Reflection

The course of this research into cross-cultural and intercultural communication has given me much pause for thought, particularly when I read of the experiences of consumers who had received less-than ideal treatment.  I would have enjoyed the opportunity to explore the issues of gender identity and sexuality further, and this is something I aim to do in the future to help inform my practice.  The key ideas I have taken from this project are:
*  identity is complex and is made up of many components
*  culture is more than ethnicity
*  language is not the only barrier, it's just the most obvious one
*  even well-intentioned healthcare practitioners can lack cultural awareness and practice poor intercultural communication
*  the better the therapist knows themselves, the better they can see how their identity shapes their attitudes to "others"
*  an open mind will allow you to better see your client, and their experience

Tools and Resources in the Waikato - We Get Interactive!

Now that we've established the need for better understanding by therapists of the realities of cultural experience from our clients, and the need to understand our own personal perspectives as well, what can we do to help us understand other cultural viewpoints, and whom can we turn to assist with our communication?

Language can form a large part of the problem in communicating with those from different cultures, so one obvious place to check is a translation service.  Hamilton Multicultural Services Trust (HMST) has the Waikato DHB contract for translating (written) and interpreting (spoken), with their Decypher service.  Here's an overview of the services they provide, plus some exercises for you to try (it won't hurt to have a go, I promise):

HMST is also home to the  the Waikato Migrant Resource Centre, Settlement Support New Zealand, Computers in Homes (helping refugees access computer technology), and runs a migrant employment programme.  Staff at the centre can generally help with questions concerning language, culture, and overlying religions. The DHB's chaplaincy service can be utilised by OTs wanting advice regarding religious and spiritual matters.

What Does the Literature Say? What Are Our Guidelines?

We've seen anecdotal evidence of the need for improvement in the ways that practitioners demonstrate cross-cultural awareness, and practice intercultural communication, but what does the formal evidence say on the matter, and what do our organisations say?  There is not a large body of evidence from New Zealand, but plenty has been written in other countries. Below is a screenshot of the Occupational Therapy Board of New Zealand's position on Cultural Competence:

(Occupational Therapy Board of New Zealand, 2010)

As you can see, culture is more than ethnicity, something that is reflected in the literature throughout the health field, and that has appeared time and again in the readings I have found.  Despite the positive intentions of our Board, and others around the world, Kirsh, Trentham, and Cole (2006) found that:

That this research was conducted in Canada, the home of one of the best-known OT frameworks, speaks volumes.  Kirsh et al (2006) found five main themes in their research of subjects who identified as minorities, either ethnically and/or in terms of religion or sexuality.  I have summarised them below in a Powerpoint.

Within the field of occupational therapy itself, there have been voices that have made suggestions in line with these findings, a primary voice being Michael Iwama.  His Kawa model is well-known in the field, and is based upon the organic and tangible model of a river, rather than the more abstract models that are also in use.  Of differences in cultural views of occupation, he (2006, p. 18) has written:

Whilst new and alternate theoretical materials are a challenge for myself as a student, I can certainly see where our field's most popular models may not directly translate, particularly when utilised with people from collectivist cultures.

References

Occupational Therapy Board of New Zealand.  (2010). Cultural competence. Retrieved from http://www.otboard.org.nz/Competence/CulturalCompetence.aspx

Iwama, M. (2006). The kawa model: Culturally relevant occupational therapy. London, UK: Churchill Livingstone.

Kirsh, B., Trentham, B., & Cole, S. (2006). Diversity in occupational therapy: Experiences of consumers who identify themselves as minority group members. Australian Journal of Occupational TherapyI, 53, (pp. 302-313).

Breaking Barriers or Creating Barriers?

I asked a number of friends if they would mind sharing stories where they had either had a positive or negative experience with healthcare professionals where cultural norms differed between themselves and the practitioner they were seeing.  The results were very interesting.  In some cases, they, as clients, were respected with regards to their culture.  In others, well, the results were not so great.  I have altered the names of contributors, for confidentiality's sake. These are the real stories of real people. As you watch the videos, try and think how you would feel from the client's perspective, and how you think you would react if you met this person when you were in the position of power as a practitioner. What would you do if you saw or overheard a colleague behaving in these ways?

 

 Amy's Story

George's Story

Karla's story

So that's the not-so good. The times when a lack of cross-cultural understanding led to poor intercultural communication. Now I'll share some examples that are much more positive.

 

 Carol's Story

Henare's Story

 

These examples are much closer to what we should be aiming for.

Know Yourself

In order to be able to understand the cultures of others we must understand our own.  In the first year of my degree, we had a social anthropology paper, in which we looked at the iceberg model of culture, created by Edward T Hall in 1976 (in Devarakonda, 2013).  For those not familiar with this model, here's a short video:

(ConstantForeigner, 2013)

As you can see, there is very little about any culture that is openly displayed, and what is on display can be difficult to interpret without an understanding of the psychology and philosophy that is beneath the surface.  For this paper, we also had to create our own version of the iceberg.  For my analogy, I used a river delta.  I chose this as my model because I connect to the sea, it is very important to me spiritually.  Maori are a Polynesian people, a people of the Pacific Ocean, seafarers and voyagers.  We came to this land via the sea, we are a nation of moderate-sized islands, and in most parts of the country, are no more than a few short hours from the sea.  In my model, pictured below (Brown, 2011), the river is the seen behaviour, the tidal flats are the marginal areas that some observant people may notice, and the sea itself is the unseen.  The river is clear-cut, the flats diversify and become more difficult to follow, and the life in the sea is almost entirely below its surface.  At the delta, the tide goes in and out, allowing what is unseen to feed what is seen.

(Brown, 2011)

Without a sound understanding of our own cultural norms, we cannot see the ways in which our behaviours, psychology, and philosophies may impact upon those from differing backgrounds to our own, and we cannot see how this may impair our ability to engage with such people in a therapeutic way.

References

Brown, M.L. (2011, November 3). River delta [Image]. Personal collection.

ConstantForeigner (Producer). (2013, June 5). Edward T. Hall's cultural iceberg [Video file]. Retrieved from http://www.youtube.com/watch?v=c6aeqXaXOSg

Devarakonda, C. (2013). Diversity and inclusion in early childhood: An introduction. London, UK: SAGE Publications Ltd.

What is Cross-Cultural Communication?

So what exactly is cross-cultural communication?  It pays, firstly, to look at what defines cultural communication.  Cushman and Craig (in Philepsen, 2003) suggest that cultural communication is made up of two basic components; networks and codes.  Networks include "nations, culture, class, subculture, region, community, and family" (p. 36), and codes are "language, dialect, and accent".  Non-verbal communication cues such as body language and gestures can also be included under codes.

Language and dialect can mean more than just the basic language spoken and its variations, such as Mandarin with its numerous dialects.  Language can also be a subset of a specific language, that depends upon an environmental, cultural, or occupational context.  Different sports have language specific to them, that may seem unintelligible to a speaker of that general language who does not have knowledge of that particular sport.  Cricket has a number of interesting terms, such as silly mid-on, googly, beamer, third man, slips, reverse sweep, and yorker.  To a cricketing fan this language makes sense, but to the uninitiated, such terms would most likely seem nonsensical.  Similarly, different employment fields have their own languages, as do different religions, and different leisure activities.  There are an untold variety of both formal and informal language subsets within any language.

Who are you speaking to today?
(U-coaching, 2013)

Cross-cultural communication occurs when a person from one culture, with its own networks and codes, tries to understand the networks and codes of a person from a different culture (Prosser, 2012).  When two people from different cultures meet, and attempt to communicate, this is called intercultural communication.  Spending time looking at cross-cultural communication assists the individual in their intercultural communication.  Obviously it would be near-impossible to understand all the various dialects and cultural norms on the planet, but by having a look at those most common in our area, we can improve our ability to build therapeutic relationships with members of our local population.



Reference:

Philepsen, G. (2003). Cultural communication.  In W.B. Gundykunst (Ed.), Cross-cultural and intercultural communication (pp. 35-52). Thousand Oaks, CA: Sage Publications, Inc.

Prosser, M.H. (2012). Cross-cultural communication. In Encyclopedia of communication theory (pp. 248-252). Retrieved from http://www.sagepub.com/edwards/study/materials/reference/77593_6.1ref.pdf

U-coaching. (2013). Cultball [image]. Retrieved from http://u-coaching.de/wp-content/uploads/2010/04/cultball.jpg

An Introduction

My name is Megan, and I'm in my final year of a Bachelor of Occupational Therapy.  I'm of Maori, Scottish, Welsh, Irish, and Cornish descent.  As a person of mixed ancestry, who identifies more with a minority culture in a post-colonial nation, I find myself straddling two different worlds in my daily life, including the way in which I view my health and well-being.  Despite being in my mid-thirties, and living in a country where indigenous values and meaning are recognised to some extent within the healthcare system, and in healthcare education, I still encounter difficulties on a routine basis within the health sector.  This can, at times, be frustrating.  Having a bicultural experience of health and well-being, of personal and community values, the language I use to express myself, and the ways in which I find meaning in my life, I am subject to conflict of some philosophical kind in most things that I do and most places I go.  If it can be difficult for me, having the advantage of being born and raised in this country, and belonging to a culture that is specifically touched upon within mainstream education, I wondered how difficult it may be for those from other minority cultures, especially those that are more recent arrivals, and for whom English is a second language.  My life's journey has constituted exposure to two main cultural experiences, mainstream western New Zealand, and Te Ao Maori (the Maori world).  Here is a picture of New Zealand's population at the 2006 census, the values do not add up to 100%, as individuals who identified as belonging to more than one ethnicity were added to each category that they acknowledged:

(Statistics New Zealand, 2013)

As you can see, 42.8% of the population identified as something other than just European, and 28.2% identified as something other than just European and/or Maori.  This tells me that communication and values for over a quarter of the population of New Zealand could be significantly different to what I am accustomed to.  In order to be the best therapist I can be, I am going to expand my learning, step outside my cultural comfort zone, and take a look at a world that is right on my doorstep.

Reference

Statistics New Zealand.  (2013). Ethnic groups (from 2006 census) [graph]. Retrieved from http://www.stats.govt.nz/browse_for_stats/snapshots-of-nz/nz-in-profile-2013/about-new-zealand.aspx