I am sure many of you, just like myself, have to read information and pass a yearly test to show that you are culturally competent to care for your patients. Recent events in my life have shown me that this testing is not nearly enough.
A long time cancer survivor, who was very involved in our supportive services and in helping others along the way with their cancer journals, recently died. We had the honor of knowing her for 13 years. To show our respects, staff took a collection and wanted to send flowers. The funeral was very quick and no calling hours were mentioned. This raised a red flag for me as I knew she was Jewish. What did I know about Jewish culture?
I didn't have any close Jewish friends and had never been to a Jewish funeral before. The same could be said of my coworkers. I decided to do some internet research on my own and was surprised to find that sending flowers to a funeral or mourner’s home is strongly discouraged in Judaism -- the flowers will wither and die in a few days, reminding everyone of their loss. They also consider this trying to “pretty up” or hide the reality of death. It is best to offer your presence and give to a charity in memory of the one who has died. I sure was glad I hadn’t ordered flowers. We decided to write a letter honoring her legacy and donate the money to a charity.
Then there was the matter of the funeral. I attended along with many of those from our cancer support group. None of us were familiar with Jewish funerals. The casket was closed and in the very back of the room. All the men were given a head covering to wear. At the cemetery, the family and then the others in attendance threw dirt on the grave -- to hear the earth landing on the casket and recognize the reality of death and begin to let go This was very difficult for some of the older people in our group to understand as it was so different from what their experiences with funerals had been. I had a lot of teaching to do.
We were all used to calling hours before the funeral, but the Jewish people “Sit Shiva” after the funeral. This is the time when people visit and bring food to show their respect.
On another note, today I attended a hospice conference that focused on diversity and inclusion. I became even more aware of how much I really did not know. It was very enlightening. I cannot recap the entire conference, but will share a few case studies that made an impact on me.
The first was of a Muslim who spoke with his doctor through an interpreter (a person of his choosing). He was being given the option of receiving chemotherapy for his cancer. This would involve the use of a continuous infusion through a pump The man said he did not want chemotherapy. His disease progressed and chemotherapy was once again offered. He said he would take pills or shots but no pump. What was discovered was that the man feared the pump would interfere with his praying (on his knees and bowing forward to the floor). If this had been discovered earlier, a plan to meet his needs could've been met.
The last example was a man who did not take his hypertension medication because he thought it was for “being hyper,” but of course this was not the case. He did understand high blood pressure, but did not know that was the same thing as hypertension.
When we are working with our patients, we need to take a minute for “teach back.” Have them explain to us what they understand about what we tell them, ask questions, and teach in a way that they can understand. I will be much more diligent now in looking up the cultural practices of my patients so I may better care for them.
Has anyone else had any experiences with lack of knowledge regarding cultural diversity?
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