The Mold of Cultural Competency

Wednesday was my first day at Health Center 6. Expecting  to be shown the ropes and dealing only with in-house tasks, the learning curve was designed to be somewhat flat as I gained my bearings. Little by little, I thought, and soon I would be able to take the training wheels off. Then the phone rang. My mentor picked up the phone and started speaking broken Spanish. Suddenly the phone was handed in my direction. “You speak Spanish, right?” Nodding, I nervously grasped the phone and spoke into the receiver.

^{Health Center Six serves a large proportion of Hispanic patients; more than any other PDPH health clinic in Philadelphia. As a result, cultural competence is a vital point of emphasis. Photo Source: Shepard University, Diversity and Cultural Competency Seminar, http://www.shepherd.edu/safweb/specialevents/resources/default.html}
Little did I know in the moment that this scenario on my first day would ultimately set the tone for my role as the Prescription Assistance Program Advocate(PAP).  At Health Center 6, more than 60 percent  of the patients I have the privilege of serving on a daily basis are of Hispanic descent. At first, I thought this was due to an unusually large Latino population around 3rd Street and Girard Avenue.  However, after speaking with the providers, nurses, clerks, and other healthcare professionals at  Health Center 6, , I realized the significance of language and culture on patients’ choice of clinics. Many of the  patients at Health Center 6 take multiple buses, trains, and trolleys to receive care at a clinic where they are comfortable listening and speaking in their native tongue. Whether it was a mother from Honduras searching for an affordable medication for her one year old son’s eczema, or a recently retired Peruvian gentleman searching for a practical method to deal with his emphysema, comfort and reliability keeps Hispanic patients coming through my doors.

With my clientele in mind, I found that the NHC training we recently received on cultural competency and language access really struck a chord with me. Ms. Jones, a veteran of the Health Federation, talked about various strategies that make an employee professional and courteous when serving patients that speak other languages. In her eyes, these methods improve  efficiency and advance the patient-provider relationship, , which is critical in any healthcare setting. In particular, she made two points that I vividly remember and actively try to incorporate into my day-to-day service in Prescription Assistance. First, she emphasized the importance of  being understanding and allowing extra time to interact with patients of another culture. . I quickly began to realize that since Spanish is not my native language , it is best to speak slowly and clearly, with the ultimate goal of helping  the patients feel as relaxed as possible. I strive to emphasize quality of care rather than quantity of patients seen, especially given that  I have my own office and do not have a set, structured patient schedule, contrary to some of the other healthcare professionals in my health center. I realized  that creating this safe atmosphere for my patients to escape the constant hustle of a busy clinic improved mood and morale significantly, as optimism would fill the room. My patients’ typical complaints such as “I’ve been waiting around all day” became “I really appreciate your willingness to tend to my needs.” “I’m nervous about not being able to afford my medications” turned into “I see I have multiple ways to receive my medicine now”.

The second piece of knowledge Ms. Jones shared was to ask open-ended questions, in simple and clear language to the consumer. The concept of establishing rapport was also stressed, which I began to understand was critical in the PAP office. My first month at the clinic, a Bolivian lady in her late 40s  came to see me about receiving insulin, as she was recently diagnosed with Type 2 diabetes. She was visibly nervous, unsure how her life would be impacted by the burden of diabetes, both physically and financially. I talked her through the application process to receive her insulin and asked her if she wanted additional material on how to administer her insulin each day. She nodded eagerly and took the pamphlet I offered. However, the more I discussed what the pamphlet contained, the less she contributed to the conversation, instead resorting to nodding and “Si”. Seeing this, I began asking more open-ended questions, including “What questions do you have for me?”. With this, , she was empowered to speak up about her thoughts and feelings g, instead of being told what to do. It was through this method that she admitted she was illiterate, and would not be able to understand the pamphlet, devoid of pictures. This allowed me to provide her with visual  information as well, and we were both able to move forward from an otherwise potentially difficult situation.

These two principles, along with my situational experiences thus far in the PAP office, have really helped heighten my awareness of the impact cultural competency has. I believe a critical component to healthier communities begins with developing social capital, which encompasses establishing harmonious rapport, as well as utilizing patience and showing empathy.
 

This blog post was written by NHC Philadelphia member Chamara Fernando.
Chamara serves as the Patient Advocate at Philadelphia Department of Public Health-Ambulatory Health Services Health Center 6.