Being culturally aware in the pharmacy

The importance of building trust with patients and understanding their specific cultural needs

NT pharmacist Samuel Keitaanpaa recently presented to NAPSA Congress 2019 in Adelaide about the importance of being aware of patients’ different cultural backgrounds and how to approach this.

Mr Keitaanpaa lives and practises in Darwin in the Northern Territory, and said his childhood experiences taught him about the variety of cultures in the world.

“No matter where you’re practising in Australia, you’re going to be working with people from a different background from you,” he told congress delegates.

“No matter where you travel in Australia you’re going to be working with a different group of people, and it’s really important to reflect on your practice about how you’re actually going to do that.”

With a particular interest in health systems, Mr Keitaanpaa said he has spent time thinking about what is behind negative health outcomes, in particular for some groups of people.

“One thing that became apparent at the start of my career was the disparity between the people that we’re trying to work with and our own culture and world that we live in.”

He shared a story about a childhood friend of his who had died of renal failure.

“He was a multi-platinum, ARIA-winning superstar who had performed with Elton John, and he died penniless on a beach in Darwin of kidney failure.

“I thought, if the most successful people of a different culture can’t achieve positive healthcare, there’s something that’s not right about that.

“I look at things like this and think, well I’m not inherently racist, I don’t believe anyone in this room going into healthcare is inherently racist, but our system is designed around the English language and around a Western biomedical model of health, and that doesn’t necessarily fit with a lot of other cultures.

“And I think that’s a really important recognition to have if you want to be an effective pharmacist because you have to know what your patients are expecting of you and what they’re willing to do.”

Mr Keitaanpaa emphasised the importance of communication, which in turn builds trust with patients.

“When that connection doesn’t work and that communication doesn’t work, the patient essentially doesn’t do what we need them to do, and that’s where we notice the negative health outcomes.

“We see this both on an individual level and within the health system … On a system-wide level we notice with things like Closing the Gap, which was a massive strategy that we’re now realising we’re never actually going to achieve the goals that we intended to.

“We continue to see a massive disparity in life expectancy between Indigenous and non-indigenous Australians. We’ve done better on child mortality but we’re still lacking in other areas despite increases in healthcare.”

Mr Keitaanpaa shared another story about his experience Shanghai where he found it difficult to locate a pharmacy and then, when he did, due to language barriers was unable to communicate the medicine he needed.

“It just showed that what they were used to as pharmacy wasn’t what I was used to as pharmacy.

“If someone’s coming into your pharmacy and they don’t feel like you’re explaining what’s going on, they don’t trust you, and if they don’t trust you they’re less willing to engage with you.

“And to me that’s one of the most important bits when we talk about culture – it’s this idea that culture is more than the language you speak, you can’t just define culture by ‘that’s a brown-looking person’, ‘that person doesn’t speak English’.

“These are easy ways to identify there might be a difference but culture in itself isn’t linked to that – it’s not even linked to geographically where you come from.

“You try telling someone from Queensland that they’re the same as someone from New South Wales – doesn’t fly. You try to apply the way you practise pharmacy in inner-city Melbourne as you would to rural Perth – it’s not gonna fly.

“So we have to recognise that language differences are an indicator that culture might be different, but we need to get out of this mindset that being culturally competent means identifying people that are very different from you – they’re recent migrants, they look different, they talk different.

“Culture is actually in everything,” said Mr Keitaanpaa.

“Australia and New Zealand for example – we say we’re fairly similar, but we are very different culturally, and that makes those little differences about how well you can engage with your patients and how much you can build that trust. Because without that trust they’re just not going to want to work with you. And if they’re not going to want to listen to you they’re not going to take your advice. It’s a waste of everyone’s time.”

How can pharmacists on-hundred-percent look after all their patients of their different cultures?

“You can’t,” he responded, adding that there’s too many differences.

“The simple thing is that there’s always one culture that’s present. And that’s your culture, because you as the pharmacist are the one that’s going to be engaging the patient – it’s you that’s trying to have the intervention.

“So actually, in all these different cultures, it’s what you’re bringing to the table that’s going to make the difference rather than theirs. Yes it’s their culture that is the issue you’ve got to work around, but it’s your culture that’s the problem.”

Mr Keitaanpaa points out that pharmacists need to be aware of their own culture and what viewpoint they bring to the table, in order to recognise how to approach others’ cultures.

“The recent migrant from Zimbabwe is perfectly happy with their culture at home. It’s their interaction with your Western culture that’s going to be problematic. So all you need to do is think about your culture,” he concludes.

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