Viewpoint Sarah C. Smith, RN, MA, CRNO

Get some culture: The need for cross-cultural awareness is closer than you think

n* n November 1998, I was privileged to be the keynote speaker at the 14th annual nursing symposium in

1 Riyadh, Saudi Arabia. My week there gave me more than just the lifelong mem- ories I had anticipated. It allowed me to revisit and reestablish my awareness and commitment to cultural diversity and its impact on the delivery of meaningful and satisfying patient care.

The religion of Islam and the Arabic language create the culture and, conse- quently, have a great impact on the deliv- ery of ophthalmic health care in Saudi Arabia. Men and women have separate waiting rooms. There are prayer rugs in the main concourse of the hospital to per- mit the men to face Mecca when called to prayer (which happens 5 times each day) without having to leave the immediate vicinity. The hospital cafeteria serves tra- ditional Arabic foods, as well as additional “westernized” dishes. Although there are many more native and Arabic-speaking health care providers than in previous years, there remain a number of inter- preters to increase understanding and communication between patients and non-Arabic-speaking health team mem- bers. One of the most dramatic cultural differences I noted was the immense patience displayed by the Saudi patients, which is due in part to religious ethics that stress the importance of faith, good

deeds, and mutual respect rather than individual importance.

The health care system is national and world renowned for its excellent stan- dards. Hospitals operate on the standards set forth by the Joint Commission for Accreditation of Healthcare Organizations (‘JCAHO). All Saudi nationals have a right to access primary, secondary, and tertiary levels of care.

The eyes hold special cultural attach- ments. They are truly thought to be the “windows to the soul.” Taking pictures of people is difficult because there is still a belief by some that a part of the person’s soul can be captured in the picture. This belief also presents problems in providing some ophthalmic care and treatments. For example, sometimes parents will not per- mit enucleation for a retinoblastoma tumor in a child. Sadly, many children in whom retinoblastoma is diagnosed con- tinue to a terminal disease state.

Another culturally set predisposition to the delivery of health care in the Saudi population is the importance of the opin- ions of other family members, especially elders. Often decisions are made by an entire group of people, not just the moth- er or father.

The positive aspects of cultural diversity and difference, however, far outweighed the potential negative aspects. I returned home determined to become more cultur-

Reprint requests: Sarah Smith, RN, MA, CRNO, Editor, Department of Ophthalmology, Universi- ty of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242- 1091.

Insight 1999;24:3-4.

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INSIGHT The Journal of the American Society of Ophthalmic Registered Nurses, Inc. Volume XXIV, No. 1, January-March 1999 3

ally sensitive to my patient population. I Yes, my pilgrimage gave me much more searched for evidence of the need for cross-cultural awareness here, and, indeed, I did not have to go far. Some recent sta- tistics I uncovered are that 14% of current US citizens’ first language is not American English. In 10 to 12 years, that figure could grow to 30%. With the evolution of global business 40 to 50 million interna- tional visits are made to this country each year. By the year 2000,25% of the US population will consist of what we have generally called “minority groups.”

than I ever expected. One of the most personal gifts I received was a reawaken- ing to the importance of preparing for cross-cultural care and the necessity for good communication, open-mindedness, flexibility, and empathy. I take a refreshed attitude about patient percep- tions and expectations with me these days. I think I listen more and am cus- tomer service oriented in a new and slightly different way. Get some culture! It was certainly good for me.

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4 Volume XXIV, No. 1, January-March 1999 INSIGHT The Journal of the American Society of Ophthalmic Registered Nurses, Inc.