CULTURE IN MEDICINE Cultural Immersion in a Cultural Competency Curriculum

Objective: Cultural competency is becoming increasingly important nationally. During recent seminars held throughout Hawai’i on Native Hawaiian health, several questions were raised related to cultural competency. First, can providers’ cultural competency improve the poor health status of Native Hawaiians? Second, how can Native Hawaiian physicians, who are trained in Western medicine and Western ways of thinking, bridge the gap that exists between them and traditional Native Hawaiian approaches to health and healing? The purpose of this curriculum was to teach community physicians how to become more culturally competent and to see whether adding an intense cultural immersion experience would increase the success of the curriculum. Description: The Native Hawaiian Center of Excellence of the John A. Burns School of Medicine at the University of Hawai’i, the ‘Ahahui o na Kauka (the Native Hawaiian Physicians Association), and the CME sponsor, the Straub Foundation, designed a CME curriculum entitled, ‘‘Increasing Cultural Competency in Native Hawaiian Physicians.’’ The five-day program was offered in August 2000 on the islands of Maui and Kaho’olawe. Kaho’ olawe, a former Navy bombing target, is currently uninhabited but access to the island is granted monthly to Native Hawaiian groups for cultural purposes. Since there are no facilities on the island, all the participants’ food, water, camp gear, and personal items were brought over by boat. The participants were 23 physicians, two traditional healers, guests, and family members. The curriculum addressed the following topics: historical and cultural aspects of Native Hawaiian health; traditional healing methods, including herbal medicine (La’au lapa’au), massage (Lomi lomi), and conflict resolution (Ho’oponopono); traditional diet; cultural competency from a global perspective; cultural competency in the medical school; and how culture affects the MD–patient relationship. Intense cultural immersion experiences were included. Activities such as tours and hikes to archeological and culturally significant sites, sessions for family and spiritual sharing, prayers, chanting, music, hula, and ecologic restoration work projects enabled the participants to experience traditional Native Hawaiian values of aloha (to care for), malama (to take care of), ‘imi ‘ike (to seek knowledge), loko maika’i (to share), and olakino maika’i (to be healthy). Everyone also participated in cooking, cleaning, and transporting gear. Discussion: This novel approach to a cultural competency curriculum was very well received. The ability of speakers to meet objectives was rated on average 4.6 on a scale of 1 (poor) to 5 (excellent). The written evaluations were extremely positive. The following comments summarize what participants liked about the experience: ‘‘incredible program, site, environment,’’ ‘‘cultural immersion,’’ and ‘‘learning occurred on many levels.’’ One physician commented that it was ‘‘the best CME program ever!’’ The few negative comments concerned the breadth and limited time for discussion of many of the topics addressed. There are plans to repeat the program next year. Modifications will include decreasing the numbers of speakers to allow for more discussion time and increasing the attendance of non-Native Hawaiian physicians. Inquiries: Martina L. Kamaka, MD, Native Hawaiian Center of Excellence, John A. Burns School of Medicine, University of Hawai’i at Manoa, 1960 East–West Road, Biomed B–204, Honolulu, HI 96822.