Journal Entries
December 12, 2013
This class required students to read various documents or book chapters and watch recordings of addresses given on the topic of cultural competency and write journal entries. The words below are from those journal entries. Most were meant to be a personal reflection on the subject and not displayed for public view. I do so here with raw emotions.
Journal Entry for: Tervalon, M., & Murray-Garcia, J. (1998). 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, 9(2), 117-125.
Beyond the need to complete a required course for my major I like to find purpose and value in each course I take. My time is valuable, evermore so now that I am so busy. I don’t like to waste time. One pursuit I find to be a waste of time is busywork that directs me to process information that I do not believe I will ever use. At first I was worried that this class would be such busywork. I did not feel the need to be educated about diverse cultures and having lived in multicultural communities all of my life I was pretty sure I knew how not to be a bigot. This reading changed something for me. I thought I knew what “Cultural Competency” meant. I was wrong.
While reading this article I was most struck by speaking of relations between healthcare provider and patient in terms of humility. I am convinced that all acts of bias are based upon pride. The assigned value between the two or more distinctions of race, ethnicity, language, culture, gender, sexual orientation, class or ability is the basis of all prejudice. Who places the value? Society has been such a poor judge in terms of where value should be placed. I hope to use the definition of actions to incorporating cultural humility in all of my future years as a midwife. When Tervalon and Murray-Garcia spoke of the goals as cultural humility and defined it as, “incorporat[ing] a lifelong commitment to self-evaluation and critique,” I found my objective for this course.
The article listed a distinct mix of identifiers that for me has a more valuable distinction than only speaking of discrimination based upon race, gender or sexual orientation. For example, I may have long identified the intrinsically immoral behavior of treating an individual disrespectfully based upon the color of their skin but would I ascribe the same disgust when I treat someone poorly just because they are not as educated as I; or they live in “that part of town.” It is worthy to note that we can at times act without regard for the education we have received on cultural awareness because of our attitude. I needed this change in attitude. I now understand that increasing knowledge without a change of heart in terms of cultural humility would be like learning that you could save someone’s life by applying a balm of a miracle ointment and then never using it. Cultural humility may mean the difference to life and death if we ignore signs and symptoms. For example; because we have been told that all (fill in the blank here with a culture other than your own) express their pain beyond what is normally expressed by those in the general population, we choose to ignore the possibility of an impending uterine rupture.
When speaking of self-evaluation the authors say this means, realistic and on-going self-appraisal. This I can do and I will do. I vow to always be a student of my clients. I pledge to ever be humble enough to assess each individual based upon their experiences without predisposed judgments or generalities.
Journal Entry for: Garcia, R.S. (2004). The misuse of race in medical diagnosis. Pediatrics, 113, 1394-5.
Dr. Garcia's ethnic description of his daughter's genetic mixture is just slightly more varied than that of my own grandchildren. My eldest daughter's children are one-half Ecuadorian (of indigenous tribes), one quarter Cuban (of Spanish immigrants), one-eighth English and the rest mixed European heritage with a Native American ancestor according to family lore. Which genes made it into their DNA? When speaking in terms of medical diagnosis will they be more predisposed because of their genes or more protected by their family's lifestyle? When making assumptions about possible a diagnosis it is fine to include possible diseases because of genetic connections but it is vital to be thorough to consider those not commonly found in racial populations and or gender.
This is also true of gender. Not all disease known to be predominately suffered by women are found in men as well. For example, I am not the only member of my family to suffer from Fibromyalgia my cousin's husband also has all symptoms of this syndrome most commonly found in women. My brother has Multiple Sclerosis a disorder more often found in women also although when men have MS they are often more severely disabled by it as in my brother’s case.
When speaking in terms of midwifery what could be assumed incorrectly in expectant mothers? Would all African American young women be single teenage mothers or at risk for preterm birth? Should race be part of the questions asked when caring for pregnant women? Should we assume that because a woman may be from a lower socioeconomic part of town that she eats poorly and cannot afford to do better? Even worse as a home birth midwife could we unknowingly presume that since more minority women deliver prematurely these women should not be considered candidates for midwifery care in an out of hospital setting at all? These rhetorical questions (I hope the answers are obvious) could be of concern automatically if we looked at populations rather than individual some. Just a few days ago a black woman told me that when in the care of a midwife at Kaiser she was assumed to be a teen mother without a partner. In fact the young woman was 20 years old at the time and was treated horribly with comments that even if true are not respectful or necessary. I share the story with a fellow doula and she stated that it is common in her observation that minority young women are be assumed to be single teen mothers.
How do we do better? By speaking with respect to clients of all ages in every socioeconomic class and of any race or sexual orientation we empower all women. We need to ask the women we serve the nature of their family histories without regard for their race and listen to their stories to learn their needs. If a woman presents with symptoms we need to consider all possibilities and not just those which would be predominately be found in members of her race.
Journal Entry for: Miller, J., & and Garran, A.M. (2008.) Chapter 1 - Background: Social identity and situating ourselves. In Racism in the United States: Implications for the helping professions (1-12). Belmont, CA: Thomson Brooks/Cole.
I am not surprised that I have strong feelings of frustration when it comes to racism. I was lovingly taught by wonderful parents to treat everyone with equal respect. This chapter gave me hope for a better experience than just moving through the motions. I am committed to examining myself and finding my general place in society. I agree that I dislike the terms used to describe individuals by the color of their skin but nor do I think that we need to identify each person by their ancestral home and add American. Race is much more complex. I’m sure a person who is 100% Sudanese is not pleased to be identified as African American because she has black skin. Shouldn’t we ask about her struggle to escape her homeland through a terrible camp in Cairo Egypt to land in the home of the free before assuming where she received her scars? A walk in another’s shoes may not be possible but we must try. That none of us is a bystander to racism is a new concept to me. While I would certainly never stand paralyzed when another is beaten would I hold my tongue when they are lashed by words?
I am not yet ready to say that I feel privileged by the color of my skin. I do understand the concept, but, I think, because I am a woman and I feel all women have at some degree been victims of discrimination, I am subjected to discrimination in many forms. I am also a member of a religious sect whose forbearers were oppressed and driven out of lands in the United States before finding peace in being apart from others to grow into a community well respected in all nations around the world. I value the work that it takes to stand up for your rights as a human being and support all who do so. I can see the value that it has to be of a privileged class I’m just not sure I feel privileged.
When reading that the authors understand that no one reading this book is responsible for the systemic racism I was relieved. Often I feel powerless to address it. I am committed to press past my comfort zone in a way that expands my thinking and creates new insights into the experiences of the women I hope to serve in the future. No one persona can erase the past, I am powerless to do so, but I feel empowered to make one small change in my own life and heart to identify my own internalized patterns that may need to change.
I am committed to becoming the best midwife I can be. I am not perfect but I hope to be perfectly humble in my work. Humility is one attribute that even in striving for the perfection of it we can lose sight of the pride we may feel by our humility but I shall try. I hope to develop a lady's hand, a hawk's eye, and a lion's heart along with humility for the lessons that each woman may teach me.
Journal Entry for: Centers for Disease Control and Prevention. (2000). A discussion with Camara P. Jones MD, MPH, PhD. CityMatCH Video
The video of the interview with Dr. Camara Jones was a very informative; it made me think. I was moved to consider the questions she posed at the end of her discussion.
How is racism operating here (within midwifery services)? Am I in denial that racism exists? How can I change? I also had other questions form while listening to her. Am I committed to setting things right? Could I be expressing or holding prejucial beliefs unintentionally? I hope to “strike a balance between pushing [myself] to do more while also being gentle with [myself].” (Miller and Garran, pg. 3)
So in striking this balance what is my responsibility? Is it my responsibility to see that the soil is enriched? Does it take a person of color to eliminate racial disparities in my future birth center? Will I need to intentionally recruit a midwife of color to appropriately care for women of color in my neighborhood? Is this not also discriminatory? Am I incapable of understanding the differences in the realities for women of color so much that I should not be a midwife for someone not of my race? If so won’t this always keep the “soil” separate? Just because I hope to have a luxurious spa-like atmosphere in my planned birth center - with a likely higher than average price tag does that mean I am ignoring a segment of my community that may not be able to afford the luxury?
I do believe that the midwives model of care is the best system of reproductive health care for all women. Therefore, midwifery care should not be limited to the few who can afford it. So how will I make it available to all when my costs for operating a luxurious birth center may be higher than if I only offer the option of home birth? One of my reasons for opening a birth center in the first place is because not all women live in circumstances that are conducive to giving birth in their homes. Women whose homes are too far removed from the centrally located hospitals for example or women who for one reason or another do not live in their own home where they can have privacy or control over the environment. Why do I plan for it to be luxurious; who would want it any other way? Don’t all women deserve to birth in a beautiful space.
In considering my personal place in the broader community I begin to consider whether or not it is my responsibility to enrich the soil; and if it is not a mandate do I want to make it part of my personal mission. One thing is clear to me and of this I am sure, I do desire to serve so that means I serve without regard for race, sexual orientation, religion, national origin, age or marital status. Why, because I believe it to be the only morally correct path.
So to return to where I began, the questions, will I answer all of them today, probably not but they are important to consider.
Beyond the need to complete a required course for my major I like to find purpose and value in each course I take. My time is valuable, evermore so now that I am so busy. I don’t like to waste time. One pursuit I find to be a waste of time is busywork that directs me to process information that I do not believe I will ever use. At first I was worried that this class would be such busywork. I did not feel the need to be educated about diverse cultures and having lived in multicultural communities all of my life I was pretty sure I knew how not to be a bigot. This reading changed something for me. I thought I knew what “Cultural Competency” meant. I was wrong.
While reading this article I was most struck by speaking of relations between healthcare provider and patient in terms of humility. I am convinced that all acts of bias are based upon pride. The assigned value between the two or more distinctions of race, ethnicity, language, culture, gender, sexual orientation, class or ability is the basis of all prejudice. Who places the value? Society has been such a poor judge in terms of where value should be placed. I hope to use the definition of actions to incorporating cultural humility in all of my future years as a midwife. When Tervalon and Murray-Garcia spoke of the goals as cultural humility and defined it as, “incorporat[ing] a lifelong commitment to self-evaluation and critique,” I found my objective for this course.
The article listed a distinct mix of identifiers that for me has a more valuable distinction than only speaking of discrimination based upon race, gender or sexual orientation. For example, I may have long identified the intrinsically immoral behavior of treating an individual disrespectfully based upon the color of their skin but would I ascribe the same disgust when I treat someone poorly just because they are not as educated as I; or they live in “that part of town.” It is worthy to note that we can at times act without regard for the education we have received on cultural awareness because of our attitude. I needed this change in attitude. I now understand that increasing knowledge without a change of heart in terms of cultural humility would be like learning that you could save someone’s life by applying a balm of a miracle ointment and then never using it. Cultural humility may mean the difference to life and death if we ignore signs and symptoms. For example; because we have been told that all (fill in the blank here with a culture other than your own) express their pain beyond what is normally expressed by those in the general population, we choose to ignore the possibility of an impending uterine rupture.
When speaking of self-evaluation the authors say this means, realistic and on-going self-appraisal. This I can do and I will do. I vow to always be a student of my clients. I pledge to ever be humble enough to assess each individual based upon their experiences without predisposed judgments or generalities.
Journal Entry for: Garcia, R.S. (2004). The misuse of race in medical diagnosis. Pediatrics, 113, 1394-5.
Dr. Garcia's ethnic description of his daughter's genetic mixture is just slightly more varied than that of my own grandchildren. My eldest daughter's children are one-half Ecuadorian (of indigenous tribes), one quarter Cuban (of Spanish immigrants), one-eighth English and the rest mixed European heritage with a Native American ancestor according to family lore. Which genes made it into their DNA? When speaking in terms of medical diagnosis will they be more predisposed because of their genes or more protected by their family's lifestyle? When making assumptions about possible a diagnosis it is fine to include possible diseases because of genetic connections but it is vital to be thorough to consider those not commonly found in racial populations and or gender.
This is also true of gender. Not all disease known to be predominately suffered by women are found in men as well. For example, I am not the only member of my family to suffer from Fibromyalgia my cousin's husband also has all symptoms of this syndrome most commonly found in women. My brother has Multiple Sclerosis a disorder more often found in women also although when men have MS they are often more severely disabled by it as in my brother’s case.
When speaking in terms of midwifery what could be assumed incorrectly in expectant mothers? Would all African American young women be single teenage mothers or at risk for preterm birth? Should race be part of the questions asked when caring for pregnant women? Should we assume that because a woman may be from a lower socioeconomic part of town that she eats poorly and cannot afford to do better? Even worse as a home birth midwife could we unknowingly presume that since more minority women deliver prematurely these women should not be considered candidates for midwifery care in an out of hospital setting at all? These rhetorical questions (I hope the answers are obvious) could be of concern automatically if we looked at populations rather than individual some. Just a few days ago a black woman told me that when in the care of a midwife at Kaiser she was assumed to be a teen mother without a partner. In fact the young woman was 20 years old at the time and was treated horribly with comments that even if true are not respectful or necessary. I share the story with a fellow doula and she stated that it is common in her observation that minority young women are be assumed to be single teen mothers.
How do we do better? By speaking with respect to clients of all ages in every socioeconomic class and of any race or sexual orientation we empower all women. We need to ask the women we serve the nature of their family histories without regard for their race and listen to their stories to learn their needs. If a woman presents with symptoms we need to consider all possibilities and not just those which would be predominately be found in members of her race.
Journal Entry for: Miller, J., & and Garran, A.M. (2008.) Chapter 1 - Background: Social identity and situating ourselves. In Racism in the United States: Implications for the helping professions (1-12). Belmont, CA: Thomson Brooks/Cole.
I am not surprised that I have strong feelings of frustration when it comes to racism. I was lovingly taught by wonderful parents to treat everyone with equal respect. This chapter gave me hope for a better experience than just moving through the motions. I am committed to examining myself and finding my general place in society. I agree that I dislike the terms used to describe individuals by the color of their skin but nor do I think that we need to identify each person by their ancestral home and add American. Race is much more complex. I’m sure a person who is 100% Sudanese is not pleased to be identified as African American because she has black skin. Shouldn’t we ask about her struggle to escape her homeland through a terrible camp in Cairo Egypt to land in the home of the free before assuming where she received her scars? A walk in another’s shoes may not be possible but we must try. That none of us is a bystander to racism is a new concept to me. While I would certainly never stand paralyzed when another is beaten would I hold my tongue when they are lashed by words?
I am not yet ready to say that I feel privileged by the color of my skin. I do understand the concept, but, I think, because I am a woman and I feel all women have at some degree been victims of discrimination, I am subjected to discrimination in many forms. I am also a member of a religious sect whose forbearers were oppressed and driven out of lands in the United States before finding peace in being apart from others to grow into a community well respected in all nations around the world. I value the work that it takes to stand up for your rights as a human being and support all who do so. I can see the value that it has to be of a privileged class I’m just not sure I feel privileged.
When reading that the authors understand that no one reading this book is responsible for the systemic racism I was relieved. Often I feel powerless to address it. I am committed to press past my comfort zone in a way that expands my thinking and creates new insights into the experiences of the women I hope to serve in the future. No one persona can erase the past, I am powerless to do so, but I feel empowered to make one small change in my own life and heart to identify my own internalized patterns that may need to change.
I am committed to becoming the best midwife I can be. I am not perfect but I hope to be perfectly humble in my work. Humility is one attribute that even in striving for the perfection of it we can lose sight of the pride we may feel by our humility but I shall try. I hope to develop a lady's hand, a hawk's eye, and a lion's heart along with humility for the lessons that each woman may teach me.
Journal Entry for: Centers for Disease Control and Prevention. (2000). A discussion with Camara P. Jones MD, MPH, PhD. CityMatCH Video
The video of the interview with Dr. Camara Jones was a very informative; it made me think. I was moved to consider the questions she posed at the end of her discussion.
How is racism operating here (within midwifery services)? Am I in denial that racism exists? How can I change? I also had other questions form while listening to her. Am I committed to setting things right? Could I be expressing or holding prejucial beliefs unintentionally? I hope to “strike a balance between pushing [myself] to do more while also being gentle with [myself].” (Miller and Garran, pg. 3)
So in striking this balance what is my responsibility? Is it my responsibility to see that the soil is enriched? Does it take a person of color to eliminate racial disparities in my future birth center? Will I need to intentionally recruit a midwife of color to appropriately care for women of color in my neighborhood? Is this not also discriminatory? Am I incapable of understanding the differences in the realities for women of color so much that I should not be a midwife for someone not of my race? If so won’t this always keep the “soil” separate? Just because I hope to have a luxurious spa-like atmosphere in my planned birth center - with a likely higher than average price tag does that mean I am ignoring a segment of my community that may not be able to afford the luxury?
I do believe that the midwives model of care is the best system of reproductive health care for all women. Therefore, midwifery care should not be limited to the few who can afford it. So how will I make it available to all when my costs for operating a luxurious birth center may be higher than if I only offer the option of home birth? One of my reasons for opening a birth center in the first place is because not all women live in circumstances that are conducive to giving birth in their homes. Women whose homes are too far removed from the centrally located hospitals for example or women who for one reason or another do not live in their own home where they can have privacy or control over the environment. Why do I plan for it to be luxurious; who would want it any other way? Don’t all women deserve to birth in a beautiful space.
In considering my personal place in the broader community I begin to consider whether or not it is my responsibility to enrich the soil; and if it is not a mandate do I want to make it part of my personal mission. One thing is clear to me and of this I am sure, I do desire to serve so that means I serve without regard for race, sexual orientation, religion, national origin, age or marital status. Why, because I believe it to be the only morally correct path.
So to return to where I began, the questions, will I answer all of them today, probably not but they are important to consider.
References
Tervalon, M., & Murray-Garcia, J. (1998). 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, 9(2), 117-125.
Garcia, R.S. (2004). The misuse of race in medical diagnosis. Pediatrics, 113, 1394-5.
Miller, J., & and Garran, A.M. (2008.) Chapter 1 - Background: Social identity and situating ourselves. In Racism in the United States: Implications for the helping professions (1-12). Belmont, CA: Thomson Brooks/Cole.
Centers for Disease Control and Prevention. (2000). A discussion with Camara P. Jones MD, MPH, PhD. CityMatCH Video
Tervalon, M., & Murray-Garcia, J. (1998). 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, 9(2), 117-125.
Garcia, R.S. (2004). The misuse of race in medical diagnosis. Pediatrics, 113, 1394-5.
Miller, J., & and Garran, A.M. (2008.) Chapter 1 - Background: Social identity and situating ourselves. In Racism in the United States: Implications for the helping professions (1-12). Belmont, CA: Thomson Brooks/Cole.
Centers for Disease Control and Prevention. (2000). A discussion with Camara P. Jones MD, MPH, PhD. CityMatCH Video
Reflection
I have often, since taking this course, read of the plights of individuals seeking respectful medical care. The most profound of the stories I have encountered is that of Lia Lee told in the book The Spirit Catches You and You Fall Down. I reviewed the book in a blog post. I continue to learn from the thoughts and information presented in this course and I always plan to do so. It is a very important topic for every professional in the field of medicine, especially holistic medicine, to understand that each individual comes to the exam room with a unique background, upbringing, and culture that influences how they will respond to the "treatment" prescribed. I endeavor to always learn from to ask the women in my care the "Eight Questions" developed by Arthur Kleinman and found in Anne Radioman's book. (Read an excerpt containing the questions here: Academic Medicine: June 2001 - Volume 76 - Issue 6 - p 621).
1. What do you call the problem?
2. What do you think has caused the problem?
3. Why do you think it started when it did?
4. What do you think the sickness does? How does it work?
5. How severe is the sickness? Will it have a short or long course?
6. What kind of treatment do you think the patient should receive? What are the most important results you hope she receives from this treatment?
7. What are the chief problems the sickness has caused?
8. What do you fear most about the sickness?
1. What do you call the problem?
2. What do you think has caused the problem?
3. Why do you think it started when it did?
4. What do you think the sickness does? How does it work?
5. How severe is the sickness? Will it have a short or long course?
6. What kind of treatment do you think the patient should receive? What are the most important results you hope she receives from this treatment?
7. What are the chief problems the sickness has caused?
8. What do you fear most about the sickness?
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