Culture and Diversity in Member Care—Part 8

Summary:
Broadening Our Boundaries

Oh me oh my! Oh me oh my!

So many funny things go by.

Some with two feet, and some with four.

Some with six feet, and some with more.

Where are they all from? Who can say.

For sure they come from far away.

Dr. Suess (paraphrased) One Fish Two Fish Red Fish Blue Fish

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Member care is an international, inter-disciplinary field. People in the field are diverse. People we work with are diverse. In member care, as in global health, and as in life, we want to promote understanding, respect, and competency regarding human diversity and cultural variation.

As we have seen throughout these eight entries, multicultural competency is something we want to intentionally pursue in order to do member care well (e.g., cultural sensitizers, Resolutions, case studies, international cases/culture bound syndromes) Multicultural competency is also something which we naturally grow into as we connect with different people, places, and perspectives. In terms of Gestalt therapy, think of it as an ongoing process of “expanding our experiential boundaries” and “broadening our borders”.

The book mentioned above, One Fish Two Fish, is one of my favorites. It is a terrific place to conclude (or  also to start) our discussion. So many things we want to learn about life, including diversity and deviance, are found in this book. It is for adults as much as it is for children. In addition, as you read it carefully and reflectively with curiosity, you will most likely tap into your amazing inner world, filled with your own diversities and variations, congruence and incongruence, playfulness and seriousness, and many other lively polarities!

If you do not have access to this book, you can watch/listen via two You Tube videos (in two parts).

http://www.youtube.com/watch?v=2FIcXpDMcw8

http://www.youtube.com/watch?v=Nvqnbvqm5SI&feature=related

“Every day,

from here to there,

funny things are everywhere.”

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Reflection and Discussion (and leave a comment!)

1. What did you think of the video version of the book?

Any favourite parts?

2. List three things about human life that you discovered in these books?

Any things about your own life?

3. Describe a couple ways how diversity and deviance are conveyed in this book.

Anything soothing or disturbing?

4. How can you use this book as a source to develop multicultural competency?

Or as a member care tool in other areas?

5. Which of the eight entries in this topic (over the past several weeks) were the most helpful for you and why? You might want to skim the entries again or perhaps go back to the first entry and review the outline. List three things you will practically do to increase your multicultural competencies.

Culture and Diversity in Member Care—Part 5

Resolutions: Multicultural Competence

International Member Care Retreat 2000

El mar sus millares de olas mece divino.

Oyendo a los mares amantes mezo a mi niño…

Dios Padre sus miles de mundos mece sin ruido.

Sintiendo su mano en la sombra, mezo a mi niño.

Gabriela Mistral, Desolación, 1922

The sea rocks its countless waves

God rocks His countless worlds

Hearing the loving waves

Sensing God in my world

I rock my child.

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Mission/aid workers, like the people with whom they work, are a hugely diverse and culturally varied group. As mentioned in the last entry, there are about 400,000 foreign mission workers and nearly 12 million national workers, according to the estimates from Johnson, Barrett, and Crossing, in the January 2010 issue of the IBMR. We thus want to better equip ourselves to deal with such diversity and thus make member care as relevant as possible. In short, we want to encourage understanding, respect, and competency regarding human diversity and cultural variation.

Let’s have a look at one professional body’s comments on culture and gender—resolutions from the American Psychological Association (APA, 2004). There are of course similar perspectives from other fields/professional bodies and countries. It would be fascinating to review and compare many of these. It would also be helpful to use these materials as a springboard to write some trans-culturally relevant guidelines on cultural variation and diversity in member care! These guidelines would be helpful for further developing multi-cultural competence.

Keep in mind that although it is not explicitly stated in this document by the APA, much of the thinking is founded upon the 1948 Universal Declaration of Human Rights (UDHR) and subsequent human rights-related instruments. See especially the Preamble and Article 1 which recognize  “the inherent dignity" of eveyone; that "the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world;” and that “All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.” These principles from the UDHR in turn can be definitely linked to core principles in Judeo-Christian thinking on the intrinsic worth of humans as beloved image bearers of God.

The Resolutions from the APA (excerprted below) are obviously very USA-centered. They are nonetheless heading in the right direction as they call to internationalize the field of psychology in general and increase the multi-cultural competence of American psychologists in particular. Note that in the entire document there are actually 26 “Whereas” statements and 12 “Let it be resolved” statements.

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Resolution on Culture and Gender Awareness in International Psychology   American Psychological Association, 2004

(Excerpts--click on the title/link above for the full version)

"WHEREAS an estimated 60 percent (or more) of the world's psychologists now live outside the US...

WHEREAS psychologists outside of the US have generated perspectives, methods and practices that correspond to the needs of the people in their societies and data that are relevant to the development of a more complete psychology of people...

THEREFORE LET IT BE RESOLVED that the American Psychological Association will:

(4) encourage more attention to a critical examination of international cultural, gender, gender identity, age, and disability perspectives in psychological theory, practice, and research at all levels of psychological education and training curricula.

(5) encourage psychologists to gain an understanding of the experiences of individuals in diverse cultures, and their points of view and to value pluralistic world views, ways of knowing, organizing, functioning, and standpoints.

(6) encourage psychologists to become aware of and understand how systems of power hierarchies may influence the privileges, advantages, and rewards that usually accrue by virtue of placement and power..."

Reflection and Discussion

1. What other guidelines/statements in this area of culture/diversity/gender are you familiar with?

2. What would be three succinct principles or areas to emphasize in a member care statement about awareness of human culture, diversity, and gender?

3. Describe how some of these principles in the APA Resolutions relate to Scripture and/or the UDHR.

4. It can be argued that it takes some professional bodies a long time to catch on to the relevance of cultural variation, human diversity and gender equality. Why is this so? Any examples?

5. How could the APA Resolutions be useful to further develop multicultural competence for you in your work and setting?

Culture and Diversity in Member Care—Part 3

Cultural Sensitizers for Good Practice

“Is it true that all of you folks in Africa really live in trees?”

a North American student bewilderedly asked her new African classmate.

“Yes it is true,” replied the recent trans-Atlantic arrival, with a slight grin.

“But don’t worry, it's not so difficult, because we we all have elevators.”

(inspired by a quote in Figuring Foreigners Out, 1999, p. 157)

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In member care, as in life, we want to promote understanding, respect, and competency regarding human diversity and cultural variation. How do we develop these qualities? One interesting way is through “cultural sensitizers” which are a special type of brief case studies. Culture and the Clinical Encounter, is an easy-to read book filled with dozens of these sensitizers-cases

Culture and the Clinical Encounter: An Intercultural Sensitizer for the Health Professions  (1996, Rena Groper, Intercultural Press; You can also preview a large part of the book this book on Google Books)

In each case presented in this book, cultural factors have a significant impact on how health problems are perceived and treated—by both the patients and the health professionals. Each case includes a choice of four possible responses for dealing with the situation, with an explanation in a separate section as to the appropriateness of each response. The book concludes with 10 pages of helpful principles for working with those from different cultures, including the awareness of the influence of our own culture on our perceptions of others (Section Four). We find the sensitizers to be challenging and quite fun! It is a great way to further develop helping skills regarding human diversity/cultural variation.

Culture and the Clinical Encounter is written in a multi-cultural context for medical care practitioners in North America. However, you will likely see its relevance for other settings too. Perhaps you will want to develop similar sensitizers for your own setting. It would also be great to see something like this developed more specifically for the member care field.

Other Books (among many!)
Here are two other books on culture appreciation/learning that are east to read, enjoyable, and filled with lots of examples and practical helps.
**Figuring Foreigners Out: A Practical Guide (1999) by Craig Stori
See preview at Google Books
**Foreign to Familiar: A Guide to Understanding Hot- and Cold-Climate Cultures (2000) by Sarah Lanier

Note: Be sure to check on sites like http://www.amazon.com/ to compare prices.

Reflection and Discussion

1. Do the first two sensitizers on the Google Books site linked above. How did you do? Note that the answers are not included in the Google book preview—if you are not sure feel free to contact us!

2. Give an example of a culturally insensitive thing that you have done. Also, what is an example of a culturally insensitive thing done to you?

3. Think of a situation in cross-cultural member care that would make a good cultural sensitizer. What would be a couple wrong responses and what would be some more helpful responses? (e.g., seeing a person who is of the opposite sex and from a more traditional culture, for an “informal” time of counselling, giving the person a friendly hug, looking the person in the eye often, calling the person by his/her first name, meeting the person in the family home where the relatives can hear some of the conversation, ending the session “on time”, doing most of the talking as the other person nods his/her head, etc.)

4. How could you use the three books mentioned above in your setting, training, or organization? For example it might be helpful to have a short refresher time together and go over some basic principles and also issues specific to your setting, using some of the book materials as a point of departure.

5. What would be a couple indications for not being “culturally sensitive?” Any experiences of this in your life/work? (e.g., someone is a danger to themselves or others but this is not acknowledged by family members for cultural reasons; not allowing a child to participate in a “cultural” ceremony or celebration; challenging the belief in past sins or spirits as being the cause for chronic/incurable illnesses, etc.)

Culture and Diversity in Member Care—Part 2

Mental Health for All

Up into the cherry tree

Who should climb but little me?

I held the trunk with both my hands

And looked abroad on foreign lands.

Robert Louis Stevenson

We are reviewing materials that promote understanding, respect, and competency regarding human diversity and multicultural settings. One of the most outstanding resources we know is a book written to practically help health care workers in almost any setting around the world—Where There is No Psychiatrist. Member care workers and all those with member care responsibility, regardless of their mental health backgrounds, will also find this manual to be very helpful and at times probably even fascinating!

Think of this as a reference tool to better support the well-being of mission/aid personnel. Think of it also as a tool for mission/aid workers to get a better understanding of common mental health problems that can affect the variety of people with whom they work.

Where There Is No Psychiatrist: A Mental Health Care Manual (by Vikram Patel, Royal College of Psychiatrists, 2003) Summary below and purchase information is from Teaching-Aids at Low Cost (TALC). You can also preview this book at Google Books.

“After giving the reader a basic understanding of mental illness, the book goes on to describe more than 30 clinical problems associated with mental illness, and uses a problem-solving approach to guide readers through their assessment and management. There is also a section which contains quick reference information for common problems. The manual is divided into four sections with the first giving an overview of mental illness and dealing with the different types of mental disorders using a simple classification; the second deals with clinical problems including a chapter on the most disturbing and worrying clinical problems that you will encounter, the third covers integrating mental health and considers how mental health can be promoted in the community, the fourth discusses localising the manual for your area and accessing resources.”

Reflection and Discussion

1. Recall a cross-cultural situation in which you were trying to help a person with mental health needs. What helped and what did not help?

2. List three basic principles for helping someone from another culture who seems to be struggling with some type of life problem.

3. How might you approach someone who is struggling with a problem if this person were a colleague, or a neighbour, or a student/person you were training?

4. How could some of the materials in Where There Is No Psychiatrist be used to further train people in your organization/setting? Who would specifically benefit from going through this training?

5. List a couple ethical considerations when using the materials in this book in cross-cultural settings.

Culture and Diversity in Member Care—Part 1

Overview

Mental Health in a Diverse World

I met a little Elf man once, down where the lilies blow.

I asked him why he was so small, and why he did not grow.

He slightly frowned, and with his eye, he looked me thru and thru.

"I'm quite as big for me," said he, "as you are big for you."

John Kendrick Bangs

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The next eight entries on diversity and culture describe important resources for good member care practice. The resources are primarily from the mental health fields and reflect the growing mental health movement around the world. We encourage you to go online to download and/or purchase some of these resources. They are designed to promote understanding, respect, and competency regarding human variation and multicultural settings.

The materials in these entries are meant to complement the practical knowledge that we all acquire from connecting with others from different backgrounds and cultures. The capacity for greater cultural understanding is available in our very own culture(s) too. As Pierre Casse says in Training for the Cross-Cultural Mind “There is no need for you and me to go around the world to search for some type of cross-cultural adventure. Just stay where you are. Talk and listen to the person next to you.” (1981, x). For those of us working in multicultural settings, this type of basic “training experience” can be all the more valuable when we simply take the time to interact with the person next to us.

We have also found it invaluable to learn from multicultural mentors/friends and to stay in regular touch with international media/issues (examples are in the Media that Matters section on the Member Caravan website). For us, developing competency in human diversity and multicultural settings, at its core, is part of life-long learning. It involves first-hand experience, intentional study, curiosity about others, and a mindset that appreciates human variation.

What’s Ahead--The Lineup

Part One: Overview (Culture and Diversity in a Changing World by the World Federation of Mental Health)

Part Two: M etal Health for All (Where There is No Psychiatrist: A Mental Health Care Manual by Vikram Patel)

Part Three: Cultural Sensitizers for Good Practice (Culture and the Clinical Encounter: An Intercultural Sensitizer for the Health Professions by Rena Gropper)

Part Four: Well-Being for All (No Health Without Mental Health by World Health Organization)
Part Five: Resolutions--Multicultural Compentency (Resolution on Culture and Gender Awareness by the American Psychological Association)

Part Six: Global Mental Health--Issues and Interviews (Various inverviews from Global Health TV)
Part Seven:  International Cases--Understanding the Divertsity of Disorders (Cultural Formulation/Culture Bound Symdromes and International Cases, from DSM IV TR and DSM IV Casebook)

Part Eight: Summary

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This resource below is available to download for free.

We encourage you to study it and discuss it with others.

Mental Health in a Changing World:
The Impact of Culture and Diversity

World Mental Health Day 2007
World Federation of Mental Health

Chinese, English, French, Japanese, Russian, and Spanish

Click on the title/link above for the full version.

Excerpts
"There are approximately 6.5 billion people living on planet Earth. Within that number, there are more people living outside their country of origin than at any other time in history. One person out of 35 is an international migrant — 3% of the global population. If we look at our world to-day, is there any single culture, race or religion that is 100% contained in one single country? We can find dramatically different languages, religions, family relationships and values, as well as views on health care and treatment wherever we go, including in our own respective countries. A female mental health professional born and trained in India may have moved to the United Kingdom and is seeing a male client born and raised in Ecuador — how do they communicate and how do each view the same mental illness?”

“Culture may influence many aspects of mental health, including how individuals from a given culture communicate and manifest their symptoms, their style of coping, their family and com-munity supports, and their willingness to seek treatment. Likewise, the cultures of the clinician and the service system influence diagnosis, treatment, and service delivery. Cultural and social influences are not the only determinants of mental illness and patterns of service use, but they do play important roles.”

“In the mental health care setting, culture impacts how people:
• Label and communicate distress
• Explain the causes of mental health problems
• Perceive mental health providers
• Utilize and respond to mental health treatment."

Reflection and Discussion

1. What were some of your first cross-cultural experiences?

Were any like the one described in the opening poem, The Little Elf?

2. List a few ways that you have developed your cross-cultural skills.

Which ones have been the most enjoyable and why?

3. With which cultures are you most familiar?

Which culture/nation would you really like to learn a lot more about?

4. How do you continue to grow in your work in multicultural settings?

What roles do the media and movies have for you?

5. Which of the topics in the above resource interest you the most (World Federation for Mental Health)?

Are there any parts that you would want to adjust or further develop?

Member Care and the Hippocratic Oath, Part 3

Some Ideas for Responsible Practice:

Respect, Relate, Reproduce

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Diego Reivera, The Flower Carrier, 1935

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Non hay tan dulce cosa

como la fidelidad

nin miel tan sabrosa

como la buena amistad.

Tem Tob, 14th century, Spain

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Translation:

Good, faithful friends are sweeter than anything.

*

“To consider dear to me, as my parents,

him who taught me this art;

To live in common with him and, if necessary,

to share my goods with him;

To look upon his children as my own brothers,

to teach them this art.”
*

This second section of the Oath, quoted above, might not seem too applicable for us in the member care field. The type of close teacher-student relationship described here is not exactly the same today as it was 2400 years ago in Greece. But let’s look into it more closely. I would like to suggest that we extract three broad principles from this section that are relevant for member care practitioners.
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Applications
1. Respecting Senior Colleagues.
We show respect to (and “consider dear”) the senior practitioners in our field. For me, this applies to people whose proven character and proven contributions are sustained over time. It especially applies to those aged 70+ who were working in the pre-member care field in the 1970s and even 1960s. We show respect by listening carefully to their input and honouring them in our gatherings.
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Personally I so enjoy learning more about our roots as a field and the efforts of those who trail blazed so long ago. Often these folks were not even aware that they were blazing anything but rather thought that they were just doing their job. These folks in their steadfastness and depth inspire me: Stringham, Lindquist, Foyle, Narramore the Grossmans and surely many more! As Tolkien says of Aragorn, a “senior (Ranger) practitioner” in the Lord of the Rings, “the old that is strong does not wither, deep roots are not reached by the frost.”
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The Oath indicates that the teachers and the students have a close personal and working relationship. They may even “live in common”. I likewise want to encourage member care workers and senior practitioners to connect closely together for personal and professional learning. Would it ever be possible for practitioners and senior practitioners to “live in common” in some sense? Now that is quite an idea! Perhaps the closest thing that I am aware of is sharing a room together at a conference for a week, or working on a field-based project for a few weeks, or working on staff together as part of a course or school for a few months. And maybe there are additional types of relationships that we can creatively consider. Why not?
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The Oath also mentions providing practical support for teachers/senior practitioners as needed. The labourer is worthy of her/his wages. Note that there is no clear requirement for remuneration in the Oath, and perhaps this is not mentioned so that senior practitioners would not be tempted to exploit underlings for money. Perhaps the default arrangement as much as possible was pro bono instruction. Paul the Apostle gets into this point in 2 Corinthians 11 regarding his status as a senior (apostolic) practitioner. He reminds the Corinthians (as he did the Thessalonians and other churches, e.g., I Thes. 2:9) that he served them freely and was not a financial burden to them even though he could have honourably and ethically asked them to help meet his needs. Bottom line: keep our financial relationships clear, and don’t exploit anyone who needs our services or whose services (such as training) that we ourselves need.
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2. Relating Closely with Colleagues.
Our relationships with the family members of teachers/senior practitioners is the next broad principle. Apparently priority was to be given to children (sons) of the medical teachers. There seems to be a sense of duty to look after the teacher’s children as well as a strategic sense that the children will be in a good place to continue the medical profession, having watched and learned from their parent who is a physician.
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How to apply this? Well, I like the idea of getting to know the families of senior colleagues and also the families of a few close colleagues. Many family members and others can benefit beyond the dyadic teacher-student relationship. And maybe we will be seeing second or even third biological generations of member care practitioners. Again I say, why not? But consider these caveats: let’s avoid any type of nepotism or favouritism in the member care community. And let’s not confuse professional roles and responsibilities with personal preferences and gain that produce conflicts of interest, not to mention envy and resentment.
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3. Reproducing Knowledge/Skills.
We provide services but we also try to multiply our services reesponsibly. In fact, as member care practitioners we try to multiply ourselves—our competencies as well as our character. Training in many contexts can thus also involve "imparting our own lives" (I Thes. 2: 8). This is a special privlege and responsibility to be taken very seriously. It also requires accountability. “Let not many of you become teachers knowing that as such you shall receive a stricter judgement” (James 3:1).

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One additional application is to mention that it is especially challenging to offer instruction well in light of the diversity of the member care world and mission/aid settings. One example among many: how to intervene in a “troubled” family/team setting in which the parent/team leader is seen as being rigid and authoritarian by some members and as exercising firm, caring authority by others? These types of sitautions certainly "stretch" our own experiential and practice boundaries. Good member care practice often requires going beyond the familiar (or with reference to the Oath, we go beyond the family of our senior teachers) in order to embrace the diverse. We have to cross sectors and disciplines, genders and generations, in addition to crossing cultures. Have a look at the material from the World Federation of Mental Health, prepared for World Mental Health Day 2007: Mental Health in a Changing World: The Impact of Culture and Diversity

http://wfmh.org/COVERS/2007WMHDAY.jpg
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Final Thought
An important part of our member care practice involves responsibly: a) respecting other practitioners, b) relating to other practitioners, and c) reproducing other practitioners. Can we really read all of these responsibilities into the second section of the Hippocratic Oath? Well, yes, in a general way. Without overstepping our interpretive bounds, we can build upon our Greek predecessors. We can use this part of the Oath as a further springboard to help us consider how we want to practice responsibly.
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Reflection and Discussion
1. Is there a senior colleague with whom you regularly relate? Do you have any special type of agreed-upon relationship?
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2. Are there member care workers who look to you as being something like a senior colleague, and consult with you for help?
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3. Who are your closest colleagues? How close are you to their family members?
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4. What are the pros and cons of member care workers who link personal and professional relationships together?
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5. In what ways are you reproducing your knowledge and skills within your sphere of influence? What thoughts do you have about training (i.e. responsible multiplication) in light of the diversity of caregivers/settings?