Culture Brokers, Clinically Applied Ethnography, and Cultural Mediation

Abstract

This chapter looks at the practice of cultural mediation and the role of culture broker in medical settings with a focus on the cultural consultation service (CCS) of the Jewish General Hospital in Montreal and ethnopsychiatric consultation clinics in France and Italy. We first provide an overview of the concept of culture broker and culture in anthropology and its introduction into the medical settings of underserved communities, especially Aboriginals and immigrants. We then explore the most recent cultural mediation models emerging in the last 20 years in Europe, focusing on a few examples of implementation and policies. The culture broker is a go-between who sensitizes clinical practitioners to patients’ belief systems and encourages patients to “trust” the institutional system. Definitions of culture brokers, their professional recognition, and the roles they play in mediation vary cross-nationally and depend on different ideologies of citizenship and power relations. In practice, culture brokers are usually situated between two approaches: one, aimed at assimilating the immigrant’s point of view to the healthcare system and larger society, and the other, a more inclusive two-way exchange that offers space for each participant to understand the other’s point of view through providing opportunities for negotiation and empowerment strategies. We illustrate the complex and challenging role of culture broker at the CCS service through significant vignettes. They aim to show how culture brokering practices are context-based, depending on the embodied ability to recognize, tolerate, and mediate between diverging regimes of interpretation.