Before traveling to Bassett-St. Elizabeth Family Residency Program in Utica, the SOAN 355 class devoted considerable class time to understanding the many issues that can arise when patients from other cultures seek medical care in the United States. We read a book by Anne Fadiman entitled The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. Fadiman's ethnographic work describes the experiences of a young girl named Lia, who lives in California with her parents and is diagnosed with severe epilepsy. Lia's parents come from the Hmong culture in Laos, where people identify what Americans refer to as epilepsy as a special and unique relationship with the spirits. Thus, an epileptic may be deemed a shaman and source of wisdom later in life as a result of this relationship. We see the obvious conflict that this creates between the two cultures, because Lia is considered to be blessed by her parents, but is deemed severely ill and impaired by her doctors. 

After speaking with the nurses, support staff, and medical residents of the Bassett-St. Elizabeth Family Medicine Residency Program, we understand that they have indeed encountered several issues of cultural concern among their patients, which they are taking steps to address. These concerns range from language barriers and communication difficulties, to dietary concerns and religious practices of the patients, to sensitive subjects such as gender, modesty, and sexuality.

Our hope is that the following Guidelines to Practice will provide an overview of the various issues of concern to health professionals when serving a culturally diverse clientele. Particular emphasis is placed on the concerns of those ethnic groups, immigrants, and refugees residing in Utica and utilizing the medical services of St. Elizabeth's.