Brain Injury Professionals and Cultural Competence

This neuropsychologist shares his experience and advice about culture, ethnicity, and brain injury rehab.

The mistakes that professionals can make in working with an Hispanic family or an Hispanic client, well, they're varied. They are as varied as Hispanics are varied. And Hispanics are very varied ethnically, in education, in culture, in country of origin, even in language within Spanish and outside of Spanish. In my part of the country, we have a lot of Mexicans from the area of Oaxaca whose first language is Mixteco, which is an indigenous language. And so you see an Hispanic name and you hear they're from Mexico, and you think it's going to be Spanish and it turns out not Spanish. There are of course lots of different forms of Spanish, and I find that although I do reasonably well with Mexican Spanish, I have a harder time with Puerto Rican and Cuban Spanish. So there's variability in language. And assuming that everybody is the same in that regard isn't going to work. In addition to the great cultural variability that there is across Latin America, we probably have a greater variability of levels of education than we have within the United States. Most of the time with people in the U.S. who grew up here, we can count on them having primary and often some high school education, often much more than that. There are large numbers of people who come to the U.S. from countries in Latin America who have no education. And of those who have no education, some are illiterate, some are quite literate because they've learned by other means, and you can't assume that because they haven't been to school that they're illiterate. So there's a whole lot of variability that we need to find out who do we have and not stereotype. That's one starting place. And then how acculturated they are to here, how they view their relationship to majority culture and so on. And then there are other things that have to do with interpersonal style. If you get in there and say, "Hello, how are you, let's get right to work," that's not going to work. [laughs] You need to spend some time working on the relationship and establishing some kind of sense of connection before you're ready to move ahead and work. And I think that may even be more true when you're working across culture than when you are within culture. So you can have that camaraderie and that connection a lot faster if you can recognize and give those signals that you're from a common background. I fall somewhere in between often because in speaking Spanish I put a lot of people who speak Spanish more at ease, sometimes even if they're better at English than Spanish and we just drop a few words in Spanish here and there and make a few references, and there's kind of a little bit of settling in. But of course I'm not Hispanic in origin and Spanish is my second language, and they can sense that, so it'll take me longer perhaps than someone else. But you have to spend some time establishing that credibility, and you don't know when you arrive what's going to establish that credibility. Sometimes it's the diplomas on the wall, what we call the ego wall--all the diplomas. Sometimes that does it. Sometimes it's how warm and friendly you are. Sometimes it's whether you have some knowledge or background in understanding their culture. Sometimes it's just whether you're open to finding that out and that you can convey that openness. I work with a lot of different cultures, and I know some reasonably well; others I don't know very well at all. And when I'm with someone that I don't know their culture very well, which may include some Latinos, depending on where they're from, I'll say that up front, and I'll say, "I don't know that much about where you're from." "Please help me out here. I'll try to do my best to understand." "And if you find that I'm missing something, please let me know." That may help or it may not, depending on who it is. But certainly spending that time to make sure that you have a foundation from which you can work is very important. We as North Americans tend to work with the individual, so much so that our funding for rehabilitation and healthcare services are very individually oriented as well. But if we're going to be effective, we have to work with the person's context and with family members. And sometimes that takes figuring out which ones and how to get in touch with them and how to make that work. That might mean going out, as I said before. It might mean making some phone calls, inviting people in. There are a variety of ways. And you may not even know at the first. It's not necessarily the formal closest relative, and it may be extended family that are most important. You need to kind of hear out and wait until you figure out who are the people that are important here, who hold influence, who are they going to believe, who are they going to trust. You may or may not be able to work directly with that person. That person might be a few thousand miles away, but you may have to call them up or say, "Well, what would Tia Tita say about that?" "Can you call her and ask her what she thinks?" And so you need to just try to figure it out.
Posted on BrainLine April 29, 2009.

Produced by Victoria Tilney McDonough and Brian King, BrainLine.