When Dr. Joseph Betancourt spoke on “Solutions for Disparities: Delivering Quality Care to Diverse Populations” in Chattanooga TN, he delivered both unusual expertise and a personal model for future healthcare. Dr. Betancourt’s family came from Puerto Rico to NYC and he talked about his childhood as interpreter for his grandparents to their doctors. Today, Dr. Betancourt is Director of the Disparities Solution Center and Senior Scientist at the Institute for Health Policy at Massachusetts General Hospital. With his medical degree, fellowship in Minority Health Policy and Masters from the Harvard School of Public Health, Dr. Betancourt is now a well-respected expert in cross-cultural medicine.
To achieve organizational cultural competence within the health care leadership and workforce, it is important to maximize diversity. This may be accomplished through:
• Establishing programs for minority health care leadership development and strengthening existing programs. The desired result is a core of professionals who may assume influential positions in academia, government, and private industry.
• Hiring and promoting minorities in the health care workforce.
• Involving community representatives in the health care organization’s planning and quality improvement meetings.
He was showing me paintings that hung on his living room wall. He had painted these over the years and wanted me to have one. He pointed to a painting of a Bosnian girl (whom he had met in Seattle) with a very serene expression on her face. “Or you can look at this one”, he said with a chuckle as he turned around pointing in the opposite direction; “it is interesting but not very pretty.” He called the painting -“the obnoxious bird, the bird from down under”.
A requirement for my medical school was to participate in health teaching. I chose to provide an informal session on alcohol, sex and drugs for a small group of freshman girls, the next generation of diverse women. I find this subject so important, because the issues confronting teenagers are numerous and can create a significant generational gap between them and their parents. It’s not as simple as just staying clean and not having sex to avoid pregnancy. The reality is that most teenagers at some point will drink alcohol and take drugs and/or become sexually active.
A fellow student recently equated being a medical school student with bumpy downhill skiing. You rocket down a hill and you jump, making some of the jumps, and missing many others. However, you can’t look back because you’ll fly into a tree. Of all the descriptions of being a first-year medical student, this is my favorite. Unfortunately, at the time all I could think about is how I hate downhill skiing. It terrifies me. Is hurtling down a hill on thin strips of metal to be considered fun? So, how do I, and all of us, get through this experience, and do it together, without flying into a tree?
Wake up in smiles
Because you are alive,
As God permits you
To see another day
Providing patient care without regard to race, ethnicity, gender, or religion is a core value of all medical professionals. However, do they extend the same level of tolerance, stand against prejudice, with other members of their profession?
Beginning in colonial America, the myth of the drunken Indian persisted throughout the 19th and early 20th centuries. The current, more “enlightened,” explanation for the high incidence of alcoholism among Native Americans, concludes that since they were exposed to alcohol for only the past few hundred years, they were genetically unprepared and, therefore, have little genetic “immunity.” American Native people, therefore, have little tolerance for alcohol, become intoxicated on small amounts, and, consequently, experience high rates of alcoholism. This belief, like many others concerning Native American culture, adds to the stereotype of genetic inferiority that continues to influence white American thinking.
Ninety years of living reduced to this: the slow counting of breaths followed by the Himalayan trek from bed to bidet to dimly observe the color of pee, the lethargic, sometimes movement of bowels, the hasty swipe with a baby wipe. And here we go again.
Regardless of whether it is a sudden sickness, fever, or an accident, a disability forces a person to face a new reality. No longer the same, he or she has to tackle the impediments that bind and overcome the barriers that appear on his or her horizon. A person in such a situation is labeled disabled.