When family physician Robin Councilman took her first job at the county medical center in Minneapolis, she didn’t expect to be assigned to a Hmong clinic. She had no idea which diseases were most common among the refugees or even how to talk about health with them. “Resettlement agencies drop them at the door and leave them,” Councilman says.
She soon learned that many of her Asian patients suffered from depression and post-traumatic stress disorder. They were at very high risk for parasites, tuberculosis, viral hepatitis and malnutrition, among other urgent problems. And she couldn’t simply jump in and offer the appropriate drug. Councilman quickly discovered that her biology-based view of illness and treatment had no relevance for her new patients. For them, disease reflects an imbalance between social, natural and supernatural forces and may require shamanic or magical healing.
Like other physicians and public health researchers who serve diverse populations throughout the world, Councilman found herself stepping across a gulf of mystery on both sides. On issues critically important to survival, she had to win her patients’ trust and interpret illness in ways they could understand. During eight years at the Hmong clinic, Councilman was clearly successful: Among other measures, immunization rates have soared to 90 percent, hepatitis B infections have dropped and more refugees have begun to use mental health services.
Journalists who want to climb inside another culture and report fairly on it have far less at stake, but we can learn a great deal from the strategies Councilman and her colleagues discussed during a week of meetings at a Salzburg Seminar on Multicultural Healthcare in Austria last fall. Perhaps more than anything, they encouraged an attitude of humility, observation and attention.
“Ask questions and listen. You have to realize they may know things you don’t know,” she pointed out — a concept that may seem obvious, but isn’t always practiced.
To get an honest answer, health workers — and journalists — must first know what to ask. That means letting a community define its own problems and concerns, rather than importing these from the outside, the physicians suggested. When researcher Anjali Capila began to study traditional health practices among Kumaoni women in the Himalayas, for instance, she asked villagers what they did to stay healthy. One told her, “I don’t answer wrong questions.”
Capila tried again, thinking she had phrased her thoughts poorly. But after several minutes of silence, she still got no answer. Finally, she realized that the inquiry had no meaning to her source. So instead of asking more questions, she began to listen. She built trust by asking community health workers to introduce her to villagers and to take her to their homes. She talked informally with women when they brought their children for vaccinations. And instead of relying on government officials for help, she waited to interview them until her research was nearly complete.
For the Kumaoni women, health connected to their status in the family, their access to information and their ability to act on it, their self-esteem and their voice in the community. It was a way of life. Once Capila understood the villagers’ own framework for thinking about health, she could find out what she wanted to know.
Capila also found unconventional ways to discover women’s concerns. In one study in the Himalayan Garhwal, she collected songs, both impromptu verses and those that women had passed down from mother to daughter. She learned about parts of their lives they would never have described to a stranger, such as the sadness they felt while their migrant husbands worked far away in the plains.
More and more, journalists will find themselves covering immigrants living in towns and cities across the United States. Hmong families, for instance, have settled in every state but Wyoming. On deadline, it’s tempting to rush in not only with questions formulated, but answers in mind, too. Instead, research the community you are entering, then spend time with the people who live there. Capila urges a deeper sort of attention when working in a culture different from your own: “Be present to it,” Capila says. “That’s what becomes even more important to the research than listening to what was said.”
Sally Lehrman is a member of the SPJ board and national diversity chairwoman. The Knight Foundation offers fellowships for journalists to attend weeklong sessions at the Salzburg Seminar on global issues. For information, visit www.salzburgseminar.org.