The Expat Family: Kids at School

Posted on December 26, 2011 by admin

Expats families relocating to the US may be familiar with the bureaucratic and administrative side of sending their children to American schools. But how will American culture influence your child’s education?

Many expats are surprised to find that the values American teachers are trying to teach may be different from their own. Expats who understand the  classroom culture and who have regular communication with the school will be better equipped to handle cultural differences and conflicts as they arise. 

Inside the classroom
The American classroom is often more informal than many expats are used to in their home country. Students often work in groups and classroom conversation is normal. Students are encouraged to ask questions, express individual opinions, and think creatively. Rote learning is limited. Class participation is highly valued and considered in grading. Children do not get homework every night, and in elementary school, they rarely get homework on the weekend.

What if I’m unhappy with my child’s school or teacher?
Speak up!  You can request a meeting with the teacher to discuss concerns. Come prepared with specific issues to discuss and the changes/results you would like to see. Express your concerns directly but politely. If you cannot resolve the issue with the teacher, you should make an appointment with the principal to discuss the problem.

Get involved!
For the expat’s trailing spouse, getting involved in your child’s school is a great way to learn about the culture, prevent isolation, meet other parents, and find out about your child’s classroom activities. Join the PTA, attend parent/teacher conferences, and volunteer for class and school activities.

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Should Physicians Tell Patients the Truth?

Posted on August 2, 2011 by admin

Many Western doctors believe it is best to give full disclosure to patients regarding the diagnosis, treatment options and potential outcomes of severe or life threatening illnesses. This is considered the patient’s right to autonomy.

While patient autonomy is held in high regard in the US, for many other cultures including Arab, Asian, Latin American, as well as parts of Eastern and Southern Europe, disclosing an illness is undesirable. It is seen as a burden to the patient while withholding information gives peace and hope.

Many non-western cultures believe the illness is a shared responsibility of the family. They may prefer that the family receive information regarding diagnosis, as well as make decisions about and organize patient care. The family may ask that the patient not be told of the diagnosis.

Patients and providers will work best together when the relationship is based on trust and respect. For this reasons, physicians must consider the cultural beliefs and desires of their diverse patients regarding illness and treatment.

Physicians should find out the preferences for disclosure at the time of intake, before any testing is done, to avoid appearing as if they are hiding information they already know.  Physicians should find out:

  1. How does the patient/family view illness? Is it purely biomedical (Western) or more spiritual and holistic?
  2. Does the patient/family value individual decision-making  or collective family decision-making?
  3. Does the patient want to be told about the diagnosis, treatment options and possible outcomes? If so, in how much detail? If not, who should be told? Who will be responsible for decision making?

Physicians should show respect by incorporating the cultural values and beliefs  of patients and families into the decision-making process, even if it is in contrast to the physician’s own beliefs.

Posted in American culture, Arab culture, Asian culture, Hispanic culture, cross cultural communication, healthcare | Tagged , , , , , , , , , | Leave a comment

Understanding Patients Customs and Beliefs

Posted on June 28, 2011 by admin

Clinical staff can improve their relationships with patients by understanding the diversity of health care customs and rituals across cultures.  Clinicians should also identify their own cultural filters and biases and how they impact client services.

Understanding patients’ and one’s own beliefs will help clinicians identify typical barriers to effective health care delivery and outcomes that are due to cultural orientation.

Examples of customs and beliefs may include:

Latino
1. Personal relationship and trust between provider and patient is extremely important.
2. Belief in fatalism or God’s will. This can affect whether or not they seek care and adhere to treatment.
3. Medical decisions often involve the whole family.
4. May use traditional or folk healers and medicines.
5. Since Latin culture is hierarchical, patients often view the doctor as an authority figure and may not express disagreement or lack of understanding.

Asian
1. Asian culture views health in a more holistic light than in Western culture. Health is not only physical, but spiritual, social and environmental.
2. Balance and harmony of opposing forces leads to good health. (e.g. yin and yang; Ayurveda (Indian) medicine).
3. Fatalism affects views of illness. This can include punishment or curses from spirits for wrong doings in this or past lives.
4. Traditional healing includes herbal medicines, as well as acupuncture to restore flow of chi (the life force in everything)
5. Medical decisions are made with the family. Often, bad news is withheld from the patient.

African American
1. Faith and prayer are an important part of the healing process.
2. African American culture has a history of a strong mistrust of the health care system.
3. Belief in fatalism or God’s will.
4. Extended family and friends play an important role in successful treatment and healing.
5. Tradition of herbal remedies. Health care providers should ask about these to avoid potential drug interactions.

Here are some good websites for more information on patients customs and beliefs:

A Sample of Health Beliefs of Some Regions and Peoples of the World

Cultural Competence Health Practitioner Assessment

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To learn English, learn about your own language

Posted on June 6, 2011 by admin

English language learners tend to use English in ways stylistically similar to their first language, both when speaking and writing. That is why an effective language  training program must include developing awareness of cultural norms of communication.

Learners must identify not only the stylistic norms in English communication, but in their native language as well, to develop awareness of what is and what is not, appropriate and effective. Identifying similarities and differences in stylistic norms will make you more aware of your errors in English.

The following are examples of styles contrasting with U.S. English:

U.S. English

Linear

Direct

“Face” not important

Abstract

Procedural

Concise

 Other Styles

Circular

Indirect

“Face” very important

Concrete

Relational

Digressive

It is important to remember that appropriate language use and cultural competence cannot be separated.  Language training must include helping learners recognize  both  linguistically and culturally appropriate usage, and to be able to apply this knowledge when communicating.

Linguistically appropriate usage (ie, grammar) is easier to learn and usually taught explicitly. Culturally appropriate usage is more difficult to adopt and is rarely taught explicitly. Awareness is the first step in this process.

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The Business Case for Culturally Competent Health Care

Posted on May 23, 2011 by admin

Culturally competent health care is good business. Health care organizations that can provide culturally and linguistically appropriate services to their diverse clientele at all points of contact will have better service delivery and health outcomes, while boosting the bottom line.

Clinical staff must be familiar with the diversity of health care beliefs and practices across cultures. Clinical staff should be able to apply cross cultural strategies for effective intake and interviewing, history taking, and delivering bad news.

Non-clinical staff must know how to create a welcoming and helpful environment for LEP clients. They should be able to assess a client’s English language ability and adjust their message to better collect information, communicate processes and give directions.

When both clinical and nonclinical staff can communicate effectively and deal appropriately with clients from different cultures, you will see:

  1. Decreased medical errors
  2. Decreased medical costs
  3. Increased patient satisfaction
  4. Improved primary and preventative care
  5. Improved patient comprehension of treatment
  6. Improved patient completion of treatment and health care outcomes
  7. Improved patient/provider relationships
  8. Improved marketing to a major consumer demographic segment
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5 Ways to Encourage Punctuality and Time Consciousness

Posted on April 6, 2011 by admin

Concepts of time vary by culture. This can create cross cultural conflict or misunderstanding in the workplace. American managers who work with employees from polychronic cultures should be aware of these differences and apply techniques for encouraging monochronic awareness.

How can American managers who are working with polychronic employees encourage a more time conscious work environment?

1.  Discuss in the hiring process. If you are hiring people from polychronic cultures, it is helpful to clearly define tasks and duties as well as standards about schedules, punctuality, deadlines and consequences for not meeting these standards.

2. Be seen. Lead by example. Let employees watch you work to see your pace and use of time.  Be punctual yourself . Keep to planned schedules and deadlines.  Be sure to arrive on time and prepared for meetings.  Make unscheduled visits to see how time is being used.

3.  Build relationships.  Polychronic cultures are also relationship oriented. Take the time to build relationships so workers will feel personally obligated to meet deadlines and schedules. Let them know how it negatively affects the team when they aren’t punctual.  A personal commitment to team success is excellent motivation. Praise team members when projects and tasks are completed on time.

4.  Set Dates and Targets – Be very clear about what specific deliverables are required on what specific date and/or times.   Give plenty of lead time. .Some workers may not have a clear idea of what is required of them and, for cultural reasons, not ask for clarification or question their superior. Make the dates and targets for each member clear to the entire team to get buy in from all members and to strengthen team cohesion.

5.  Address the team. Saving face and group acceptance are central to polychronic cultures. If deadlines and schedules aren’t met, address the entire team as an issue that affects them all. Have the team identify the reason for missed deadline and ways to avoid it in the future. Praising an employee by name as standing out from the group can be undesirable or embarrassing.

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When My Time Isn’t Your Time

Posted on April 6, 2011 by admin

Time is a culturally bound concept. Hispanic, Arab, African and Asian cultures are polychronic. They see time as fluid and flexible, with schedules secondary to relationships. American culture, on the other hand, is monochronic. Time as rigid and inflexible, with punctuality, deadlines and schedules highly valued.

Monochronic Cultures:

  • English speaking cultures, Northern Europe
  • Are sequential and linear
  • Do one thing at a time
  • See time as a limited resource to be managed
  • Dislike interruptions and digression and focus on completing the task
  • Time commitments (deadlines, schedules, appointments) very important
  • Are low-context
  • Follow set plans
  • Accustomed to short-term relationships

Polychronic Cultures:

  • Hispanic, Arab, African, Asian cultures
  • Are multi-track and circular
  • Do many things at once. Time for different tasks can overlap,  as long as all tasks get done.
  • View time as abundant.
  • Are relationship oriented: Interruptions are normal, expected and often welcome.
  • Fulfilling time commitments depending on circumstances and relationship.
  • Change plans often and easily when circumstances change.
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5 problem areas in English pronunciation

Posted on March 24, 2011 by admin

Why do I have an accent?
Non-native English speakers often use the pronunciation and communication style of their native language when speaking in English, resulting in accented speech.  Below are 5 common problem areas that can interfere with intelligibility when speaking in English. Accent Modification training can be a great help in addressing these problem areas.

1.  Intonation
Intonation refers to the paralinguistic vocal features such as: pitch, loudness, resonance, quality and flexibility. Speakers vary these to  show intent and emotion.

2.  Stress
Stress is extremely important in English and carries a great deal of information. There is stress on both word and sentence levels. Stress can show contrast, if the information is old or new, the focus of the message and other information about the speaker’s intent.

3.  Thought Groups
This is how speakers’ group words into phrases to make their ideas clear.  Thought groups put information in understandable chunks to help lead the listener through the speaker’s message.

4.  Linking
Linking is how we transition from word to word. It is based on the last sound of the first word and the first sound of the next word. Without linking, speech sounds choppy and disconnected.

5.  Vowels /Consonants
English is not a phonetic language, so it is often hard to know how to pronounce  a word by its spelling. Pronunciation in English is based on sounds, not spelling. Some sounds in English (th for example) don’t exist in other languages.

Error in these areas can make it difficult to be understood by native English speakers. The degree of the problem will vary depending on one’s native language, awareness of English pronunciation rules, and personal differences in language learning ability.

What is your native language, and which areas do you find the most problematic?

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Stages of Cross Cultural Awareness

Posted on March 16, 2011 by admin

Cultural awareness is a way of thinking about and viewing the world. It means understanding, respecting and successfully interacting with those whose world views, values, behaviors, communication styles, customs and practices are different than one’s own.

Cultural Awareness occurs in stages.

Stage 1: People are all the same.
This is the conviction that we all, deep down, hold the same values and beliefs. This very limited perspective is most often due to a lack of experience with difference.

Stage 2: Cultural differences exist, but my culture is the best.
In this stage, we realize that differences in cultural norms, values, customs and beliefs exist. However, they are seen as less desirable than our own, or even threatening. The desire is both to defend one’s own culture and minimize others.

Stage 3: Other cultures are of value and I can learn from them.
In this stage, we recognize the complexity and richness of other people’s cultures. We accept and see the potential benefits of other cultures’ values and beliefs. We may even choose to adopt some of these values or behaviors.

Stage 4:  More than one cultural frame of reference exists.
We become aware of our own cultural filters and begin to adapt our perceptions and behaviors. Through repeated exposure to or education about other cultures, we develop a deeper  understanding of a culture’s unique traits, values and norms. People in this stage can shift communication style and behaviors to effectively and appropriately  interact with diverse cultures.

Individuals in the first two stages are less likely to identify and resolve intercultural conflict than those in the latter stages.

Which stage are you in?

Posted in Uncategorized, cross cultural communication, cross cultural conflict, managing diversity | Tagged , , , | 3 Comments

5 Standards for Delivering Culturally Competent Healthcare

Posted on February 8, 2011 by admin

Culturally competent healthcare delivery is not just the right thing to do, it ‘s also good business sense. It is the culturally competent organization that will have a competitive edge in the health care market and a decreased likelihood of liability/malpractice claims.

The culturally competent healthcare organization:

1.  Empowers staff to work comfortably and effectively across the cultural and linguistic boundaries.

2. Takes a holistic view of health, inclusive of cultural health beliefs and practices, as well as the physical, mental and emotional aspects of diverse groups.

3. Provides training opportunities that tie cultural competence to improved health outcomes and promote culturally competent care, including awareness of:

  • demographics of cultures served and relevant cultural data
  • disease and illness patterns
  • health and wellness beliefs
  • expectations about provider/client relationship
  • communication style (both verbal and nonverbal)
  • relevant laws relating to cultural and linguistic access
  • Self-awareness of one’s own cultural beliefs, biases, and communication patterns

4. Promotes a system of recruitment and retention of qualified staff from diverse backgrounds who understand their patient cultures and communities in order to support an organizational culture that can better serve the community.

5. Incorporates linguistically appropriate services and provide appropriate language assistance at all points of contact. This may includes bilingual staff, interpreters and written materials (including signage)  in commonly used client languages. This may also include accent reduction training for employees to be more understandable to clients.

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