Cross Cultural Service

According to Illich (1968), hypocrisy is, perhaps, an instinctive trait shared by majority of Americans. They are mentally prepared to accept that the motives of potentially legitimizing the 1963 international volunteer action are not applicable when it comes to performing the very same act five years later. “Mission vacations” involving the poor people of Mexico was the trend among wealthy American students during the initial half of the decade. Emotional concerns for the just-found poverty beyond the nation’s southern border, together with utter thoughtlessness to the far severer state of the domestic poor, warranted this benevolence. Intellectual understanding of the challenges linked to successful volunteer action failed to dull the spirits of the soi-disant volunteers, papal volunteers, and Peace Corps (Illich, 1968).
Illich (1968) believed the presence of institutions such as the Conference on InterAmerican Student Projects was actually insulting to the Mexican nation. He claimed he felt revolted by the whole thing and believed their actions and good intentions were not interrelated. To him, the theological idea of good intentions can help no one. Indeed, according to the Irish, good intentions mark the way to hell, which summarizes this theological understanding. However, he did state that he had profound faith in American volunteers’ good will (Illich, 1968).
This, though, may be explained through a terrible want of innate delicacy. By their very nature, Americans can’t help eventually being vacation salesmen for a bourgeois American lifestyle as they know no other life. Such a group couldn’t be conceived if there was no relevant ‘mood’ created in America in support of the notion that a true American has to share the blessings of the Almighty with underprivileged humans. The notion that all Americans have a few things to give, which they always must, explains the decision of students of that period to spend some months in Mexican villages and aid their farmers to develop (Illich, 1968).
After weapons and money, American idealists are the third greatest export of North America; they can be found in all arenas: teaching, voluntary work, missionary work, economic development, community organization, and vacationing altruism. Ideally, their role may be defined as service. In fact, they often alleviate the destruction wreaked by weapons and money, or attract third-world societies to the advantages of a world of accomplishment and prosperity. At this point, Illich (1968) feels that we had rather emphasize to Americans that their lifestyle is simply not sufficiently alive to share with all (Illich, 1968).
America can only survive if it persuades the remainder of the planet that it is a sort of ‘Heaven on Earth’, in Illich’s (1968) opinion. Its survival is contingent on the universal acknowledgment by the world’s “free” people that its bourgeois society has attained their goals. The American lifestyle, to the speaker, had grown into a religion that had to be adopted by everyone who wished not to perish by weapons like the napalm or sword. America has been striving worldwide to safeguard and develop minorities who consume that which is affordable to the American majority. This was the aim of the Latin America-United States bourgeois Alliance for Progress (AFP). However, this business association increasingly requires protection by weapons that enable the minority capable of “making it” to safeguard their accomplishments and procurements (Illich, 1968).
The AFP has garnered considerable success within the Latin American region in terms of increasing the share of individuals who have become more affluent (that is, the small share of bourgeois elites), besides giving rise to ideal military dictatorship conditions. Initially, the dictators served plantation owners; however, they currently defend the novel industrial complexes. Illich (1968) asserts that the American students aid Mexican underdogs in accepting their destiny. Their sole accomplishment within rural Mexico is creation of chaos, and, at most, convincing Mexican females to wed a self-made, affluent youth who disregards tradition. The worst they could do in the name of community development would be creating sufficient chaos to give rise to actual shooting at the end of the vacation, and rushing back home to hear jokes on Mexicans (Illich, 1968).
Finally, Illich (1968) advises the students to remain home, actively participate in the elections, understand what they’re doing and why, learn communication skills, and grasp the concept of failure. He believes it is extremely unfair for linguistically ignorant Americans to be imposing themselves on rural Mexicans when they are utterly unaware of what locals think of them and what they are doing. It is also highly detrimental to an individual to define what he/she desires to do using terms like “good,” “help” or “sacrifice” (Illich, 1968).
Approaches to Cross-Cultural Service
The majority of the anxiety created within the life of Lia Lee and her family may be attributed to their non-adherence to physician-established therapeutic plans. Particularly, their incapability of maintaining the strict schedule of drug administration necessary for the effective management of her repeated seizures led to severe medical complications, risking Lia's life. For ensuring compliance with her treatment plan, it was decided to relocate Lia from home (i.e., from parental care) to foster care. Seizure management, in Lia’s case, was associated with innumerable challenges, like the need for administration of several medicines according to a strict schedule and repeated medicine regimen modifications for ideal symptom management. Such a complex medicine regimen proved particularly tricky for Lia's non-English-speaking parents, who had absolutely no understanding of contemporary medicine. Furthermore, a lack of professional translation services at hand meant facility workers and home healthcare providers had scant alternatives to make her parents grasp complicated instructions (Fadiman, 2012).
Different cultures perceive reality differently. Thus, it is vital that healthcare practitioners realize the way these views affect their grasp of perspectives impact their understanding of clinical and health care. After all, medical realities are constituted on the cultural basis; also, and the grounds for several healthcare-related decisions, like the time and place to seek medical assistance, duration of assistance, and assessment of success, emerge externally from the biomedicine culture. As per Kleinman, all clinical encounters are “transactions between explanatory models” typically entailing serious inconsistencies in cognitive matter, besides therapeutic values, aims and expectations. Instead of communicating instructions and anticipating that patients will conform to them, practitioners need to grasp patients’ understanding of their own ailments, and negotiate therapeutic plans considering patient perspectives (Fadiman, 2012).
Cultural clashes take place partly due to the assumption in biomedical culture that biological matters are of greater clinical import, more real, more interesting, and more basic as compared to sociocultural and psychological problems. The key matter of interest is disorder, rather than sickness, and its main aim is to cure, rather than to heal. This point of view underscores not psychosocial management but a technical quandary. It is not as concerned about ‘meaning' as the remaining healthcare forms. Patients are viewed as machines. Hence, reorienting our view and strategy and taking into consideration psychosocial elements which typically contribute to a greater extent to patient understanding of wellbeing and ailments may render biomedical solutions more effective. Strategies which fail to take into account patient outlook on their ailment may result in non-conformity, suboptimal care, and dissatisfaction (Brinkmann, 2018).
There is a greater likelihood of incomprehension and disagreement when a patient hails from a culture which perceives ailments to be beyond the biomedical system. It is particularly critical, in such cases, that providers make an attempt to comprehend patient viewpoints. Comparing the physician and patient models helps clinicians discern key inconsistencies which can result in clinical management issues. Moreover, these comparisons aid clinicians in understanding the elements of their explanatory model which require more explicit explanations to patients as well as their family members, besides deciding upon the most apt patient education form. That is, despite the convincing advantage of biomedical resolutions and justifications, a grasp of patient standpoint enables practitioners to concentrate educational efforts to ensure maximum likelihood of resonance with patients. Kleinman recommends posing several related questions to patients and patient families targeted at clarifying and facilitating this aspect (Fadiman, 2012).
Spiritual views contribute significantly to grasping the cultural gap between the provider’s and Lia’s family; the former felt the latter required the support of a local child protection organization for enforcement of his medical instructions. Fadiman’s story of Lia Lee reveals that all aspects of life are linked to spirituality for the Southeast Asian Hmong community (Fadiman 1997). Individuals with powerful spiritual beliefs, who feel ailments have spiritual causes, might require further support services (e.g., religious specialist, spiritual counselor, hospital chaplain, etc.). These service providers may collaborate with other healthcare team members and facilitate patient care. But even in the absence of such specific cultural know-how, sensitivity towards patient families by utilizing the bioethical autonomy principle could result in a more dialogic patient-provider relationship (Fadiman, 2012).
Fadiman’s work indicates that the human scientific perspective and growing pool of empirical studies within the domains of cultural competence, bioethics, and medicine-and-religion have facilitated a greater likelihood of understanding the way these clinical encounter elements affect both individual and population group cases. Ever since, Merced’s clinician community has provided a succession of avenues of community training/education, which includes training the healers of the Hmong community with regard to medical procedures. Such measures aim at improving trust between healthcare facility workers and Hmong community members. Further, facility employees have reconsidered care-related points in which Hmong community healers can be included; currently, they perform around eighty-five rituals and interventions. Such a cross-cultural marriage of biomedical technology and cultural beliefs may forge trust and relationships between communities from one case to the next (Brinkmann, 2018).
Physician-patient relations are grounded in layers of faith. It is taken for granted by patients, in general, that all professionals possess requisite abilities and knowledge for adequately performing their roles. Patients enter into therapeutic relationships with competence being the first trust level. While physicians normally don’t have to earn this facet of trust, it may be lost (e.g., if any significant/fatal error occurs on the part of the physician). The technical competence expectation is backed by ethical codes, professional role-regulating rules, and institutional procedures. As this constitutes the minimal trust level, clearly, forging an effective client-provider relationship which generates wellbeing or restoration of health entails more than mere clinical ability and know-how: it needs to entail something within their interpersonal interaction (Laws & Chilton, 2012).
Conclusion
It may prove highly rewarding to healthcare providers to work with those belonging to a different cultural background. Fadiman explains how the Hmong community’s culture deepened her personal insights into family, empathy and assistance. Such valuable views may be missed if the emphasis is solely on delivery of biomedical solutions. Contemporary medicine provides tangible resolutions to ailments and, according to Kleinman, can treat “both disease and illness.” Practitioners’ attempts at providing such solutions to a culturally-diverse patient pool will succeed better if they learn to accept others’ views and cultivate within themselves the requisite skills for incorporating them into everyday clinical decision-making. Their personal lives will also be enriched through being open to perspectives which differ from their own (Brinkmann, 2018).


References
Brinkmann, J. T. (2018, May). The Spirit Catches You: Cultural Collisions and Cooperation in Medical Encounters. Retrieved March 1, 2019, from https://opedge.com/Articles/ViewArticle/2018-05-01/the-spirit-catches-you-cultural-collisions-and-cooperation-in-medical-encounters
Fadiman, A. (2012). The spirit catches you and you fall down: A Hmong child, her American doctors, and the collision of two cultures. Macmillan.
Illich, I. (1968, April). To hell with good intentions. In Conference on Inter-American Student Projects. Cuernavaca, Mexico. Retrieved from http://www.swaraj.org/illich_hell.html
Laws, T., & Chilton, J. A. (2012). Ethics, Cultural Competence, and the Changing Face of America. Pastoral psychology, 62(2), 175-188.