Barrel Strength

Institutions which deal with the public have to practise “diversity”, but the diversity hospitals practise is based on metrics of real differences, about which no politically correct squeamishness can be tolerated. In an environment where people’s lives are at stake, little allowance can be made for pride, prudery, or excessive sensitivity to bodily functions.

Hospital staff is generally locally-hired and of the dominant culture. Patients can be anybody: immigrants unskilled in either offical languages, or natives of different, unassimilated cultures. How different? And how is it handled? The answers are fascinating because they illustrate how an institution must deal with the realities of cultural and racial differences, in a time when political correctness would deny their existence or their significance.

1. Inuit

A local hospital is the chief receiving point for Canada’s Inuit (Eskimos to our American readers) when they are flown south several thousand miles from Baffin Island and other bleak Arctic deserts for medical attention. They can be seen outside the hospital on cold winter days smoking cigarettes in their summer parkas, without hats or mitts, quite comfortable in the winter breezes that blow around the place. Their hands our warm when ours would be freezing.(biological difference #1). Their children are brought south and their parents accompany them. Sometimes the person who has brought the child south is not the parent. Indeed, Inuit seem to be relatively less concerned with biological parentage as the basis for actual parenting. My informant tells me that often the person accompanying the Inuit newborn or baby is not the actual biological parent, and no one in the village thinks it odd or seems to mind (cultural difference #1).

The nurses and the doctors need to be able to assess how much pain a person is in. How can you do this when people are so stoic they do not express pain, or at least, not like caucasians, arabs, Africans, Tamils and others do? The hospital devised a pain comparison book, showing five pictures of people in pain, from mild to agonizing, with one set of figures showing a caucasian and another an Inuit. The Inuit figures shows increasing degrees of tension around the eyes, which we would not notice, because we are used to pain being expressed more around the mouth – think of those Greek agony masks for tragedy. And believe me, the differences in the Inuit features are small.

Is this a biological difference or a cultural one? Let’s be bold and call it Biological Difference #2.

Inuit agree with you by raising the eyebrows, and disagree by lowering their eyes. We do the same automatically when greeting people, though eyes downward indicates deference, not disagreement, and eyes raised means “I greet you”, and not “I agree with you”. Inuit can be smiling and laughing with you but if the eyes are lowered they do not agree. (Cultural difference #2)

2. Communicable diseases versus cultural patterns

Normally parents of any culture want to sleep in their children’s rooms when they are sick. In some third -world cultures, failure to do so would be considered a breach of every norm of parental responsibility.  In some Canadian hospitals, all children’s rooms are private so that parents can sleep beside their children. There is no effective set of visiting hours for the parents of sick children; one fo them is almost always present when the child is in crisis.

But some diseases are highly contagious, and the parent must be separated if the disease is not to spread. Which rule trumps which rule? Does an Afghan mother whose baby has meningeal toxaemia get to stay at her sick child’s bedside along with her four year old daughter? No. Western science trumps Afghan culutural patterns. Mother and daughter must stay out of the room.

3. Muslims

A Somali 14 year old male is in hospital with possible brain injuries.  He is surrounded by five women: his mother, his mother’s visiting Somali friend, the neurologist, the nurse, and the occupational therapist. Also present is the father.

Question: Is he cognitively impaired? The standards test is to be able to follow a finger moving with the eyes. A woman administers the test. He either ignores her or cannot do it.

How do you mark up the medical chart? Has he failed the test because he is cognitively impaired by concussion? Or does he fail to follow the finger because, as a Muslim male, he does not direction from his inferiors? Or is he being an adolescent jerk?

The attendant wrote: “Cognitively impaired or showing adolescent male behaviour.” She did not express an opinion whether the cognitive impairment came from the possible concussion or from Islamic attitudes towards women.

Conclusion

The front lines of dealing with cultural and racial differences are hospitals. I will continue to gather anecdotes about how hospitals have to operate between the exigencies of medical practice and the felt pressure of being politically correct. So far, medical science prevails.