Ethnicity, Culture & Diversity Ourselves Ourselves and other people How it affects us at work Bradford’s Asian community

Who are you?

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

Understanding different cultures … or stereotyping?

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

Working as a GP with Patients from Bradford’s Asian community Useful things to know

Bradford’s 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

Most Bradford Asian families originate from Mirpur

A reminder - don’t generalise, don’t stereotype, don’t forget importance of Class Education Religion Age/generation

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

Muslim patients Don’t drink alcohol - in theory Don’t take tablets or medicines during fasting hours in Ramadan Women aren’t allowed to pray when bleeding

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

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)

A reminder - don’t generalise, don’t stereotype, don’t forget importance of Class Education Religion Age/generation

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