AIMS: To explore whether and how immigrant general practitioners (GPs) in two major cities in Norway think that their own ethnic background affects their practices and their work.
METHODS: Qualitative focus group and individual interviews with seven immigrant GPs, five men and two women, age 36-65 years. Their clinical experience in Norwegian primary health care ranged from four to 30 years. Analysis was conducted by systematic text condensation.
RESULTS: First, immigrant GPs described a gradual process of becoming bicultural: the GPs communicate with immigrant patients on their own terms and draw upon their special knowledge from abroad to help selected patients, while also adapting to Norwegian cultural expectations of the GP's role. Second, the GPs described being aware of cultural issues in consultations with immigrant and Norwegian patients, but rarely making these issues explicit. The GPs ventured that cultural awareness, together with their personal experience in their own countries and as immigrants in Norway, made them able to sometimes help immigrant patients better than Norwegian GPs. Third, immigrant GPs experienced a big workload related to immigrant patients, but they accepted this as a natural part of their work. Fourth, immigrant GPs felt that they had to work harder and be more careful than their Norwegian colleagues in order to avoid complaints from patients, and to be accepted by colleagues.
CONCLUSIONS: Immigrant GPs express broad cultural competence and keen cultural awareness in their consultations. The immigrant background of these GPs could be considered as a special resource for clinical practice.
This article attempts to melt the two concepts of multiculturalism and health education. It defines multicultural health education and provides a rationale, presents a series of examples of what is presently being done in Canada, identifies needs and gaps, and proposes a number of potential strategies for furthering the development of the field of multicultural health education.
Recent decades have witnessed an increased interest in the cross-cultural study of mental disorders. This interest has manifested itself across a variety of disciplines and has served as an impetus for the development of a number of subdisciplinary specialties. Regardless of the different names which have been applied, the central concern of all of these specialties has been to illuminate the role of cultural factors in the etiology, expression, course, and outcome of mental disorders. From their success in achieving these purposes, it is clear that the cross-cultural study of mental disorders has contributed greatly to our understanding of the role of cultural factors in mental disorder. The purpose of the present paper is to discuss some of these contributions and, in the process, to call attention to the fact that all aspects of mental disorders are inextricably linked to the sociocultural milieu in which they are generated.
Available upon request at the Alaska Medical Library, located on the second floor of UAA/APU Consortium Library. Ask for accession no. 102029.
Cultural psychiatry has evolved along 3 lines: 1) cross-cultural comparative studies of psychiatric disorders and traditional healing; 2) efforts to respond to the mental health needs of culturally diverse populations that include indigenous peoples, immigrants, and refugees; and 3) the ethnographic study of psychiatry itself as the product of a specific cultural history. These studies make it clear that culture is fundamental both to the causes and course of psychopathology and also to the effectiveness of systems of healing. The provision of mental health services in multicultural societies has followed different models that reflect their specific histories of migration and ideologies of citizenship. Globalization has influenced psychiatry through socioeconomic effects on the prevalence and course of mental disorders, changing notions of ethnocultural identity, and the production of psychiatric knowledge. A cultural perspective can help clinicians and researchers become aware of the hidden assumptions and limitations of current psychiatric theory and practice and can identify new approaches appropriate for treating the increasingly diverse populations seen in psychiatric services around the world.
The Interior & Northern Regional Training Office, based at the Fairbanks Native Association in Fairbanks, Alaska, developed and field-tested a course titled PPC(293) Codependency: An Overview and ACOA Workplace Issues. The course was also approved for state certification as a substance abuse counselor. After completing the course evaluations and reading student synopsis papers, a new emerging problem or concept appeared: Now that this new phenomenon has emerged in the field of chemical dependence called codependency, how does this relate to the Alaska Native culture and value system, and can this phenomenon create even more problems for people in treatment, or should we look at this as a critical variable which may precipitate relapse, especially for those Natives in recovery who return to a dysfunctional familial environment?
Available upon request at the Alaska Medical Library, located on the second floor of UAA/APU Consortium Library. Ask for accession no. 101983.
Since the publication of "Towards a Culturally Competent System of Care" (1989), dozens of books and training materials on cultural competence and its sister field in the private sector, managing diversity, have been published. Yet, despite the consistent call for commitment to a long-term developmental process, organizations too often maintain the simplistic view, if they express any at all, that recruitment of bilingual and bicultural service providers and training in culturally related topics alone will lead to a culturally competent organization.
The role of cultural background in the etiology of depressive symptoms associated with hysterectomy has been rarely explored. However, the increasing interest in the transcultural aspects of psychiatry in the last decade gives a particular relevance to this subject. In the current study, 152 women underwent hysterectomy in a downtown hospital of a large city. The population under study consisted of women of various ethnic backgrounds, French Canadian (35%), English Canadian (29%), European (22%) and other (14%). The women completed the Zung self-rating depression scale (SDS) before the operation and six times after during a one year period. They also answered two questionnaires, the first before the operation and the last one a year after. These questionnaires explored the presence of fears, misconceptions, the attitudes toward the operation, the satisfaction regarding medical care and the general pre- and post-operative adjustment. English Canadian women reported the lowest scores on the SDS; they had few misconceptions and fears. They had the best post-operative adjustment of the three groups. French Canadian women showed intermediate scores on the SDS and expressed more misconceptions and feelings of mutilations pre-operatively. Women of European origin showed the highest scores on the SDS at all observations, expressed more regrets about the operation and had a more difficult post-operative adjustment than the other two groups. This study suggests that cultural factors may contribute to the reaction to hysterectomy in women of different ethnic backgrounds. Education, the type of society: patriarchal versus matriarchal, the emphasis on the women's reproductive ability in a particular culture, are among other factors that seem to play an important role.