Learn About Good Medicine From A Nepali Doctor

Kamana Khadka

There was a time in my life when my interpretation of “good medicine” was quite narrow.  So narrow that I defined good medicine by – English speaking Doctors, highly efficient nurses, huge and widespread hospital buildings, high-tech lab equipment, sophisticated imaging machines, and best procedures money could buy.  And then I grew up.  The picture I painted of good medicine was far from complete.

Health is more about our cultural, social, and environmental settings/beliefs and less about cutting-edge medical care. 

Yesterday when Dr. Shakti Basnet, Nephrologist at Bir Hospital in Kathmandu, Nepal, shared photos of him paying reverence to dialysis machines used at Bir Hospital on the occasion of Dashain, biggest festival in Nepal; perfect blend between medicine and culture suddenly came to life.

“I am a Doctor and a Hindu.  I do not find any conflict between those two worldviews.  In fact when my patients see me paying reverence to the machines that are used in treating their illness, we connect at a whole different level.  My patients feel a sense of relief knowing that even the Doctor doesn’t look at the machine as just a machine but a medium that will take away their pain.  They feel better already,” says Dr. Shakti Basnet. 

A rare find in United States.

I have been a consumer of healthcare in United States.  Fortunately, I am pretty healthy.  Hence my personal experience with healthcare in United States is limited to annual check-ups.  But I have accompanied close friends to their “somewhat complicated” health visits.  I have spent nights beside their hospital beds as they were recovering from surgery or other health complications.  I have interacted with medical professionals on my friend’s behalf.  I am quite familiar with the taste of healthcare delivery in United States.

Let me tell you, it tastes bitter.  It even has a bitter after taste.  Strictly business.

“What is the value of my life at the hospitals in United States?” is the question I often ask myself.

Just another “infected body” that brings business.

People’s individuality, culture, language, traditions…Umm, out the healthcare window. 

Efforts are being made.  Yes, true.  But ask anyone who has been working for a sustained period of time to promote culturally responsive health care in United States and they can tell you that despite decades of efforts, very few solid action items are in place at our hospitals; our hospitals in United States, accessed by world’s most diverse patient population.  Have you paid attention to our country’s changing demographics?  Ok, then you know these efforts are just Not Enough.

So far, Doctors from developed countries such as United States have been coaching Doctors from under-developed countries such as Nepal on Do’s and Don’ts of good medicine.  I think it is time we turn the tables.  There is a lot Doctors from developed countries need to learn from Doctors from under-developed/developing countries. 

High-tech tests and cutting-edge research does not guarantee good health.  In fact it takes away “human voice” during health care delivery.  

Let us learn about good medicine from Nepali Doctors. 

Wish you all a very Happy Dashain.  May this Dashain bring victory over the demons of sickness similar to Goddess Durga’s victory over Dushashan, the demon of all demons.

Congratulations Miss Nina Davuluri, The First Desi Miss America

Kamana Khadka

         Miss Nina Davuluri made history by becoming the first Indian American crowned to be Miss America, 2014.  Ms. Davuluri, a 24-year-old Fayetteville, New York native and an aspiring physician, is the daughter of Indian parents who emigrated from India 30 years ago.

         I am most excited about Ms. Davuluri’s platform “Celebrating Diversity Through Cultural Competency.”  If you saw her performing the classical Indian dance in the stage of Miss America Beauty Pageant, you know the kind of “celebration of diversity” I am referring to.  Each sound made by Ms. Davuluri’s Ghunghroo, the musical anklet tied to the feet of Indian classical dancers, as she danced to the beat of Indian drums, brought to life, all the stories, struggles, and victories of Asian Americans and Americans of other race/ethnicity in the United States. 

         In 1965, the United States Congress liberalized law restricting Asian immigration.  The Immigration Reform Act of 1965 was framed as an amendment to the 1952 McCarran-Walter Act, under which quota system was implemented in the immigration process and preference was given to skilled laborers and relatives of United States citizens.  This legislative action made a tremendous shift in the Asian Indian population from only a few thousand in the 1960’s to over 300,000 by the mid 1980’s.  Today with a population of 3.2 million, Asian Indians, make the top three largest Asian groups in the United States.  In 2011, the estimated population of Asians was 18.2 million, making them the fastest growing population in the United States.

         Despite the drastic change in demographics of the United States, which communicates a clear message that the image of today’s “American” is not only what used be the typical “blonde hair, blue eyes, and fair skinned” individual; reading Twitter feeds full of racist comments in response to Ms. Nina Davuluri being crowed as Miss America, 2014 shows nothing but the need for cultural competency. 

And NO, the one-hour online cultural competency training provided by your organization that you sit through and check the box, as having “successfully completed the cultural competency training” is NOT ENOUGH.

         In response to a significant population of Americans who have expressed their deep disappointment upon Ms. Nina Davuluri’s win, I would like to respond by quoting Frenchman J. Hector St. John Crevecoeur’s article “What Is An American?” written in 1782 – “He is an American, who, leaving behind him all his ancient prejudices and manners, receives new ones from the new mode of life he has embraced, the new government he obeys, and the new rank he holds.”

         Friends, celebrating diversity and being culturally competent is more than taking Bollywood dance lessons, watching foreign movies, being able to digest spicy foods, or even traveling to foreign countries for few weeks and posting tons of fun photos on social media.  It is in moments like this when we can genuinely celebrate the win of a truly deserving Indian American beauty queen as Miss America 2014.

Congratulations Nina Davuluri.  You Go Desi Girl!

"Ok, But Where Are You Originally From?"

Kamana Khadka

          August 15, 2013 marked Hamro America’s first 4-hour cultural competency workshop.  With 112 registered participants, facilitating Diversity Leadership Alliance’s (DLA) August workshop was a thrill of a lifetime for me personally.  March 29, 2013 was when we got our first break to facilitate two sessions, 90 minutes each, at the Eighth Annual Cesar Chavez Conference. With few other facilitation, presentation, and consultation opportunities along the way, this was our first ‘big fish.’  As an agency, less than a year old, we loved every bite of it.  We are not stopping here.  We are going National - to Philadelphia this October.

         One of the innovative pieces in this 4-hour workshop was the title itself “Ok, But where Are You Originally From?”  Over the course of my stay in America, first as an international student and later as a working professional, this particular question has developed a deeper significance in my life.  I am usually a very patient person. There are very few things that I just cannot stand and one of those is being asked the question, “Where Are You Originally From?”

         Don’t get me wrong.  It is not so much about the question. It is about what follows the question.

         “Wow, you don’t have an accent.”

         The complete stranger after having asked me the question either compliments me for speaking English so well or they look at me as though I don’t understand English at all.  Even after 10-15 minutes of good conversation, I have experienced almost reactive additions of elaborated hand gestures as soon as I disclose - “I am originally from Nepal.”

         I am a proud Nepalese, a woman, a passionate learner of culture, a fierce advocate for diversity, a Nepali language speaker, a firstborn daughter, a volunteer English as a Second Language Instructor, often unprepared but excited traveller, a hater of injustice, a non-profit worker, a public health student, a loyal friend to the refugees and immigrants, a lifelong learner, and apparently brave enough to explore arranged marriages in recent days.

         So, the stranger’s question and/or reaction doesn’t describe me. At all. 

         During the August 15^th workshop, one of the participants from a Hispanic/Caucasian background shared a question she was repeatedly asked as a child by her classmates in school.

         The question was – “What are you?”

         In the audience was a participant from an Asian/American background who was shaken to the core of her being, after listening to this question.  She was so affected and in disbelief that she openly expressed her emotions.  We spent some time exploring the “What are you?” question. But unless we educate each ‘culturally blind’ individual, the same question is going to be asked to someone else in some other form.  At my workshops, not only do I share my experiences but I make you dig into yourself and share yours also.  It is called co-learning.  This is the only way you can learn to celebrate diversity.  Trust me.            

         For the reasons that population of people like me is growing exponentially in today’s America, recognizing the diversity of culture and different ways of life has become unavoidable. In exploring the loaded baggage that comes with “Ok, But Where Are You Originally From?” question, we also looked at cultural competency in a continuum.  We explored the dynamics of differences and we came up with our own tools and strategies for cultural competency.

         Below is a collective/combined list of strategies the groups came up with:

·      Hold cultural competency workshop as on-going training to the staff.

·      Provide staff incentives to participate in cultural events. 

·      Host diversity and cultural nights.

·      Be open-minded, have open ears, adjust to cultural differences so that personal views and beliefs are not imposed on others.

·      Adopt “inclusive developmental practices” as an organizational policy.

·      Identify cultures within the company.  Create a plan.  Get the “buy in” of management to conduct diversity and inclusion training/workshops.

·      Hire trained and qualified interpreters. Provide translated materials.

·      Provide cross-cultural communication skills training on expressive and receptive methods of communication.

·      Revive cultural diversity committee to help doctors be culturally competent in practice.  Also make sure that:

1.   Representative members are from a diverse background.

2.   The mission statement is reflective of cultural inclusiveness.

3.   Needs assessment are not only conducted by they are followed by action.

4.   Cultural competency is part of educational curriculum such that it is included in the experiences of student, faculty, staff, and administrator at a university level.

·      Listen to your client before making recommendations on their behalf.

·      Be open to customizing your services based on the client’s cultural needs.

         The group was absolutely amazing and the vision of Hamro America LLC “Culturally competent service for all, disparities for none” was successfully transferred to organizations and individuals who participated in the workshop.  I am so very proud of them all.

         Also a very special thanks to Mr. Essen Otu, Diversity Director at Mountain Park Health Center for the lead to DLA.  I am really grateful to Mr. Bob Enderle, Board Member of DLA, for all his candid guidance and feedback throughout my preparation for this workshop. I would also like to thank Ms. Christine French, Board Member of DLA for her openness and encouragement. 

Please remember Hamro America LLC for your next cultural competency exposure.  Invite us to your organization.