IQ10: Tuberculosis and Cultural Humility (TB Talk, Pt 2)
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Rick Harp: Welcome to Infectious Questions, a public health podcast from the National Collaborating Centre for Infectious Diseases. I’m Rick Harp. This episode continues our look at tuberculosis with NCCID’s Shivoan Balakumar. Hello again, Shivoan.
Shivoan Balakumar: Hello.
Harp: Now, last episode, we introduced End TB 2017, a meeting of the North American Region of the International Union Against Tuberculosis. It was there that you met this episode’s featured guest. Who is she?
Balakumar: Kay Wallis is a special projects manager with the Curry International Tuberculosis Center. She actually presented at the event on cultural proficiency among healthcare providers, or, as she calls it, cultural humility. I asked her to go into the knowledge gaps that many practitioners still confront in this regard.
Kay Wallis: Well, I think I would start by saying that there is a tremendous baseline of understanding and skills among people in the public health workforce. And so, I want to definitely honour that because it is so necessary to the work that people do, that they’re already bringing a tremendous knowledge base and ability to work in cross-cultural situations.
Now, having said that, there are still lots of challenges for many of us in the field, and one of them I think is just to step back for a moment because we’ve become very focused on the cultural differences of the patients. But we perhaps would be served by stepping back a little and looking at our own cultural identities because we are bringing those to the patient-provider relationship. So, to know that there are power differences between patients and providers, that the provider is bringing their own cultural identities to the mix, and those are certainly impacting the interactions. So that, before I even start thinking about what my patient is bringing to our interaction in terms of cultural identities and how I might mitigate those, I want to think about my own attitudes and values that I’m bringing.
Balakumar: Again, that’s Kay Wallis, a U.S.-based TB educator. I also asked Ms. Wallis what other resources, training and support she thought could benefit TB programs in Canada.
Wallis: What I hear a lot from providers is that no matter what interpretation resources they have for several different languages or the languages that their patients speak, there’s always a need for more and easier access to trained medical interpreters.
Another thing that would benefit providers, I believe, is even more training and experience in doing the kind of interviewing that really helps them get at the patient’s perspective, what the patient’s needs are. As we know, cultural humility is an integral part of patient-centred care, so knowing the kinds of questions that will help you understand what the patient’s perspective is, which may be very different from what the medical model of the care that you’re trying to provide.
So, getting a sense of what is the patient’s personal history, and what is their immigration status, if any, their ethnicity, their language background, their educational level, their gender identification and family structure. Perhaps where they come from in their culture TB is called something different; they think it has a different causation. Ask them about why they think it started when it did, and how long they think it’ll last.
And, most importantly, I think providers would benefit from being reminded that one of the first questions should be, ‘What is most important to you, and what can I do to help?’ Because I know we come in with a particular medical agenda, but if we take the time—and we can with tuberculosis interviewing—if we take the time to really understand what their needs are, then we can negotiate a treatment plan that’ll work for both.
Balakumar: So there it is, my conversation at End TB 2017 with Kay Wallis from the Curry International Tuberculosis Center at the University of California San Francisco.
Harp: Thank you for this, Shivoan.
Balakumar: My pleasure, Rick.
Harp: And thank you for listening to Infectious Questions, a production of the National Collaborating Centre for Infectious Diseases.
Production of this podcast has been made possible through a financial contribution from the Public Health Agency of Canada. Note that the views expressed here do not necessarily represent those of the Agency. The host organization of the NCCID is the University of Manitoba. Learn more at nccid.ca.