part two: About Hawaiian Culture for the Travelling Nurse

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Review of “Peoples and Cultures of Hawaii: The Evolution of Culture and Ethnicity”

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.

Suggestions

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.

“Local”

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!

part one: Guide to Hawaiian culture for the Travelling Nurse

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Exotic Hawaii?

I have a friend from the mainland who thinks Hawaii is really really exotic. and I suppose, compared to Indiana, it is. Then again, Indiana would be considered exotic in its own way if an anthropologist from some other country were to visit there. For me, having lived in Nepal, the answer would be – no. Pretty bland compared to Patan. We wonder why people think Americans ( the WASP kind) are arrogant? it’s because they(we?)  assume that the yardstick culture, the frame of reference by which everything is to be judged, is the one “they” grew up in. (whoever they may be….)  There’s a great poster from Syracuse Cultural Workers that applies, here.

Images from TV

Ask yourself what your image of Hawaii is. Chances are it’s from television.  Or maybe the movies. The Chamber of Commerce here is alway thinking of ways to promote Hawaii on the mainland. It’s no accident that the Pro Bowl is played here. (In January when everyone else is freezing.) What is Hawaii like from the inside?

For Travelling Nurses

Anyway, there has always been a subculture within nursing, of Travellers. Nurses with specialized skills who come to Hawaii for an exotic experience.  Now that I have been here seven years, I feel comfortable enough to compile a quick guide to cross-cultural nursing as applied to Hawaii. Particularly Honolulu.  Every nurse that goes to nursing school here already has learned these things.

The first question is, How did everyone get here? Honolulu is the most “majority-minority” city in the USA, the only state where European descendants have never been in the majority. You expect to find Hawaiians here, and 40% of all Hawaiians in the world, live on Oahu, as is fitting. but they are now a minority.

Yes, this is an issue.

Resources

IMHO, the best book on Hawaiian culture is Peoples and Cultures of Hawaii, written by two guys from the John A Burns School of Medicine. UPDATE: I am pleased to report that a new edition of this was released in 2011 –  There is only one review of the 1980 edition written on Amazon, but I think that reviewer knew what he was talking about,  it is incredibly insightful. The book is a classic, I will run down to the store and get the new one!

From a sociological or anthropological perspective, nurses absolutely need to learn about and respect the culture of which ever person they are caring for.  Frankly, that has always been something I loved about nursing. The variety of manifestations of the human spirit is what makes earth a great place.

Most nursing school nowadays require students to buy and use a reference book on this topic. Many of these books have a section on Hawaiian culture.  And also about Nisei, and about Pacific Islanders and Samoans.  All well and good. There is a gap in the professional literature. When we assign students to ask about the culture of a given client, they sometimes come back and say

“Well, he said he is part Pordagee, Hawaiian, Chinese, Filipino and Swedish. What do I put down on the assessment form? do I have to look up all of them?”

“Nah, just put down ‘local’ ”

Local?

So then the question becomes, “Is there a distinct culture known as ‘Local’ around here, and if so, what is it?”

It’s a chapter waiting to be written in the edition of all those cultural atlases. Take note: whoever wishes to tackle this can become famous in a scholarly way. I do have to warn you: this is a minefield of political correctness. Be prepared to be flamed.

I don’t think I am the one to write it, but I will give suggestions to whomever is brave enough to assume this task.

Pidgin

First, language. There is a specific dialect of English spoken here, known as “Pidgin.”  And yes, you will hear it spoken, but only if you listen carefully. Pidgin, or “local talk” is also, a loaded political subject, since the colonialist Americans tried to eradicate it. You can find it on YouTube.  Because of the musical inflection of pidgin, it is not possible for a person from the mainland to fake it and pretend they are local; but if you are here you need to learn  how to enjoy it. I also highly recommend the book “Pidgin to Da Max” as a hysterically funny guide to the subject. There are examples on YouTube.

I suppose that Rule Number One rule for any person from Da Mainland would be, never assume that a person speaking pidgin lacks intelligence. ( a terrific link!)  Think of pidgin as a whole different language which just happens to contain elements of English. In fact, college students often are able to slip in and out between the King’s English and Pidgin just as if they were two different languages.  The decision to use one or the other is very sophisticated, situationally driven, and a conscious one. Because of historical active discrimination against pidgin-speakers, if a bilingual Pidgin/English speaker thinks you are condescending toward them because of it, you will find your job here much more difficult. Trust me.

A student of mine who was Asian, had studied on the mainland ( Nebraska!) for a year, and she said that one of the reasons that she came home was, she was tired of the fact that the Nebraska-based students assumed she didn’t speak English well. She said that prior to that experience, she never considered whether Asian-Americans could be the subject of racism. It had simply never occurred to her.

The former Saint Francis Hospital had a rule about language: The official language of the hospital was English, and employees were forbidden to speak any other language in the daily conduct of their work. Think about that one. The patient population was multicultural in a dazzling way, though, and if the patient initiated the conversation, it was okay. The staff there was capable of greeting them in the same multitude of languages. Actually, it was something I loved about working there.

Rule Two

Which leads to rule number two: learn about the culture of your coworkers, just as much as you learn about the culture of the patients. After all,they are probably one and the same. We had a new faculty person from New Orleans, Louisiana – a fascinating and wonderful American culture all of its own. One day at class break, I asked for volunteers to teach her how to fold a paper crane…. and ten students happily shared time to talk with her about origami and what it meant for them. Wicked cool.

Rule Three?

rule three is – “chill.” as in learn to chill.  (read every definition!) Be advised, this is also the most “Asian” City in the USA. Certainly the most polite of any city I have been in, and I have lived in a few. The most respectful and mellow. If you drive like you are in Boston or New York City, you will have a problem on the roads here. Here you will learn patience and how to enjoy a gentle sense of humor.

Food – sometimes only Zippy’s will do!

Next is food. there is a distinct Hawaiian cuisine, known as the plate lunch. You can get rice for Breakfast at McDonald’s.

I would be remiss if I omitted some of the great comic talents of Hawaii that are able to examine and poke fun at their own culture. Then of course, so much of cultural knowledge consists of little tidbits; discrete factoids that we would call “Pearls of Wisdom”

The North Shore is Going Off!

There is a distinct surf culture in Hawaii.  Subject of a whole nother blog.

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