Reaching Out to the Community and to the World
A Healing Landscape
A group of about twenty men and women sat in rapt attention as a tall, well-dressed young man spoke of how as a youth in Haiti he learned to listen to his dreams and to allow them to guide his path. The man was Niete Decimus, a Vaudau (Voodoo) priest and anthropologist, and the listeners were medical residents at Boston University Medical Center. They were brought together as part of a new training program instituted by BUMC’s Department of Internal Medicine. This session, led by medical resident Cynthia Garner, drew upon the resources of the Boston Healing Landscape Project (BHLP), a partnership of researchers, health workers, anthropologists, and scholars of religion, that is charting a course to integrate alternative medical practices into Western medicine.
 In the United States, where new immigrants often arrive with native traditions intact, the relationship among certified medical workers, traditional practitioners, and non-native patients is often fraught with shadows of skepticism and misunderstanding. The Boston Healing Landscape Project has assumed the task of helping Boston’s medical practitioners—who work in a city of tremendous diversity—understand the complex and varied landscape of healing and medicine.
“We encourage doctors to think about different culturally and religiously defined approaches to healing,” says Linda Barnes, director of BHLP. “We also work with doctors on anthropological issues that are part of their everyday practice.”
While the tools and health-care goals of BHLP are unique, Barnes says she owes much of her initial thinking on the subject to Harvard professor Diane Eck and her Pluralism Project. “Diane Eck’s work on growing religious pluralism in the United States got me thinking about the comparable trend happening in health care.”
 A thrust of the group is developing information resources for Western practitioners. One, an online database of herbs used by various ethnic groups in Boston, provides information about substances’ physiological effects, chemical makeup, possible drug interactions, and toxicities. Another project in development is a country index that links to online resources that can help doctors and medical students better understand the cultural, religious, and political backgrounds of non-native patients. An interactive world map allows the user to select a country of interest. By clicking on, say, Africa, then on the country of Ghana, the user is taken into a series of menus that provide information on immigration, health-care issues, spirituality, religion, and economics. “The Country Index provides a Web resource that contains the best information available on a range of issues affecting our foreign-born patients,” said Barnes. “It is designed to be easy to use in a clinical setting when taking the medical history of patients from other cultures.”
When doctors are sensitive to different religious and cultural outlooks on health, says Barnes, they can make better recommendations to their patients. For example, BHLP researcher and General Pediatrics Fellow Lance Laird is working to understand how Muslims are represented in medical literature and how Muslim patients perceive the Western health-care system.
Medical interpreters are an important—yet relatively new—resource in helping doctors bridge these cultural gaps. Justine de Marrais, a project manager and researcher with BHLP, has looked at the role and effectiveness of medical interpreters as cultural brokers in medical settings. One example de Marrais gave—which, coincidentally, she said, inspired her current research—was when doctors in the pediatric ward noticed a small red ribbon tied around a baby’s waist. De Marrais and doctors in the ward learned later from an interpreter that the tying of protective ribbons is a common practice among some Southeast Asian peoples. “The ribbon served as an amulet or talisman to ward off harmful spirits. The removal of that ribbon could have been very offensive to the parents,” said de Marrais.
Although there are potential benefits, according to de Marrais, there is disagreement about the overall value of interpreters as cultural liaisons. “Right now there is not a lot of consensus on whether medical interpreters play a legitimate role in communicating cultural practices,” said de Marrais. The group’s findings suggest that the lack of consensus may be the result of inconsistent relationships between doctor, patient, and interpreter. According to de Marrais, these relationships depend on a number of key variables including the “cultural fluency” of an interpreter and whether or not an interpreter has previously worked with a particular doctor or nurse. “In spite of these variables, recognition is growing that interpreters are positioned to provide an important service to patients and doctors,” she said.
As Boston’s population continues to diversify, the medical field grows more complex—and the value of cross-cultural knowledge and understanding increases. “It hasn’t been a tough sell to doctors,” says Barnes. “We are giving them useful information that applies to their everyday reality.”
In 21st-century Boston, it seems, there is no single road to wellness—but the BHLP is creating an invaluable map of the terrain.
For more information about the Boston Healing Landscape Project, see www.bmc.org/pediatrics/special/bhlp/.
—by Jeremy Miller |
