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).