“Perhaps instead of aiming for cultural competency, we should strive for cultural humility—understanding that we are not the experts in this local environment.”
My time at Clínica de Familia in La Romana, Dominican Republic has been an amazing period of personal and professional growth and learning. This was my first experience living and working abroad in a community over an extended period of time and it has been wonderful to work in a culture that is so different from my culture back home. From this experience I have felt so humbled by the amazing work of my co-workers and have learned what it means to foster cultural humility and a better understanding of my environment.
After this experience, I feel that the term people use to describe my cultural experience as growing in “cultural competency” is in and of itself inaccurate. This term of competence assumes that you will be able to master another culture and have grasped all there is to learn, assuming a position of superiority. Even after all of my months in La Romana, I find myself constantly learning new cultural nuances and understanding what different cultural exchanges mean. Perhaps instead of aiming for cultural competency, we should strive for cultural humility—understanding that we are not the experts in this local environment.
We must understand that perhaps we have a point of view of how a project could be better carried out, but as the outsiders we need to recognize and respect the perspectives of our local partners. This is their community and they will have the lasting impact on whether or not a project is sustainable. Sustainability is only possible with buy-in from local partners and community ownership. It is through the relationships that I fostered and my acknowledgement of our local partners as experts that I had the privilege to work on such a wide variety of projects at Clínica de Familia.
Hope and Joy
My evaluation project at Camp Hope and Joy, a HIV adolescent camp, and collaboration with camp staff led to the creation of a yearly focus group with the parents/caretakers of our campers. This focus group is a more feasible way to receive feedback and creates a space to reform the connection between the parents/caretakers and camp director that was lacking.
This camp really embodied its name, giving children the opportunity to experience the joys of being a child, while also giving them the hope that they are equally entitled to a future and to dream, not to be held back by their HIV diagnosis.
HIV Pediatric Nutrition Program
I led various quality improvement efforts for Clinica de Familia’s nascent HIV pediatric nutrition group. When I first joined the team, I sat down with the pediatrician and social services coordinator to learn more about the program to together identify areas that could be improved or further developed. From these discussions we realized that a key member of the child’s care team was not included in our nutrition team meeting, the child’s health promoter. We promptly invited the health promoter department to join our team in order to shed some light on the home life of the patients, providing a well-rounded perspective on patient care.
Fiestas de Nutrición
Another collaborative initiative I’m proud of is the formation of fiestas de nutrición or “nutrition parties”—a support group for Clinica de Familia’s HIV pediatric population. The parties are held four times per year and serve as a time for the health promoter and the pediatrician to present on a nutrition topic as well as open the floor for discussion. These fiestas provide an opportunity for continuing parental education around nutrition, while also providing some support group time and a healthy snack to the children. The first fiesta we held was in January and it was a great success! The parents received more individual time with the pediatrician and had more opportunities to ask questions.
I helped create a procedure manual documenting how the nutrition parties as well as the other parts of the program, like data collection, are conducted. The procedure manual will hopefully provide some continuity to the program, as the primary director of the nutrition program is the rotating pediatric fellow who changes every two years.
Maternal and Child Health Annex
In addition to the projects above, I also worked with our support group “adolescents in action” for adolescent mothers at the Maternal and Child Health Annex. These monthly support groups provide ten expecting mothers with the opportunity to walk alongside others in the same stage of pregnancy and creates a space for them to learn new motherhood information from various community health talks and activities. In this program we cover a variety of topics ranging, including: breast-feeding, taking care of your baby and myths and truths about pregnancy. During this time the mothers also make a craft for their child and the health educators answer any questions or fears the mothers may have about their pregnancy. Through this group I learned more about adolescent health and how to create a safe, comfortable and educational environment for vulnerable communities.
I greatly enjoyed this experience in La Romana and know that I have a new community here in the Dominican Republic. I learned so much from my co-workers—what it means to truly give, that a friendly “hello” goes a long way and the importance of flexibility and having faith that everything will be fine. Things may not go exactly as planned, but we must adapt and work with what we have.
Most importantly, I learned that it is cultural humility that we must try and grasp and not cultural competency. We must acknowledge the times when we don’t understand the culture or setting we are in. I gained countless professional and personal lessons and feel grateful and honored that this clinic and this community has given me the opportunity to get to know them and learn from them. I am also grateful for the InterExchange Christianson Grant for supporting me on this project!