Tucked in the heart of the Cedar-Riverside neighborhood in Minneapolis is the People's Center, a clinic that is centered on providing culturally centered-care to an often marginalized community. Cedar-Riverside is a diverse neighborhood and is often referred to as Little Mogadishu for its vibrant Somali community. We reached out to the People's Center to gain greater insight in to how healthcare providers across the country can be more culturally inclusive, especially when it comes to women's intimate health.
Patient and community educator Nawal Hirsi and certified nurse midwife Christine Rangen shared their experiences with us and provided several tips for other healthcare providers.
1. Take yourself out of the equation. Do not impose your beliefs and way of health on the patient. Make the interaction a conversation and learning opportunity for the both of you.You may learn about new traditional methods to health, which can be incorporated into their care plan. The time you spend with the patient is about her and her health, not only about you and your care plan .
2. Let the woman take the lead. Be open to how much a woman wants to disclose. Be attuned to where she wants to take the conversation and do not have pre-determined objectives. You may not know what this patient has gone through physically and emotionally. It takes time to build trust and rapport, and one visit may not lead to an in-depth conversation or follow-through with the proposed care plan, but the next time she comes in she may feel more comfortable opening up or following through with recommendations .
3. Withhold judgement. Don’t be surprised in what the patient is sharing with you. All is normal when it comes to the range of life experiences. Expect the unexpected. Hold a welcoming posture and don't be shocked.Trust is built through the patient feeling that her life experience and perspective is valued and respected. If the patient feels judged the trust won’t be there and the care plan will be rejected.
4. Think beyond this visit. How is this person living? What is the patient experiencing outside of the clinic? What are the obstacles and barriers and how does it all connect? It isn’t just about this visit.
5. Take down the wall. Let the patient know what you are doing. Explain why you are doing what you are doing. Make the visit educational so the patient can ask questions and allow time for them to make well-informed decisions about their care. Incorporate visual aids to demystify the tools that are being used and encourage the patient to ask questions.
6. Know yourself as a provider. Understand your perspective and your potential biases. Christine discussed her experience: "For me, I am a privileged white woman, raised in the Midwest, raised in a low-income family and now later in life middle class, highly educated, from a Christian household. I am a mom and have biracial children. All of these things shape who I am. It is important to take stock of all of the things that are part of who we are and how these aspects intersect with those we partner with in delivering healthcare. This is essential in providing culturally competent care. Realizing your limitations and privileges, especially if you are coming from the dominant, mainstream culture. As a healthcare provider there is already an inherent power dynamic, so we need to be self-aware to not allow our individual perspectives and biases impact how we partner with patients."
As a country we continue to become more vibrant and culturally diverse and with that comes an opportunity to rethink our care methods. Although these tips are focused on culturally-centered healthcare, we all benefit from more self-awareness and empathy and these practices will positively impact care for all patients, across cultures. In fact, we can learn something from these tips that will improve our interpersonal relationships, especially with people who might seem different from us--whether or not we work in the healthcare field.