aiaCONNECT

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OK, just once, close your eyes for a moment.  When you are done, keep them open to the reality for 25 million people in our country.  Imagine you are really sick.  You are in a hospital and no one speaks your language, or shares your skin color or religion.  You try to communicate through hand gestures what is wrong.  The medications you have been given have not been working.  You are not sure you are even being treated for the right condition.  Your family sits mutely in the waiting room.  Feelings of confusion, frustration, and helplessness grow with every passing minute.

Despite having just elected our first African-American President and in addition to other efforts over the past thirty years to eliminate discrimination, cultural and racial discrimination in the area of health care is alive and well in our country.

Hispanic Americans (14.8%) and Asian Americans (4.1%) comprise almost one-fifth of our population.  In spite of this, institutional barriers to good health care for these and other populations exist.  A lack of bilingual and culturally trained staff in key client contact points results in lack of access and mistreatment through miscommunication for those with limited English skills or from other cultures.  In addition, a lack of representation in medical research means the effectiveness of medical treatments may actually be unknown.

Our challenge, as a melting pot nation, is to ensure everyone receives culturally competent care and enable our health care providers to operate in an increasingly culturally diverse setting.  Achieving this requires that health

care providers understand and respect cultural differences and recognize differences within groups of people.  Ethnic and minority communities are groups with diverse histories, languages, cultures, religions, beliefs and traditions.  One band-aid does not fit all.

The same applies to research.  The typical participants courted for clinical trial research are middle-aged white males.  Minority populations, differing ethnic groups and special populations (women, children and senior citizens) lack representation in medical research.  Evidence of this inequality is found in the need for the NIH Revitalization Act of 1993 passed by the US Congress, which includes requirements for the inclusion of women and minorities in randomized controlled trials.

Health care providers and administrators need to identify ways of providing health care across cultures.  There are several means to accomplish this.  One of the more obvious ways is to make staff working in health care settings more aware of the disparity that exists.

Providing workshops and education opportunities for care providers creates awareness and sensitivity.  Giving them language skills and/or knowledge of cultural differences for populations they treat results in increased confidence levels for dealing with their patients.  This means better relationships, better communication and a more productive workplace.

Creating professional standards for cross-cultural competence within this educational component should also be considered.  Providing structure and guidelines ensures a more consistent approach.

Lastly, instead of focusing on a relatively small segment of the population, we need to ensure a more diverse representation of cultures and minority groups in medical research.  Trials should be targeted to enroll specific subgroups.  Instead of generalized medicine, research can more accurately represent the population that carries a specific disease and determine how treatments manifest themselves in various patient populations.

Don’t close your eyes to the cultural and racial discrimination that exists in our health care system.  With our constantly evolving global environment, one mode of providing clinical service to all health care patients is no longer sufficient.  Our nation functions on principles of equality.  Health care should not be an exception.  Competent and compassionate care should exist and be available to everyone regardless of their culture or ethnicity.

 ©aiaTranslations 2009

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