When a baby is born, a health-care provider uses a test, called the Apgar test, to assess whether the baby is doing well. Within minutes of the baby's birth, the test evaluates several criteria, including skin appearance, heart rate and reflexes.
A newborn's test result is part of an initial assessment that determines whether medical intervention is required and influences the choice of a care plan appropriate for the baby.
“The normal for a skin colour finding is considered to be pink, which is not always the presentation for darker skinned babies,” says Keisha Jefferies, registered nurse and PhD candidate at Dalhousie University.
Jefferies says it's a problem when a test that's widely used by doctors, nurses and midwives doesn't take into account people of colour. But it's not the only medical practice that fails to do that.
For example, when nursing students learn about performing hair and skin assessments, the person on which the procedure is demonstrated is often white. Those assessments help health-care professionals understand more about a patient's illness.
“When you go into a clinical setting and you're caring for someone who is Black and their skin is darker, it often becomes more difficult to assess the conditions.”
These are only two examples why teaching cultural competence is important in health care.
What is cultural competence?
“We reference cultural competence as having the attitudes, awareness, knowledge, skills and policies to better meet the needs of all the people we serve,” says Sharon Davis-Murdoch, co-president of the Health Association of African Canadians (HAAC).
Cultural competence respects diversity and how cultural factors such as language, communication styles, behaviours and beliefs can affect someone's health and their access to health care.
The term “cultural competence” falsely implies some endpoint that can be reached. But the exact opposite is true: a person never becomes competent.
“I have often said that cultural competence is a journey, not a destination. But standing still is not an option, so it is something that you strive for continuously,” says Davis-Murdoch.
That's why Jefferies and other scholars say the term is not accurate.
“At the end of the day what we're striving for is equitable and anti-racist care,” says Jefferies.
Equitable and anti-racist health care is a goal that's not exclusive to Black communities. It applies to people from all diverse backgrounds.
Coming close to that goal requires the integration of anti-racism across the health-care system and within both the Nova Scotia Health Authority and the Department of Health and Wellness.
“All levels of care whether it be primary health care, whether it be acute and tertiary care (i.e. hospital care) and even long term care: all of these areas of care need to be striving through that process towards cultural competence,” says Davis-Murdoch.
Barb Hamilton-Hinch, associate professor at the faculty of health and human performance says it can be as simple as health promotion materials that reflect the diversity of a population.
She says she was pleased to see posters that raised awareness about COVID-19 with images of people with African descent. They were sponsored by the HAAC and the Office of African Nova Scotian Affairs.
“If people don't see themselves reflected in the material, in the practitioners, then basically what you're saying is ‘you don't need to come here ... you don't have this illness ... we're not ready to provide services for you,'” she says.
Continuous learning essential
Achieving equitable health care isn't simple. It involves learning about the communities that the health-care system is serving and the unlearning of centuries-old stereotypes. This learning process shouldn't be left to the post-secondary level. It can start even before that at school.
“It takes understanding our history, our lived reality and our clinical needs and to always understand that one size will never fit all,” says Davis-Murdoch.
Anti-racist equitable health care also includes understanding the differences within one community.
For example, there is a lot of diversity within the Black community in Nova Scotia. There are Black diaspora communities, African Nova Scotians, new immigrants, and biracial or mixed-race people. Each community has a different history and may have different clinical manifestations of a disease.
A health-care provider needs to acknowledge that these differences exist and commit to continuously learning about them. Otherwise, the patient will become the teacher.
“It becomes a heavy load to carry,” says Jefferies. “While some patients might be very strong advocates for themselves, there are others who while they may want the best care possible, they don't maybe even know how to ask for it.”
Representation not enough
In addition to education, supporting Black health-care providers is key to anti-racist health care.
When Jefferies does a skin and hair assessment for a Black person, she says she knows how symptoms could present. She is also aware that different people within the Black community can have different symptoms.
“It's not because I was taught it as a nurse. It's because I grew up living and working with myself, working with my hair and my skin and that of my family members and close friends.”
Jefferies says Black health-care providers are underrepresented in Nova Scotia. And when they are available, they are working within the confines of a racist system.
“So, while they can make small impacts with their patients or maybe with a patient's family or in a small group, it doesn't ripple across the institution.”
That's because the system relies on Black health-care providers to take care of Black families. When a health-care provider is sick for a day or is transferred to another facility, Jefferies says equitable care goes out the window.
“I think it's extremely beneficial to have black health-care providers in care settings across the province, but we also need to change the fundamental framework of how health care is delivered.”
Nebal Snan is a local journalism initiative reporter, a position funded by the federal government.