Eyes Wide Open. Mind Wide Open.

It was early morning. The air was damp with humidity and the sun’s early rays were already sending their searing heat onto gentle skin. With backpacks and our newly made badges clipped to the sides of our shirts, two of my friends and I climbed the stairs to what would be the first of many orientations to come. Around twenty of us were gathering that morning for the MPH/MD orientation and after being awakened by a warming cup of coffee, we sat in a room for hours listening to the procedures and the types of classes that we had signed up for the next four years. The information was overwhelming, daunting, and confusing. I will be the first to admit that I spent most of my time going over the different customizations and drooling over the different maternal health and global health classes: Vaccines and Immunization Programs, AIDS in Africa, Epidemiology and Control of Infectious Disease, Comparative Healthcare Systems, Public Health and Human Rights…and so much more.

But all those little details were a blur from the morning. Through the haze of information though, there was one quote one of the speakers said that spoke to me. I found myself immediately picking up my pen and scratching down the words so I would not forget it.

“Culture always changes so we are not always competent to culture. Let us be culturally sensitive and practice cultural humility.”

What does this mean? Well, as said per statement, culture changes. Cultural evolves with time and differs between generations. As time passes, views are changed and practices are done vastly to minimally differently. Just take a look at the culture in America and how that has changed in the past forty years. Culture is dynamic. Thus, we cannot be an expert in culture. We just have to be receptive and most importantly, sensitive. We must be open and we must always be willing to learn and to adapt to whatever culture we work in or whatever culture we encounter. Whether this be in practice or daily life. I realized how important the lesson I gleaned from the quote would be for the rest of my career.

Again I saw this during my volunteering time at the Refugee Health Clinic. There I encountered patients from the Congo and Nepal. Who knew?! Who knew that such diverse populations existed in San Antonio, TX, but yet here they were coming in for healthcare. They were all such humble people looking for just some relief for their pain. They had sweet smiles and amicable faces. It was such a refreshing change for me considering I had spent the past two weeks cooped up in my OneNote and anatomy lab.

One of the last patients I saw reminded me of the culture issue again. (I am changing some characteristics of the patient) The patient from Nepal came in with a tooth ache. When the dentist examined her, she realized that the patient’s problem probably came from the practice of chewing bones in their diets. They do so to not waste anything; a very common theme in Asian cultures. The patient was very sweet with a smile on her face, an amused gleam in her eyes, and was ever so patient, opening her mouth wide open again and again so other medical and nursing students could observe. After I had stepped back from the patient, the dentist turned and looked at me seriously, posing a good question. How do you tell this patient to stop practicing a practice that she probably does daily? How do you tell this patient that an integral component of her culture is actually harming her health? And how do you ask these questions all in a respectful manner without indirectly insulting her culture? The dentist looked back at the patient with a soft, critical eye and then said simply, “It’s hard, but you try.” You try with respect and empathy directed toward the patient.

It’s true. There’s not an established method of approaching these kind of issues. But I know one of the biggest challenges for physicians in America will be the different culture and language boundaries they will encounter depending on what region of the states they will practice at. Thus, it is so incredibly important during those times of cultural and language frustration to be patient, kind, and receptive to the patients’ practices. It is an exercise of trust between patient and physician.

But really, what a gift. What a gift for us physicians to be able to encounter such different people and make such a variety of connections. One of the greatest powers of medicine is its ability to cross cultural and language barriers. Let’s all remember this for our future practice. Let’s all remember to always be culturally sensitive and practice cultural humility.



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