Cultural competency in haitian-serving community health centers in South Florida

Abstract

The purpose of this research was to explore the perspectives of health care administrators, practitioners and patients regarding the role and operationalization of cultural competency in their organizations. This work was conducted in three Haitian-serving Community Health Centers (CHCs) in South Florida. CHCs were established in the United States to provide services to underinsured individuals. In recent years cultural competency discourse has become prominent in these institutions through the establishment of federal regulations mandating these programs. The data was collected primarily through ethnographic methods: interviews and participant observation. Conversational interviews were held with the following groups of informants: staff, patients and members of the community at large. Semi-structured interviews were held with 15 physicians and administrators of the centers. Unexpectedly, institutions largely devalued cultural competency and were able to sidestep federal regulations by hiring Haitian staff. However, through interactions with patients, it was discovered that aspects of cultural competency were in fact important to them. The qualities they most desire in physicians are: accessibility, linguistic proficiency, and the ability to treat them as individuals within their cultural context. “Cultural humility” is proposed as the resolution to this dilemma. Cultural humility involves a redefining of medicine’s understanding of culture. It does not involve complex training programs or the hiring of physicians who are similar to the patient population, but is patient-centered medicine, practiced reflexively. This approach is proposed to improve communication without the undesirable assumptions and effects of the cultural competency paradigm.