 |
 |
|
|
|
|||
|
|||
 |
|||
Doctors without bias
MED program trains culturally competent physicians
By Tim Stoddard
|
|
|
Local adherents of the Yoruba religion, which originates in Nigeria, honor Elegba, a protective deity who is the messenger of the Yoruban gods, at a feast in Jamaica Plain. Through MED's Boston Healing Landscape Project, medical anthropologists and physicians have been mapping the diverse religious and cultural healing traditions of African Diaspora communities around Boston. Photo by Eugene Adams, Jr. |
|
|
|
A young Haitian mother brings her five-month-old son, Jean, into your busy urban pediatric clinic. You notice Jean is wearing a gold chain and amulet around his neck, and make a mental note to suggest that his mother remove it or pin it to his shirt so he doesn't choke on it. When you lift his shirt, you also see a cloth wrapped around his waist beneath his diaper, but nothing else seems out of the ordinary.
So begins one of several role-playing exercises Linda Barnes and her MED colleagues are developing to introduce medical students to the subtle challenges of caring for patients whose views of illness and healing may differ sharply from the Western biomedical tradition. In this 20-minute exercise, the students playing Jean's mother learn that the necklace and amulet invoke the protection of Papa Loko, a guardian force in the African tradition of voodoo; Jean's mother is reluctant to tell the doctor she believes someone in her community has put jauke — the evil eye — on her baby by kissing him and swallowing some of his saliva. She believes the stomach wrap will give Jean strength and help him grow straight and tall.
Barnes, a medical anthropologist and a MED assistant professor of pediatrics, has seen how the cultural gap between patient and physician can create obstacles to successful treatment. For the past three years, she has directed the Boston Healing Landscape Project, the MED department of pediatrics initiative to survey the cultural and religious healing practices among African-Americans and members of African Diaspora communities in and around Boston. With support from the Ford Foundation of New York, the BHLP set out in 2001 to study how communities of immigrants from countries such as Haiti, Cuba, Brazil, Ghana, and Cameroon find alternatives to Western medicine. Last month the Ford Foundation renewed its support of the project with another three-year, $700,000 grant that will enable it to continue its ethnographic research and also begin developing teaching materials for medical school curricula around the country. “We know that Ford, like all other foundations, has been hit by the economy,” Barnes says, “and we feel very grateful that they were able to renew us at this level.”
Boston is one of the best places in the country to study the interface of Western medicine and other healing traditions. Within a few blocks of the nation's leading teaching hospitals in the city, can be found Vietnamese monk shamans, Haitian mambos and oungans, Cuban santeros, Puerto Rican espiritistas, Irish charismatic priests, and Chinese herbalists-acupuncturists. In its first three years, the BHLP supported anthropology graduate students at BU and Harvard who were investigating such things as how religious healers in Boston treat childhood asthma; how the spiritual traditions of Haitian immigrants affect women's health choices during pregnancy and in the year following delivery; and how hip-hop music affects the identity, spirituality, and health habits of young African-American women.
The project will continue mapping spiritual healing practices in Boston, but will shift toward training medical students, physicians, and nurses in ethnographic research. The goal, Barnes says, is to help care providers develop ethnographic research skills they can employ outside of the clinic. “With our support, the physicians will have more time to ask a patient about his or her understanding of an illness,” she says. “Our hope is that this would help feed back into clinical interviewing skills, that it would be in the service of developing a teaching case. If we really want to transform these skills in medical culture, it makes more sense to encourage physicians to engage in this kind of study rather than a graduate student in anthropology.”
Bridging the gap
The BHLP will also begin translating its ethnographic research into teaching materials for medical schools in this next three-year grant period. “The broad goal now is to contribute to the training of doctors in ways that leave them more open to, and interested in, cultural differences,” Barnes says, “and in ways that enhance patient-doctor communication, and negotiating the handling of a case.”
Cross-cultural training is not new at MED or at Boston Medical Center, which serves a diverse ethnic population, but the BHLP is enriching the training in several ways. Barnes and members of the MED faculty will publish a casebook with a series of studies based on project research and the clinical experiences of doctors at BMC. The book will present medical students with real-life scenarios where issues of cultural differences between doctor and patient present an obstacle to forming a treatment plan. Accompanying teaching materials, such as a CD with PowerPoint presentations and a related Web site, will also explore the intersection of complex medical and cultural issues.
|
|
|
|
|
A healing ceremony, or bembe (a term referring to an African drum, a specific style of drumming, and ceremonies where these drums are played), honoring the Yoruba deity Elegba. With the support of Eugene Adams, Jr., a local photographer, the Boston Healing Landscape Project has been compiling a visual archive of various healing systems around Boston. Many of these images of botánicas, healing rituals, storefront churches, murals, and chiropractic offices can be found on the project's Web site at www.bmc.org/pediatrics/special/bhlp. Photo by Eugene Adams, Jr. |
|
|
This spring Barnes is also team-teaching a new MED seminar entitled Cultural Formation of the Clinician, Its Implications in Clinical Practice. With Lana Habash, a physician and a clinical instructor in the MED department of family medicine, Karen Bryant, a MED assistant professor of geriatrics, and Michael Paasche-Orlow, a physician at Boston Medical Center's department of general internal medicine, Barnes is helping first- and second-year medical students examine the cultural biases they might unintentionally bring to their future practices.
The problem, she says, is that many doctors are not aware of their own cultural biases. “Doctors are trained to ask, ‘What's the evidence?'” she says. “If the evidence isn't clear, it's harder for them to know how to respond to the problem. If you've been trained to believe that large, double-blind, controlled clinical trials are the only way to assess whether something is really efficacious, it's difficult to know whether to take another remedy seriously.”
Barnes also started teaching an intensive, monthlong elective in the fall for fourth-year medical students that focuses on cultural competence. Students take a close look at the variety of complementary and alternative healing traditions in Boston by meeting traditional healers in the community and attending healing rituals. In April, Barnes will lead an herbal tour of Boston as part of a continuing medical education course for practicing physicians. Doctors on the tour will meet Steven Quintana, a Cuban-American santero — literally, a priest, but also a therapist, healer, mentor, and friend — who practices Santería, a combination of Roman Catholic and West African religious traditions that originated in Cuba. They'll visit local botánicas, which sell herbs and charms used in cleansing baths and other Santería rituals, and hear lectures from pharmacology faculty from the Massachusetts College of Pharmacy and Health Sciences.
One of the larger goals of the BHLP, Barnes says, is not just to expand doctors' views of healing, but also to make the public aware of healing traditions that have long been considered inferior to more mainstream forms of complementary and alternative medicine. “If I were to run down the list of things you've read about in Newsweek,” Barnes says, “it would probably include acupuncture, homeopathy, naturopathy, chiropractic, maybe Reiki. Now, how many of those articles talk about divination, ritual healing, and orishas? There's a kind of privilege to one set of complementary therapies that are preferred by a certain social class and ethnic group. I would argue that there's bias in that formulation that goes unrecognized.”
27
February 2004
Boston University
Office of University Relations