By Maggie Finley
Culture shapes all encounters. Much of how we gain access and move through culture depends on perception, understanding, and meaning. As people of faith, we come from a place of humility, knowing we tread sacred ground. It’s already in our chaplain DNA to bridge gaps, so in spite of our differences, relationships always starts with conveying genuine concern as we plumb patient stories for their hopes, dreams, and expectations for good care. To enter into another’s pain is to approach humbly, for where we tread is sacred ground.
Fortunately, post-Vatican II, we’ve inherited the wisdom born of the revolutionary interface between social science and theological inquiry — a first step toward deconstructing the heritage of colonialism in favor of more liberating local theologies. Animated by a new sense of Shalom, incarnating the God who pitched a tent to reconcile all of creation, paradigms for pastoral ministry shifted. We were encouraged to recognize, accept, and celebrate the unbounded creativity of a Spirit already at work in all people, places, and circumstances.
I’ve been privileged throughout my chaplaincy to study multicultural and cross-cultural communication. I felt compelled to learn as much as possible, not only to become a better chaplain to a diverse population, but to come to a deeper knowledge of myself as a multiracial woman in ministry. Working at University of Washington/Harborview Medical Center’s Community House Calls and Interpretive Services in Seattle, and later at Harborview’s International Women’s Clinic, I learned about Berlin and Fowkes’ LEARN Model for cross-cultural communication. It’s simple and not unlike what we already do:
Listen to patient/family story, perceptions, concerns
Explain your perspective [role], ask them to explain as well (reframe, assess understanding)
Acknowledge, discuss differences and similarities
Recommend a plan (e.g. plan of care or referral)
Negotiate agreement (explore ways to serve)
A word about interpreters: I highly recommend using them whenever appropriate. I know some hospitals prefer telephone “language lines,” and I know we tend to be constrained by time, short staffing, and large caseloads. But they can be wonderful allies in furthering our work.
Whether or not you make interpreter-assisted visits often, you can learn contextually during visits. If possible, speak privately with the interpreter for a few minutes before and after the visit. Ask for thumbnails on the environment you’re about to enter, then at the end try to process briefly. This way you are not one more member of IDT to overwhelm with or repeat questions. Try to find practitioners actually trained as cultural brokers, recognized members of communities served. Besides language and custom, a good broker may be fluent in diverse belief systems related to health, healing, and wellness; cultural variations in the perception of illness/disease and cause; help-seeking behaviors and attitudes toward healthcare providers; and indigenous/traditional health practice.
Transcultural bridge-building is painstaking and precious. These questions have implications for how well you provide spiritual care:
How do the patient and family see my role? What, if anything, do I offer?
Is there concept and/or language equivalency? Do I need an interpreter? Are shamans, medicine (wo)men or other spiritual leaders involved in care and healing? What are some ethical pieces in the patient’s particular religious context? What rituals are there for sickness, healing, and dying? Is syncretic practice present (e.g. Native Americans who may practice both natural and Catholic religions)? If so, is it still kept secret (i.e. clandestine rituals forbidden or unlawful in the past)?
What’s the concept of family? Who are mediators or contact persons? What are customs and language for delivering bad news? What must you understand about a patient’s right to know? Are interactions gender-specific (e.g. care for Muslims)? Are family dynamics intergenerational (e.g., do Gen Xers and millennials embrace the dominant culture)?
As you probably know, many of those seeking care are from diaspora communities challenged to find footing in the dominant culture. So there may be unspoken concerns about racism, finance, immigration status, or language skill that need sensitive intervention.
Chaplain interventions can enhance cultural communication because of what’s uniquely ours to give — listening deeply to a particular narrative for what has personal meaning, connection, and congruence. Competent and compassionate presence has the potential to build relationship and beloved community — an ideal that we cannot overlook, especially when cultural divides are daily drawing attention to an urgent need for better understanding.
So questions of how we navigate culturo-religious difference may be always with us. The good news, as Okokon Udo tells us, is that “none of us can be an authority on the values and beliefs of every culture.” Competence comes from hearts “opening to and holding cultural difference with deep respect, with eagerness and willingness to learn and accept that there are many ways of looking at the world.”
Maggie Finley, BCC, is a retired chaplain from Providence Hospice of Seattle.
For further reading:
Vargas, Jose Antonio. “A New America,” in A Matter of Spirit, Intercommunity Peace & Justice Center, No. 111, Summer 2016
UW/Harborview Med. Ctr. https://ethnomed.org/
Fadiman, Anne. “The Spirit Catches You and You Fall Down” New York: GFS Press, 1997
Gittins, CSSp, Anthony J. “Gifts and Strangers: Meeting the Challenge of Inculturation,” Paulist Press, 1989