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Welcome to the Islands
When I moved to Hawaii seven years ago, I attended an orientation for new faculty at the University where they said “you either love teaching here or you hate it.” In that cohort of faculty was a blond-haired blue-eyed woman with a German accent hired to teach in one of the science departments. I did not see her again until running into her on campus seven months later when she told me she was leaving “the students here are rude and disrespectful and I have not had a successful experience. Every day is a struggle to get their attention.” I thought back to that orientation session… in the intervening time I was having a terrific cross-cultural experience learning about Asian cultures and what exactly it was that makes a classroom at the University so different that one on the mainland. Clearly, here was a person who was not able to grasp the interpersonal insights and skills we’d spent time talking about that day, and which were a continual thread to the discussions of how to help students in my department. I guess that helping her address these issues was less important among faculty in her department.
Reach out to Multiculturalism
She was not alone, and in the intervening years there are many other examples of people who either “get it” and enjoy this special place, or who just can’t quite fit in, and don’t have the tools to figure out how to cope. This extends beyond faculty at the University into every sphere of work. Of course, in some areas you can structure your work day and your life in such a way that you never come in contact with anybody who is not a “haole” – if that is the case, you are missing out on the richness and cultural heritage here. If you can learn and grow, Hawaii is a wonderful place to enjoy world cultures and the unique local culture. I truly believe Hawaii is a model for the rest of the USA in terms of how to realize that we all are persons and we all deserve respect on our merits, not just on a stereotype.
UH has an office named The Center for Teaching Excellence which helps faculty to make the adjustment to teaching in the islands. In a parallel way, I expect the UH Medical School (known locally as JABSOM) to continue their rich tradition of multicultural sensitivity and inclusion. The first edition of the book “Peoples and Cultures of Hawaii” was a solid effort in this regard, published in 1980. I’d written a review of that one a couple of years ago, since I felt that it was better at addressing Hawaii-specific issues than the usual textbook resources on cross-cultural nursing. This second edition came out in 2011 (while I was in Nepal, on an entirely different cross cultural quest…) and is due to be a beacon of hope to all medical sailors seeking harbor on our shores. Aloha!
Take a Peek
A nice feature of Amazon nowadays is to see the Table of Contents and peek inside the book; for that reason I will not repeat here what you can read in the author’s own words. The book seems to be about twenty percent longer, and chapters have been added on some of the more recently prominent immigrant groups from Asian countries that had barely been on the radar in 1980 (Cambodians and Koreans, for example). A wider variety of contributing authors are included, and often the writer is from the group they are describing. There is a glossary of terms from the anthropology literature in the back, seemingly designed to give medical practitioners a more solid footing to describe the friction points in acculturation, etc.
For these reasons, I think this book should be handed to every MD, RN, RPT, or medical professional of any type who comes to the Islands, along with their Hawaii license.
Now, all of this is not to say that the book is still perfect. From the nurse’s point of view, I wish that some of the chapters had been written or reviewed by nurses; I think the perspectives of medicine and nursing are different, and that some very practical tips on how to interact with patients and families would have improved this. For nursing, one of the main resources on cross-cultural interaction is Lipson & Dibble (from UCSF) and they too categorize each cultural group by country-of-origin; The nursing schools here tend to use that one as required reference books for student work that includes obeisance to the cultural origin of the patient at hand… with a little different focus this book would have had every right to supplant these others as the index text for this subject area.
Eye contact – or no?
Next, one of the friction points in general communication between persons from the mainland and persons from an Asian culture is body language – such things as how long to wait for an answer when you ask a question, how far apart to stand, eye contact, etc – these things are very specific and though they often sometimes vary from one Asian culture to another, they constitute an area to work on. For that reason, I think a “how to” on this subject would add.
The book makes an excellent effort to look forward – where do all the cultures go from here? But did not really look at the underclass and the “locals” as if they were a distinct subgroup – which they are. The youth of today are not major consumers of health care in the way that the elderly population would be, and youth culture evolves at the speed of light – but I would have loved to read the authors’ assessment of this. Of course, this is a moving target, and today’s “Jawaiian” craze could be obsolete long before the 3rd edition rolls out. I wish there was a website specific to this book where the authors could archive some of the updated web resources on subjects such as pidgin.
Addendum April 10 2012
One of the nifty things that happens at the school of nursing where I teach is when students do a video project for the community health class. Sometimes these end up on YouTube. Click here to see one which I think is particularly good. The student who plays the role of the Filipino lady in this video, deserves some sort of oscar – not just for the acting, but for the sense of humor which is so evidently on display.
In summary, your preparation for Hawaii should consist of more than just the Lonely Planet Guide. Get this one!