Cultural competency in professional practice

Cultural Competency Scenario: A Muslim, African Moroccan woman and a male, American clinical home health worker aide

Imagine this -- you are a male clinician in the home health care industry assisting in the at-home treating of an older African woman. The woman has recently come to this nation and needs assistance with bathing, meal preparation and other minor assistance performing ordinary acts of daily self-care. In her original nation of Morocco, this woman long faced government, social, and family-sponsored discrimination that rendered women unequal before the law and forbade such a close physical relationship between a man and a woman. (Human Rights Watch, 2004) No matter how noble the clinician's intentions, he must accept that the woman has a profoundly different and ingrained view of the sexes than himself -- and it is not his ethical responsibility as a caregiver to overcome what he may perceive as prejudices, but to arrive at a treatment plan and relationship that promotes the individual's physical health but still gives the woman a comfortable degree of autonomy that she believes is acceptable to her cultural and religious beliefs.

First of all, the clinical must come to understand the concept of translation -- can the woman understand him when he speaks in English? If not, is there a family member who can translate what he says into the woman's native tongue? If aural literacy is not a problem, will the meanings he imparts be comprehensible to the patient, in her own cultural terms? If he feels that the woman is open and willing to understand his offered perspective, he can explain that he is there to make her feel comfortable, not uncomfortable, and offer to help her feel more comfortable, when facilitating the basic care. Having a female family member present to assist the woman might be a source of comfort for the patient, even if the man's added strength is necessary to help the woman to and from the bath, for example. An additional female aide or family member could assist with the more delicate proceedings of bathing. If the woman was exceeding uncomfortable, during the first initial care requiring disrobing, she could wear a hospital gown or bathing suit.

Simply accepting a man in a caring role might be difficult for the Moroccan woman. Showing interest in what foods are both culturally acceptable as well as nutritious for the woman is important, especially as seeing a man engaged in such an unfamiliar care giving role might be surprising for her. If the medical recommendations go against some of her religious prescriptions, such as a diabetic fasting during Ramadan, a balance may need to be struck that is amicable to both caregiver, physician, and patient in such a way that does not jeopardize the woman's health. (Burden, 2001) It might even be necessary to consult a religious leader in the community, to provide theological assistance in interpreting the Koran's words on medically unadvised fasting.