Cultural Expressions of Bodily Awareness Among Chronically Ill Filipino Americans

Compared to other ethnic groups in the United States, the health care needs of Filipino Americans have been understudied. Misunderstandings frequently exist between health care providers and Filipino American patients. Jokes abound about practitioners’ frustration with Filipino American patients who agree to adhere to a treatment plan and then fail to follow through. Such attitudes risk discrimination in our delivery of health care to Filipino-Americans. Gay Becker’s excellent study takes a big step towards addressing our impoverished understanding of important values that influence the health and behavior of Filipino American patients.

Becker’s work highlights some potential pitfalls for the practitioner.

1) Striking a Balance between Diversity and Commonality. Becker repeatedly clarifies that Filipino-Americans are not a homogenous group. While this may seem obvious, we have not often acknowledged the intra- group differences within a particular race or ethnic group. Our tendencies to want cohesive, simple answers encourage us to take the data from a small sample of one cultural group and generalize it to all members. How do we strike a balance between common concepts, such as bodily experience, among many responders and the diversity within all Filipino-Americans? The discovery of pervasive concepts suggests that they represent dominant cultural values. However, not all people, nor all members of a particular family, may be equally wedded to that value. Clinically, we should be careful not to assume that all people hold the same value, but inquire about how they respond to a value that is common in their culture. This inquiry can allow for differences within generations, gender and timing of immigration. The expert on what is culturally important in clinical care is the patient in front of us. Research like Becker’s guides us to identify important questions to ask our patients, such as how dominant cultural values have influenced their life and health, rather than blindly apply the findings as fact. In this sense, Becker’s balance between studying a group that is diverse but which also exhibits some commonalities is valuable for not only for the care of Filipino-Americans but also the field of cultural competence. 2) Practitioner Beliefs and Values. Becker highlights the “long-term colonial relationship of the United States to the Philippines,” suggesting that this has increased Filipino-Americans'familiarity with Western culture prior to immigration. We must also ask, in a complementary way, how has this relationship affected our assumptions about the health care needs of Filipino- Americans? Many of my colleagues ascribe their frustration in caring for Filipino-Americans to their attitude that Filipino-Americans are just like us— i.e., they endorse biomedicine (as attested by Becker); they speak English (so literacy should be less of a problem); and they agree to follow through with recommendations (otherwise they would openly disagree if they felt like it). The cultural differences between ourselves and Filipino-Americans may not seem as obvious as they may be in patients from other cultural groups who speak a foreign language and present “exotic” understandings of health care. We must critically reflect on our own assumptions and biases in order to explore how they affect our clinical decisions and the functioning of our relationships with Filipino- Americans, and of course with all patients. 3) Expanding the Focus of Intervention. Unconsciously, we often expect that individual practitioners once becoming culturally competent should be able to rectify cultural discrepancies between themselves and patients within the context of the clinical relationship. Understanding, awareness and communication should correct most barriers. But Becker’s research demonstrates what an unreasonable task that may be by highlighting the deeper societal roots of cultural values. Practitioners and patients often feel mutually frustrated that their precious clinical visits become repetitive conversations on what should have happened regarding diet, exercise and the taking of medication. The social constraints of food in daily interpersonal relationships of Filipino-Americans (revealed in this study) appear stronger than an interaction with a health care provider every three months. The challenge for us is how to discover how best to address the conflict between two strong societal values--responsibility for a healthy life and the interpersonal meaning of food. Office level interventions may need to be bolstered by creative, community level interventions that influence the day-to-day experience of Filipino- Americans.

Such pitfalls such as stereotyping, practitioner’s biases, and a limited focus of interventions can be revealed through thorough and in depth qualitative research. Becker provides not only important information about a neglected group of the patients we serve, but also provides a model for exploring cultural issues in primary care.

Competing interests:   None declared