1. Ethnicity, Culture & Diversity Ourselves Ourselves and other people How it affects us at work Bradfords Asian community

2. Who are you?

3. Dimensions of diversity, some more visible than others Gender Age Ethnicity Nationality Language Skin colour Religion Class (wealth? education? family? Occupation Sexual orientation Political orientation Disability Culture

4. Understanding different cultures … or stereotyping?

5. General issues when language and culture differ between doctor and patient Non-verbal communication Use of interpreters Health beliefs Differing agendas of doctor and patient Need more time Practice organisation Need special health promotion materials and methods

6. Working as a GP with Patients from Bradfords Asian community Useful things to know

7. Bradfords Asian community Mostly from Mirpur in Kashmir Mostly Muslim Mostly from an unsophisticated rural community, low educational level Languages: Urdu, Punjabi, Mirpuri Dam built on houses and land in Mirpur - and Bradford mills needed labour

8. Most Bradford Asian families originate from Mirpur

9. A reminder - dont generalise, dont stereotype, dont forget importance of Class Education Religion Age/generation

10. Asian families Respect for elders Families more important than individuals Distinct roles for men and women Importance of mother in law Big families, desire for sons Taboo subjects - termination of pregnancy, STDs, domestic abuse Cultural conflict for those born in Britain

11. Muslim patients Dont drink alcohol - in theory Dont take tablets or medicines during fasting hours in Ramadan Women arent allowed to pray when bleeding

12. Some medical issues Commoner in Asian patients: TB, rickets/osteomalacia, thalassaemia Hugely increased incidence of diabetes and IHD Not tuned into psychiatric diagnoses (use the word stress) Consanguineous marriages: recessive syndromes Seem to be a high degree of medically unexplained symptoms/somatisation - BUT high morbidity Patients may be consulting other healers

13. Some common health beliefs of people from Mirpur hot and cold food Gas in the stomach is bad and can migrate to the head Important to be buried with all your organs inside so you can rise after death Eating oily food is good - not only tasty but makes you fat (being skinny is a sign of disease)

14. A reminder - dont generalise, dont stereotype, dont forget importance of Class Education Religion Age/generation

15. Want to do more? Your group presentation? Videos on cross cultural consultations Video of BBC4 programme about South Asian doctors who came to the UK