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Cultural awareness advocated in rehabilitation services
By KEVIN FRYLING
Reporter Staff Writer
As the nation's foreign-born population continues to increase, health and rehabilitation service providers must become more aware of their clients' cultural orientations and bridge the gap between their culture and that of their clients, the director of UB's Center for International Rehabilitation Research Information and Exchange (CIRRIE) said during a UBThisSummer lecture last week.
JOHN STONE
John Stone, clinical associate professor in the Department of Rehabilitation Services, offered strategies in which professionals can negotiate such cultural differences during the July 13 lecture, entitled "Disability and Culture."
Stone recalled that he experienced his first encounter with the sort of culture clashes that rehabilitation service providers face now more than ever while working years ago as a Peace Corps volunteer in rural India.
Stone spent time in India during the late-1960s surveying fields for purposes of irrigation and contour farming. But once, after a minor mix-up with the townspeople erased 24 hours of hard work, Stone discovered that his anger with the situation was at odds with the outlook of the local residents, who viewed the situation with greater aplomb.
The difference was in his cultural orientation, said Stone, a Buffalo native who spent 17 years in Brazil, as well as two in India and one in Greece. Westernized cultures often measure the value of actions in terms of their product or results, he said, while Eastern cultures often place greater emphasis on an action's intent. The lack of results from his work didn't affect the Indian farmers' attitudes towards him, he noted.
"Who you were was more important than what you accomplished," he said.
Western and Eastern cultures also differ in terms of individualism versus collectivism. Stone points out that collectivist values mean a health-care worker might face a difficult situation when a mother and daughter both want the mother present as the service provider conducts a sensitive examination or interview.
The individual-based, action-oriented culture inherent to rehabilitation services sometimes clashes with the cultural orientation of the people it serves, said Stone, who noted that cultural awareness by service providers must increase in importance as the nation's foreign-born population rises.
"About 5 percent of the population in the U.S. was born outside the country 30 years ago. Today, that number is more like 11 percent," he said.
Nearly 35 percent of foreign-born individuals in the U.S. are from Central America, he said, with about 26 percent from Asia.
Stone noted that clients from foreign cultures sometimes perceive their disabilities in different terms than their rehabilitation providers. Although modern cultures use biomedical and social terms to explain disabilities, there are other cultures that view them through religious or folk beliefs. Some see disabilities as punishment for sins in this life or a previous life, or as the result of the malevolent influence of spirits. There also are cultures that view certain conditions, such as blindness, as a source of mystical power or as a gift from God.
Moreover, reactions to disabilities are not the same across the board. Some Latino cultures, for example, find it shameful for disabled individuals to work, said Stone, because it is seen as an indication that their families are too poor or otherwise unable to provide for them. Other cultures prefer to confine disabled individuals.
However, it is not the job of rehabilitation providers to alter the fundamental beliefs of their clients, said Stone, who admitted there are attitudes that some might find "repugnant." At least outward tolerance of other beliefs about disabilities is required, he said, explaining that there are effective methods through which professionals can nudge their clients toward a more positive position on disabilities within their own belief system.
The service provider needs to be able to bridge the gap between the rehabilitation system and the culture of the foreign-born client," said Stone. For example, a rehabilitation worker who has a disabled Muslim client who believes it is rebellion to avoid a divine "test of faith" might cite the well-known statement: "For each illness, Allah provides a remedy."
Such methods are known as "culture brokering," said Stone. The term first arose with anthropologists who used it to describe individuals in colonized nations whose knowledge of both societies allowed for conflict mediation through cross-cultural communication.
He has met numerous "culture brokers" abroad who were kind individuals who eased his cultural confusions by providing pertinent facts or explanations, he said.
Heath-care workers later adapted the cultural-broker concept, he said. Mary Ann Jezewski, associate dean for research and director of the Center for Nursing Research in the School of Nursing, developed a theoretical health-services model that CIRRIE applies to rehabilitation services, he said.
Stone acknowledged that rehabilitation workers cannot know all cultures, but cultural-assessment methods, as well as general knowledge of other cultural beliefs about disabilities, enable service providers to demonstrate "cultural competence" in their interactions with clients. This resolves conflicts and makes sure that cultural differences do not prevent those who need it from receiving assistance.
"To continue to mature as professionals and as human beings, [service providers] must swim in the multicultural, multireligious, multi-ideological ocean of modern and postmodern society," said Stone. "As do all of us."