Developing Cultural Competence in Paradise
Blake Montgomery, Florida International University
The profession of occupational therapy is based on the knowledge and understanding of the intricacies of day-to-day life. A defining factor in delivering holistic, patient-centered care is understanding and incorporating the client’s culture into a unique assessment and treatment plan. Inclusive analysis and culturally sensitive interactions are not inherent, nor are they easily taught in the secure setting of a classroom. It is rare to be exposed to diverse cultural experiences as a graduate student, so when the opportunity to complete my Level I fieldwork on an island that houses an inimitable culture came up, I did not hesitate with my decision to embark on this journey to Nassau, The Bahamas.
As a graduate student in the Master of Science in Occupational Therapy program at Florida International University, I was one of a handful of students to experience a clinical rotation abroad. My month-long Level I fieldwork was completed at Doctors Hospital, located on a tropical island in the middle of the Caribbean Sea that is characteristically a vacation destination. I was never further than a walk away from white sand beaches and crystal-clear ocean water for the entire month of July; yet even in paradise, there are people with injuries and disabilities who need care and attention. In this context, the cultural variety is vast, ranging from longtime island natives to ephemeral tourists from around the globe. Because health and health care are intertwined and defined by every individual's culture, there was a diversity that demanded intercultural competence by all the professionals at Doctors Hospital (Muñoz, 2007).
In addition to the direct experience gained at Doctors hospital, I was submerged into the activities of daily living on the island and began to understand the intricacies of the culture and its effects on the everyday lives of the Bahamians. A contrast I noticed between my own American culture and the Bahamian culture, was their amicable interactions, with an emphasis on social relations within the overall community. In order to respect this characteristic, more time was devoted in the evaluation and treatment sessions to create dynamic, open patient–therapist relationships. Developing a deeper social connection with patients resulted in more comprehensive, client-centered care. Another strong contrast to my own culture was the overall nonchalance among the people on the island. The rigid structure that I had grown accustomed to in the American medical system would not function in this context. Health care in the United States is heavily mediated by insurance and is constrained by strict time frames for reimbursement. Although insurance in the Bahamas is a factor, the sessions are more cordial, possessing a natural flexibility in terms of scheduling and care. The affable culture of the islands was also integrated into ADLs. Treatment sessions that pertained to the daily activity of eating were enhanced when friends and family were incorporated into the sessions, resulting in increased involvement through shared enjoyment and social participation. An activity as universal as eating is not experienced in the same way by everyone, and I only fully understood this notion after experiences in the context of this culture. The array of food that makes up the Bahamian diet needed to be experienced firsthand, along with the rituals surrounding both preparation and consumption of the meals, to create more efficacious treatments. The Bahamian diet is composed heavily of seafood. One of the staples of this island country is conch, hence the epithet “Conch Republic.” The way that it is harvested, prepared, and consumed were all novel to me, and would have remained so unless I experienced it firsthand.
Studying abroad catalyzed my growth as a professional, opening the door to a wide range of clients, therapeutic techniques, practices, and interventions. The knowledge and hands-on experience, in combination with the relaxed culture of The Bahamas, provided an optimal learning environment to expand my cultural understanding and sensitivity, while increasing both my self-awareness and cultural humility. Fieldwork abroad allows for increased opportunities to acknowledge varied behaviors, values, and beliefs. A culturally competent occupational therapy practitioner can implement patients’ cultures into assessments, ultimately creating more impactful interactions and treatments. I implore every student to experience studying abroad. It has been shown, and I have now experienced firsthand, that interacting in an international educational setting will “increase a student’s desire to learn about themselves and others and explore difficult topics related to cultural difference and power” (Aldrich & Grajo, 2017). When striving to achieve cultural competence it is important to remember:
- The definition of health is not universal. Learning about the health beliefs and influences of a cultural group will allow you to cater your treatment sessions to the population you are serving.
- Health management is culturally specific. Illness is perceived and defined differently across cultures and will dictate patients’ and health care providers’ decisions regarding the course of care.
- ADLs are heavily influenced by culture. Eating, dressing, toileting, bathing, and functional mobility are experienced universally, but the rituals and beliefs surrounding these core activities of independence are extremely variable.
- Removing your own cultural beliefs is essential. In order to be client centered we must disconnect from our cultural perceptions of health. Our beliefs and actions have the potential to create discord in the relationship with the patient if they are not variable and accommodating.
- Incorporating culture into evaluations and interventions creates comprehensive care. If culture is disregarded during evaluations, information regarding the features of patients’ independence and ability to perform ADLs will be overlooked. This cascades into less effective treatments, inhibiting the potential of your clients.
My sincerest thanks and appreciation to Zenobia Neely, MSc (OT), CWCE; Amy Etor, OT, OTRP; and Sarah Teklet, MScOT, BSc, for continuously providing a level of education that continues to foster my growth as an occupational therapist. I also want to thank Dr. Alma R. Abdel-Moty, PhD, MS, OTR/L, for a perpetual dedication to providing fieldwork environments that are challenging and offer the best opportunity for development as both a person and a student.
References
Aldrich, R. M., & Grajo, L. C. (2017). International educational interactions and students’ critical consciousness: A pilot study. American Journal of Occupational Therapy, 71, 7105230020p1–7105230020p10.
Muñoz, J. P. (2007). Culturally responsive caring in occupational therapy. Occupational Therapy International, 14(4), 256–280.
Short Biography
Blake Montgomery is a Florida native who received his undergraduate degree in Psychology from the University of Florida. He spent 3 years working as a drafting engineer for custom architectural casework and millwork before embarking on the journey to becoming an occupational therapist at Florida International University. He enjoys the variety of challenges that the profession presents in the endeavor to return patients to their functional independence and the creativity required to solve them. He is a proponent of travelling and experiencing novel cultures and will be moving to Lilongwe, Malawi, after graduation to begin practicing occupational therapy in the next chapter of his life.