Cultural Competence in Global Health

By Nathan Douthit

[I]n the…aim to produce cultural competence, one dimension to be avoided is… narrowly defining competence… in its traditional sense: an easily demonstrable mastery of a finite body of knowledge. Rather, cultural competence…is best described… as a commitment and active engagement in a lifelong process that individuals enter into on an ongoing basis with patients, communities, colleagues, and with themselves.^[1]

            Dunton et al describe the importance of cultural competence in taking care of patients in minority communities in "Navigating care for Bedouin patients with diabetes." They describe the case of a patient with a 30 year history of diabetes. Despite his best efforts, the doctor's success when, "encouraging the patient to make lifestyle changes… proved virtually impossible." He developed End Stage Renal Disease as a result, and then suddenly passed away, likely secondary to "a heart attack due to complications from chronic diabetes."

            In light of the rise of chronic disease, specifically as demonstrated in a "minority culture within a larger Western society," the training of culturally competent physicians is essential. In this case, fatalism plays a key role. The eldest son writes,

            "During my father's disease, his socioeconomic situation was good…. He could go to the experts…. [But] he didn't consider diabetes a major threat. He was shocked when he was told he needed dialysis. He initially refused treatment for a few weeks before we convinced him with the help of his doctor…. We were sorry that he died. But in our society, we believe in God and see this as the will of God. We can't do anything about it."

            Addressing fatalism, a "main obstacle in educating and motivating patients," requires a culturally sensitive dialogue. The authors recommend focusing on quality of life rather than threat of death. Having patients "consider how changes in lifestyle will help in remaining strong and active until the prewritten day of death," may help in addressing this issue.

            According to the authors, "the link between trust and the adherence to treatment regimens is found within many communities." Training culturally competent physicians must focus on having knowledge, skills, and respect and being able to implement these effectively in cross cultural situations.^[2] "Culturally appropriate intervention channels" are key to reducing stigma and raising patient awareness of available resources.

            Cultural competence has been shown to improve many health behaviors, specifically related to nutrition, exercise and substance use habits.^[3] Culturally competent physicians must be willing to partner with local leaders. As the authors write, "if community and leaders could establish the importance of diet as something on par with the importance of vaccinations, it would contribute to changing the culture positively."

BMJ Case Reports invites authors to publish cases regarding cultural competence and humility in training global health practitioners. Global health case reports can emphasize:

            -The effects of culturally appropriate health interventions

            -Training methods for culturally competent global health practitioners

            -Disease spread or exacerbation as a result of cultural incompetence

            -Innovation in culturally appropriate interventions

Manuscripts may be submitted by students, physicians, nurses or other medical professionals to BMJ Case Reports. For more information, review the blog on how to write a global health case report.

Read more about cultural competence and humility in the interaction of clinicians with patients at BMJ Case Reports

            –A Rohingya refugee's journey in Australia and the barriers to accessing healthcare

            –Ethiopian-Israeli community

            –Analysis of the psychosocial impact of caretaking on the parents of an infant with severe congenital heart defect.

Read more about cultural competence and humility from other sources

            -Tervalon M, Murray-Garcia J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. Journal of health care for the poor and underserved. 1998;9(2):117-25.

            -Brach C, Fraserirector I. Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Medical Care Research and Review. 2000 Nov;57(1_suppl):181-217

            -Goode TD, Dunne MC, Bronheim S. The evidence base for cultural and linguistic competency in health care. New York^ eNY NY: Commonwealth Fund; 2006 Oct.

^[1] Tervalon M, Murray-Garcia J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. Journal of health care for the poor and underserved. 1998;9(2):117-25.

^[2] Brach C, Fraserirector I. Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Medical Care Research and Review. 2000 Nov;57(1_suppl):181-217.

^[3] Goode TD, Dunne MC, Bronheim S. The evidence base for cultural and linguistic competency in health care. New York^ eNY NY: Commonwealth Fund; 2006 Oct.

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