It is past time to retire the term ‘cultural competency’ in favor of the more enlightened ‘cultural humility.’ The word ‘humility’ is a problematic one for people, especially for health care providers or academics used to doing everything possible to avoid being humble. We are groomed to be arrogant. (See earlier post “Cultural Competence, Meet Cultural Humility” Aug. 16, 2011.)
But I’m reminded of one of my favorite quotes from a favorite author, William Maxwell, from his book Time Will Darken It:
“People often ask themselves the right questions. Where they fail is in answering the questions they ask themselves, and even there they do not fail by much. (…)There is no haystack so large that the needle cannot be found. But it takes time, it takes humility, and it takes a serious reason for searching.”
I juxtapose this quote with one from Craig Irvine who teaches in the Columbia University Program in Narrative Medicine. Mr. Irvine is a former Benedictine monk whose area of expertise is narrative ethics. He talks about empathy (necessary for cultural humility) as being “my experience of the mystery of my relationship with another person” as opposed to the usual understanding of empathy (in healthcare settings at least) as knowing the other person or “stepping into their shoes.” Craig states, “empathy brings me to myself.” (Quotes are from my notes of a talk he gave at a narrative medicine conference I attended in October, 2010).
We really never can know someone else, and as William Maxwell points out, many times we fail to even know ourselves. But in the words of Lyle Lovett, “Who would you be if you didn’t even try?”
That brings me to my hearty recommendation of a relatively new video I happily stumbled across yesterday (thanks to Community-Campus Partnerships for Health.) The video was written/produced by Vivian Chavez and is titled, “Cultural Humility: People, Principles and Practices.” (Aug. 9, 2012 release date/ 30 minutes in length.) The video features interviews with various people, including physician Melanie Tervalon and nurse/educator Jann Murray-Garcia, co-authors of the journal article “Cultural humility vs. cultural competence.”(Journal of the Poor and Underserved, 9(2) 117-125.)
According to Tervalon and Murray-Garcia, the three principles of cultural humility include:
- Lifelong learning and critical self-reflection
- Recognizing and mitigating power imbalances
- Institutional accountability (they emphasize for the power imbalances, but I would add accountability for the structures/support/leadership necessary for lifelong learning and critical reflection… these are usually woefully lacking.)
While watching this video for the first time I was thinking—wait! Where are the white people in this? But at least I did recognize my own white privilege arrogance in the question. I continue searching in my haystack.