The Value of Cultural Exchange in Health Care

On a Tuesday in February 2002, a happy little boy left home for school. Two hours later, he started feeling unwell, and his parents were called to pick him up. The next day, he insisted on going back to school, even though he was still unwell, and his parents allowed him. He got worse and was picked up early again and taken to the hospital. Heartbreakingly, he passed away the next day, on Thursday morning. That little boy was my younger brother, and he was only 12 years old.

I was devastated and could not process what had happened. He was young, full of life and energy, and smart! In fact, I believe he was the smartest in our family at that time. I wanted to know and understand what had happened to him. I knew death could be unpredictable, but what happened to my little brother did not seem unpredictable. No one could answer my question in a way that made sense. I even doubted that the older people around me fully understood what had happened, and so began my curiosity about the art of medicine. Curiosity met my passion for service, and I became a physician assistant.

In my nine years of practicing medicine, I have come to understand health disparities and how different cultures do not trust modern medicine due to their personal experiences. When COVID-19 hit us by surprise, there were a lot of discussions in our health care system on how to fight this deadly virus. We knew nothing about the virus, we were scared, and people were dying exponentially.

I was working as a hospitalist physician assistant (PA) and director of advanced practice providers (APPs) at Adventist White Oak Medical Center in Maryland until June 2020. We held several strategic meetings on how to protect our staff, patients, families, and the community. I remember vividly one particular meeting, where we were discussing how to contact the families of patients dying in the hospital so they could know the cause of death. By having this important piece of information, we hoped they would have closure and take precautionary measures to protect themselves and their extended families and friends.

As families were not able to visit loved ones in the hospital, we communicated with them via telephone. Families needed to know if they were exposed or at risk. We contacted families to get exposure history and counseled them about quarantine and isolation depending on whether test results were positive. At the time, it was taking more than three days to get test results back, and in some instances, it took that long to let families know that their loved ones had passed away from COVID-19. At the meeting, they asked for volunteers, but most people were hesitant to take up such a task. Almost instantly, I was reminded of my little brother’s death and what it would have meant to me if someone had told me the cause of his death. Without hesitation, I signed up for the undesirable task.

The very first patient’s family I called happened to be Haitian. When I started talking, they were reserved and did not want to answer questions. They were very skeptical. I was able to speak to them in our native language, Haitian Creole. In the midst of this ordeal, they kindly expressed their gratitude.

The following week, we had a complicated patient who ended up in the intensive care unit. Three days later, the patient’s clinical status declined and he was downgraded to a lower level of care, with a plan for palliative care and hospice. While speaking to one of my physician colleagues about the case, I learned that the patient had been confused for over three weeks. My colleague mentioned that the patient was Haitian, and I asked him if it was okay for me to assume the patient’s care. He gladly transferred the patient to my service.

Upon entering the room, I greeted the patient with “Bonjour,” which means good morning, with familiar Haitian intonation. He perked up and adjusted himself on the bed and gave me a bright smile. He asked to speak to his family. The patient felt that everyone there thought he was crazy. He was confused about why he couldn’t see his family. We had a great conversation, and I called his family. From there, the patient’s overall clinical status started improving significantly. The cultural connection clearly had a great impact on the patient’s care, and I felt the priceless value of this connection.

Who would have thought that, 20 years after the death of my brother, I would end up in Maryland caring for a fellow Haitian? This cultural connection is something I will cherish forever. It reminds me never to forget why I am in medicine, and to encourage others to remember why they are doing what they are doing today. As a physician, physician assistant, nurse practitioner, or health care leader, you have one of the most stressful jobs. However, do not let this discourage you. Instead, remember how you are impacting lives every day.

As immigrants, many of us have come to this country and worked tirelessly to achieve our dreams, facing obstacles along the way. We are dedicated to serving the community we now call home, but we also feel a strong desire to give back to our countries of origin. Whenever we have the opportunity to serve people who share our values and culture, it brings satisfaction that words cannot express.

It is important to recognize that language barriers can make it difficult for some patients to receive the care they need. That’s why it is so crucial for clinicians to be culturally competent in order to connect with patients and make them feel included and valued. When we take the time to connect with our patients on a cultural level, we can build trust and provide the best care possible. As one of the world’s most ethnically diverse and multicultural nations, the U.S. has a rich tapestry of cultures that should be celebrated and respected. Let’s work together to ensure that all patients receive the care they deserve, regardless of their background. 

Mr. Desamours

Mr. Desamours (@padesamours) is the director of APP operations, hospital medicine, at US AcuteCare Solutions, Westminster, Md. He obtained his PA degree from the University of Charleston, Charleston, W.Va.