Program Helps to Bridge Cultural Divides

The following account is true. It comes directly from the case files of Cultural Competency, a brave new Orange County program to improve the multicultural skills of people who care for people.

April, 1999: Workers from a private home health care agency enter the home of a Cuban American woman suffering from diabetes. They tend to the patient with a ham-fisted bedside manner that sparks an angry backlash.

First, they don’t speak Spanish. They refuse requests to remove their shoes and otherwise ignore the patient’s adult daughter, who is bilingual and could have helped to translate. Then, without regard for the modesty important to traditional Latinos, they start to disrobe the startled patient for a treatment she doesn’t comprehend.

When the elderly woman starts speaking Spanish loudly and quickly in the style typical of many Cubans, the workers think the patient is becoming agitated. When she strikes at them for pulling down her gown without permission, they suspect her aggression may be the result of abuse, perhaps by the daughter.

So they call in adult protective services, a county agency that can have people removed from their homes for their own protection. They concluded the problem did not lie within this Cuban American household.

But the patient needed protection, all right: From the cultural incompetence of the people who were supposedly sent to help her.

Veronica Kelley had been on the job just one week when the case came to her attention. She had just been put in charge of Cultural Competency, the new county program with a title that makes people laugh, cringe and scratch their heads.

“It’s a loaded term,” said Kelley, a licensed social worker. “It sort of implies that you’re obviously incompetent when it comes to other cultures, so we’re going to teach you to be competent.”

Plan Designed to Help Care-Givers

A year ago this month, the county launched Cultural Competency with an annual budget of $443,000 under the Health Care Agency. Kelley was put in charge of a staff of one full-time and two part-time psychologists.

She still calls it her dream job.

Kelley was born in Japan--part Irish and part Filipino--and grew up in Huntington Beach. For the past decade, she’s worked in the private sector with adults who are chronically mentally ill.

Her first mission as service chief of Cultural Competency was to assure her fellow county employees that they would not be subjected to some nefarious, politically correct, re-education campaign.

Her message: Cultural Competency is here to help.

The program is designed to assist the county in delivering “culturally appropriate and competent services to all.” That’s done through training, referrals and a lending library of books, videos and articles on multicultural issues in psychology, health care and other fields.

Among the titles: “The Accidental Asian,” “Women and Madness,” “Islam In Focus,” “Quienes Somos?/Who Are We? The Experience of U.S. Born Mexican-Americans.” (A full list of material is available at the agency’s Web site: https://www.oc.ca.gov/hca/behavioral/cultural.htm)

All the services are available to anybody, in or out of government, who deals with the county’s ever-more-diverse population. Psychologists, nurses, educators and even jail guards have used the help.

In the case of the Cuban patient, the owners of the South County health care firm knew they had a problem. They were eager to train their employees how to handle patients with a little more, shall we say, sensitivity.

So they turned to the folks at Cultural Competency for the training.

The home care workers were not aware, for example, that the eldest child in a Latino household often takes on parental authority, especially in the absence of a father. That was true in the case of the Cuban American daughter, who had no brothers to assume the role of head of household.

By ignoring her, they made an enemy out of a potential ally in the home.

“With Latinos, if you really want to get in good with them, say ‘Good morning,’ ” advised Rafael Canul, Cultural Competency’s full-time, bilingual psychologist in charge of training.

Sometimes, it’s just that easy. But there’s no handy formula for how to handle people, said Canul. No cultural cookbook with recipes for proper behavior in every case.

His advice: Just be human. Learn what you can about a culture, then treat people with respect. You can’t expect to be right all the time.

But beware. Cultural Competency is a two-way street.

During the training of the home health care staff, some nurses complained that they felt uncomfortable when Latino co-workers spoke Spanish around them. They felt the Latinos were making fun of them.

Relax, advised Canul. Often, people revert to Spanish in the workplace as a quick way to connect with each other. It shouldn’t make others feel threatened.

However, he warned, it is entirely improper for Latino employees to speak Spanish in the presence of a patient who can’t understand them. But instead of scolding workers, supervisors should issue written policies to prohibit such rude treatment of patients.

It’s not just ethnic cultures that can benefit from Cultural Competency. Gays and lesbians, drug addicts, old people, young people, patients with tuberculosis. Every group has its own culture.

Even a straight white male once visited the library at the offices Cultural Competency in downtown Santa Ana. His concern: He’s one of the few men who work as secretaries.

“We are not necessarily the experts in every culture in the world, but we know folks from a lot of cultures who are experts,” Kelley recently told the county’s Alcohol and Drug Advisory Board. “We can hook you up with those folks.”

That’s just what they did in the case of a young Vietnamese man who tried killing himself by jumping off a freeway overpass. He had been depressed because he was gay and feared that his family would disown him if they found out.

The call to Cultural Competency came from a nurse at a hospital in Fullerton where the man in his 30s was being treated. The nurse was referred to the Vietnamese Gay Alliance which counseled the young men after he came out to his relatives, who were given information on homosexuality in a way they could accept.

Eventually, the family took the man back home to Maryland.

“Cultural Competency is not something you are,” said Kelley. “It is something you are always becoming.”

Agustin Gurza’s column appears Tuesday and Saturday. Readers can reach Gurza at (714) 966-7712 or agustin.gurza@latimes.com