The subject of my interview is Sanjay who is an extraordinarily talented physician from India with whom I have had the pleasure to work for approximately four years. Cultural identity is one’s feeling of association to a group or a culture. My cultural identity is Russian American. I came to the states when I was 12 years old and assimilated to American culture very quickly. Despite spending most of my life in America I continue to maintain some of my Russian traditions and ways of thinking. Sanjay is in his mid-thirties and came to U.S. about 8 years ago. Most of his life was spent in India and his cultural identity is rooted in Indian culture. We met at coffee shop and sat talking for a few hours, picking each other’s brain, learning about each other’s culture and giving each other pointers on providing care to patients of our respective backgrounds.
Understanding different cultures as a health provider is necessary since American population is the melting pot of the worlds’ cultures. The cultural diversity of patient population requires an open mind and the desire to learn about the different groups in the area of practice. A patients’ cultural identity dictates his behavior, health beliefs, mannerisms, and all other aspects of care. The concept of cultural relativism states “that each culture is unique and should be judged only on the basis of its own values and standards” (Arnold, p 199) According to Madeleine Leininger’s Theory of Culture there are five domains of cultural influences - environmental control, communication and language, use of time and space, social roles and organization, and biological variances. Larry Purnell’s 12 Domains of Cultural Assessment model is an outline for complete and thorough culturally compatible care. (Arnold, p 205)
Environmental Control A sphere of cultural influence that encompasses personal heritage, nutrition, spirituality, death rituals, health care practices, and the role of health care practitioners in a person’s cultural identity.
Personal heritage. Sanjay was born in the city of Eluru that is located in the Andhra Pradesh region in India. Sanjays’ parents taught him to respect and value education above physical ability. Sanjay went into college for a medical degree as soon as he finished high school. He worked for 11 years to become a physician and today is one of the most respected internal medicine doctors at multiple local hospitals.
Spirituality. Sanjays’ considers himself a Hindu, which is the predominant belief system in India. He explained that Hinduism is more a philosophical point of view rather than religion with flexible boundaries that are individual for every person. Growing up Sanjay was acquainted with the belief in reincarnation and the concept of karma. For Sanjay reincarnation and karma fall in the realm of cultural traditions rather than spiritual values.
Death rituals. Sanjay compared the dying process to leaving a train station to advance to the next life. Death is more readily accepted as the next step in reincarnation process. It is generally accepted as a progression toward non suffering. Sanjay told me that in his culture people are almost always cremated. In Hindu philosophy every person originates from five elements – water, fire, air, earth, and sky. When a person passes away they are cremated, which incorporates the elements of fire and air, earth – because usually the cremation happens on the ground, and the smoke rises to the sky. The ashes then are scattered into a holy body of water completing the ritual of returning the person back to their original elements.
Nutrition. In Hindu culture cows are worshiped. The belief is that there is a holy cow in the heavens who feeds the Gods with her milk. Every cow on earth is considered to be a descendant of the heavenly cow. Though Sanjay is