National Center for Cultural Competence

Cultural Brokering: Benefits to Health Care Delivery Systems

The vast network of federally qualified health centers and agencies serving in designated health professional shortage areas will greatly benefit from a cultural broker program. A cultural broker program has the potential to enhance the capacity of individuals and organizations to deliver health care services to culturally and linguistically diverse populations, specifically those that are underserved, living in poverty, and vulnerable. The Health Care Growth initiative was launched in 2001 with the goal of adding 1,200 new and expanded health center sites to the current network and increasing the number of people served annually to 16 million by 2006. In support of the Health Care Growth initiative, a complementary initiative is being implemented for the National Health Service Corps (NHSC). This initiative is designed to reform and expand the NHSC by placing more of its clinicians in areas of greatest need. The NHSC initiative can greatly benefit from a cultural brokering program by supporting system expansion to meet the needs of larger proportions of populations that are underserved and uninsured.

DC PHYSICIAN CREATES AN ENVIRONMENT OF TRUST FOR HIS PATIENTS

Kyu Rhee, M.D., an NHSC clinician and associate medical director with Unity Health Care, Inc., Upper Cardozo Clinic, in Washington, DC, cares for a diverse patient population—from Spanish-speaking persons to Asians, Ethiopians, and individuals who are homeless—in a busy urban setting. “Cultural brokering is not a recipe approach,” he says, rather, it is the process where listening is the essential component, one that cuts across all cultures. By carefully listening to his patients, Rhee says, he benefits by understanding his patients holistically, and thus is able to better treat their health care problems. This benefit became starkly evident when he saw a woman from Zimbabwe who had suffered from headaches for 4 years and from back and chest pain for months. After talking with her, Rhee discovered she had been a rape victim, had witnessed death as a child in her war-torn country, had left her native home, and had just been divorced. Hearing these tragedies of life is an entrée into people’s lives, he says, that can benefit the provider by helping him or her to recognize cultural factors affecting patients’ health and behaviors. Dr. Rhee, in his role as associate medical director, is able to use the information he elicits from patients to enhance and improve care. Additionally, as a cultural broker, he is able to use this knowledge as a vehicle to support other providers through mentoring and inservice training.

Benefits to the NHSC

Most of the health care settings that sponsor NHSC scholars and clinicians in service are ideal locations for housing cultural broker programs. These settings include, but are not limited to, rural clinics; health departments that provide comprehensive primary care; hospital-based programs that have ambulatory care; such specialty programs as mobile clinics, homeless shelters, school-based health programs, and HIV/AIDS clinics; community mental health programs; academic programs that have a primary care community-based system of services; tribal and migrant health programs; and those health care settings in U.S. territories. A cultural broker program in these health care settings can:

  1. assess the values, beliefs, and practices related to health in the community being served;
  2. enhance communication between patients/consumers and other providers;
  3. advocate for the use of culturally and linguistically competent practices in the delivery of services; and
  4. assist with efforts to increase access to care and eliminate racial and ethnic disparities in health.
 
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Georgetown University Center for Child and Human Development National Center for Cultural Competence What is the role of cultural brokers in health care delivery?