How would you deliver culturally appropriate care to a 80yr old depressed chinese lady just migrated to Australia and living with her son's family who have now been acculturated into the Australian way of life.

-- kelera onasu (kelera10@hotmail.com), November 22, 2001

Answers

Greetings Kelera,

Several important factors you must consider. It is equally important to remember that these differences are generalizations of traditional cultural communication, and behaviors and will not apply to every individual of a specific background. China consists of many varieties of linguistic, cultural, political, economic, and health systems. Important questions to ask are; which part of China does patient come from? How long have they been in this country? There are sub-cultures within the general Chinese culture, and differences between people from Hong Kong and those in Mainland China or Taiwan. The cultural values and beliefs can differ between first, second, third, generation Chinese immigrants. Mental health is a taboo topic among the Chinese mainly due to the misunderstanding that mental illness is the same as "insanity.? Mental illness is also considered a personal issue, and not openly talked about, it is still perceived as a source of shame, and an indication of character weakness. Traditional Chinese belief is that mental illnesses have an organic, rather than a psychological cause, and it is common for Chinese patients to present with vague somatic complaints such as headaches, dizziness, and various aches and pains. Many counselors in the United States for example, have a patient centered approach that may create confusion for some Chinese immigrants since this approach lacks the structure they expect and are used to. Many question the suitability of American counseling strategies for other cultures. The contrasting concepts of the Western individualistic, independent orientation versus the Chinese collectivist, interdependent orientation, have a strong impact on providing mental health services to Chinese. For example, Asians can not understand why putting the family?s interests before one?s own is considered not correct or "normal" in the Western culture. Such recommendations of therapy such as being encouraged to think of their own needs first, be more assertive, express your feelings etc. are contradictory to their cultural style. Moreover, Chinese tend to view counselors as authorities and expect them to simply solve their problems, as opposed to offering empathy and nurturance through the counseling experience. You need to find persons who speak the patients native language to work with them. If it is impossible to find providers who speak their native language, work through translators/interpreters (note that interpreters should be bilingual and bicultural.) An empathetic health care professional, with understanding of the patient's beliefs can often be central in the psychotherapeutic process. Understand the patients social structure. It is as important to work with the family, especially the caretaker and main advocate, as with the patient themselves. Explore services within the ethnic community. Provide the patient and family with as many written materials in their native language as you can find or have a translator translate basic information about program offerings into their native language. Remember that many new immigrants encounter mental health issues relating to the immigration process, such as culture shock, adjustment issues, immigration issues etc. Treatment will only be sought and adhered to if it is consistent with the individual's socio-cultural construction of reality, or worldview. For mental health services to be successful, these services must be delivered in a culturally and linguistically appropriate manner, especially in explaining the rationale for treatment if it is different from the patient?s cultural norms. Be sensitive, open minded, and above all do your research. Assess the individual for the validity of stereotypic, cultural behaviors and beliefs you hold as true before acting. Know and understand your patients culture, history, worldview. It is just as important to know and understand your own culture and worldview.

Víctor

-- Victor (victor@culturediversity.org), November 24, 2001.