslade (a UTMB faculty member). For both internships, I was given a research project regarding organ transplant allocation, which has become a popular topic due to the severe shortage of organs for recipients in need. I discovered that other countries like Israel had proposed to prioritize donors over non-donors for critical transplants. The proposal was extremely controversial due to protest from “Ultra-Orthodox Jews” whose religious beliefs barred them from donating organs. We cannot form laws that affect populations of varying religious backgrounds before attempting to become more aware of such beliefs. This idea is particularly important in democratic societies like our own, where individual beliefs and individual voices have the right to be heard and respected. As such, health care policy makers have the responsibility of meeting the needs of a diverse population.
We, as students, also share this responsibility. We expect to be leaders in society, professing ourselves to a career based on elevating the lowest denominator of humanity—health—while respecting the religions of other people. How can we learn to be more aware, more sensitive towards others’ beliefs? I chose to become involved in a religion and culture starkly different from my own as a social and learning experience. I joined the Muslim Students Association and roomed with another Muslim member for one year. Through Koran-readings, campus lectures, peer discussions, and mosque sessions, I discovered a large community of positive students working to promote their beliefs and to dispel the misconception of the Muslim terrorist in America. After six months of participation, I became a leading recruiter for MSA’s largest campus-fundraiser, Fast-a-thon, which helped non-Muslims become more aware of the fasting month of Ramadan. Learning these principles of Islam and actively participating in the Muslim “sisterhood” on campus helped me to build my identity as a multi-cultural member of my society.
Later, I chose to become a member of the Asian American Campus Ministry in order to better understand Christianity, a widespread religion that has pervaded the social history of America. I attended Bible-study groups and lectures by Christian leaders on campus. I took a class on Christianity in Colonial Latin America. For the first time in my life, I could understand what the facades on the beautiful missions in San Antonio symbolized. I could understand the biblical references that appeared so often in the works of Boccaccio and Joyce. But most importantly, I could better empathize with patients who believe in the power of prayer, or a tangible afterlife. My experiences with MSA and AACM have helped me to develop the compassion and the empathy necessary to have constructive dialogue with patients who may choose to turn down blood transfusions, chemotherapy, or medical recommendations based on religious belief. As modern medicine continues to push the limits of scientific possibility and typical treatment, sensitivity to religion becomes more relevant than ever.
As a first year medical student at UTMB, I already find myself surrounded by a diverse group of peers with open minds and a wide range of cultural background. They strive to become bi/trilingual physicians, they are sensitive to religion, and they aspire to eliminate the national borders of medicine. The Global Health Track at UTMB has grown and become a popular concentration for medical school students; I also intend to become a participant and study abroad in Central America during my medical education. Perhaps the instant, borderless technology on which we were raised has helped to form this universal perspective of medicine, but there is no question that our rising generation of physicians is highly aware of the consequences of global disease.
We know now, from the scares of swine flu, the panic of avian flu, the epidemic of HIV/AIDS that disease is not a stationary reaper. They spread, on planes, ships, food, and hands, across countries and into our communities. Global medicine, then, has a direct effect on our local health. While this may seem to have little to do with speaking Spanish or visiting mosques, it has everything to do with implementing quality care in countries that have little access to basic medical treatment. In order to successfully implement plans for health-care and to educate the people of these countries, we are obligated to become culturally competent. We must have, at the very least, a basic understanding of their culture, their boundaries, their religion, and their opinions of medicine in order to foster trust with patients. The humanitarian phenomenon “Doctors Without Borders” has already proven that a global model for medical aid can be successful. However, it is through cultural proficiency that we can truly give modern medicine a permanent and accepted place in another’s society.
Cultural competency, then, is a critical aspect of modern medicine. We can no longer ignore the need for bilingual physicians, for culturally knowledgeable healthcare politicians, and for global perspectives on health care. The progress of medicine, after all, depends on its acceptance in each of these diverse facets of society.