Obtaining a Cultural History

Abstract

The United States is made up of people of diverse national origins, races, religions, histories, and cultures. The dynamic interplay of old, recent, and new immigrants has had and continues to have a significant impact on the national identity and ethnicity of the country. By the year 2010 one third of the United States population will be regarded as minority.1 This increasing ethnic and cultural diversity raises many important challenges for society and presents a particular challenge to health care providers. Health care providers today face the challenge of caring for patients from many cultures who have different languages, levels of acculturation, and socioeconomic status, and have unique ways of understanding illness and health.2 Cultural differences, when misunderstood, can adversely affect the cross-cultural health care provider-patient relationship. Such misunderstandings often reflect a difference in culturally determined values, with effects ranging from mild discomfort to non-cooperation to a major lack of trust that disintegrates the therapeutic relationship.2,3 One recent book, “The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures,” is an especially gripping tale about a Laotian child with epilepsy.4 The parents’ belief about their child’s illness is that a “spirit” would “catch” the child and was responsible for making her “fall down” or have seizures. They reasoned that the spirit could not be affected by medication, and thus they did not understand the need to give the child anti-seizure medication. When she continued to have seizures, the doctors reported the parents to a child protection agency. The tragic result was that the child was taken from the parents. The parents were not negligent; they were merely victims of a lack of culturally competent health care. This instance, and others, should demonstrate the need for cultural competency to all health care providers. Cultural competence may be defined as “the process in which the health care provider continuously strives to achieve the ability to effectively work within the cultural context of a client (individual,