How do you conduct a culturally sensitive conversation?

Ramzi Oulad Lmaroudia is a spiritual caregiver at GGzE Eindhoven. He provides support to a broad group of people. organ donation.

'No fewer than 1 in 3 Dutch people have a migration background. And about two-thirds of them are non-Western. It is therefore logical that this requires something from communication in medical practice. Especially when it comes to something as sensitive as the end of life and organ donation. People from other cultures often think differently about this than people with a Dutch background.'

Attention to specific needs

'In my role as a spiritual caregiver, I support people when the 'ordinary' is disrupted. Think of illness, loss, and death. Then patients, loved ones, or the bereaved need a listening ear.'

'Religious people sometimes have special needs. If necessary and desired, the spiritual caregiver can perform rituals for them, ranging from reading from the Quran - or another religious book - to praying for sick people. But Roma, caravan dwellers, and people from the Dutch countryside are also groups with a specific background and culture. For all these people, more national attention is needed for culturally sensitive care and communication.'

Being open and curious

Because of his Muslim background, Islam is Ramzi's area of focus. 'But I am there for everyone,' he emphasizes. 'Whether someone is Roman Catholic, Buddhist, or Muslim, that doesn't matter to me. Culturally sensitive means that you include and respect the philosophy of life and background of your conversation partner or the deceased. They determine a person's norms and values.'

'Attention to that is essential, because health decisions and behavior stem from it. In my opinion, two qualities are essential for having a good conversation: you must be open to others and be curious.'

Possessed by spirits

'An example is schizophrenia. Some people from the Caribbean or with an Islamic background do not see this as an illness. They think someone is possessed by spirits. You have to talk about it very differently if you want to discuss a 'treatment'. With respect, and knowledge of their culture. If you, as a practitioner or (spiritual) caregiver, delve into that, you understand why a patient or loved one says or decides something.'

Pay attention to the context

You have so-called low-context and high-context cultures. These partly determine your communication style. Ramzi explains: 'Dutch culture is an example of a low-context culture. Communication is direct, explicit, straight to the point. And: an agreement is an agreement. The words themselves convey the message.'

In high-context cultures, such as in Southern Europe and non-Western countries, the context is decisive. Religious background, tone, emotion, and the community play a role. For example, in a high-context culture, a sick elderly person is cared for by the family. In the Netherlands, it is common to place someone in a nursing home. Those kinds of cultural differences have a direct impact on conversations.

Word choice when stopping treatment

'Our Dutch communication is often not understood or appreciated. Word choice is important. The message 'We are going to stop the treatment' is clear to most Dutch people. For high-context cultures, that is far too direct. For them, it sounds more respectful if a doctor phrases it as: 'We are going to see if the treatment is still fruitful.'

Prejudices about organ donation

Cultural differences, ignorance, and prejudices also have consequences for medical treatments and the organ donation process. Ramzi: 'If you look at medical treatments, Islamic patients are often hesitant about the offer of morphine and palliative sedation. So they continue to be treated, which can lead to inhumane situations. Regarding organ donation, religious patients and their loved ones regularly struggle with questions. For example, they do not know whether they are allowed to receive an organ from, or donate to, someone who is not religious.'

Materials in various languages

Culturally sensitive care and communication can help in such situations. The spiritual counselor believes more attention is needed for this. He suggests materials, for example. 'Such as brochures and videos in the languages of people with a non-Western background. Especially in Moroccan and Turkish. But there is also little available in Ukrainian or Syrian. An interpreter doesn't always solve the problem, because a lot of information gets lost in translation.'

Policy is needed

Despite the need for improvement, Ramzi does see a positive trend. 'Here in Limburg, there is limited attention for diversity and inclusivity within spiritual care, but from Brabant onwards, there is more. Certainly within psychiatry and home care.' He does, however, advocate for a structurally more sustainable approach.

'I am occasionally invited by people on the work floor to talk about culturally sensitive care. It's nice and important that they pay attention to it. But it is also necessary to reach the layer above, so that it can become policy. It needs to have a sustainable character, both in healthcare institutions and from the government. Only then will patients and surviving relatives from diverse cultures truly benefit from it.'