Academic journal article Human Organization

Treating Ethnic Others: Cultural Sensitivity and Minority Stereotypes at a German Fertility Clinic

Academic journal article Human Organization

Treating Ethnic Others: Cultural Sensitivity and Minority Stereotypes at a German Fertility Clinic

Article excerpt

As Germany has become progressively more cosmopolitan, the concrete effects of increased migration and greater ethnic diversity have surfaced in clinical settings. This ethnographic article examines the impact of a cultural competence initiative at a fertility clinic serving patients of foreign heritage, particularly German Turks. While the acknowledgement of culture as a clinical variable raises awareness of the differential needs of minorities, it also inadvertently reifies Otherness, perpetuates formulaic approaches to ethnicity, and compromises medical treatment. Despite these flaws, many minority patients preferred culturally sensitive care to standard clinical care. I argue that the social contradictions embedded in these culturally competent care practices reflect Germany's enduring ambivalence toward "foreigners" in its multicultural society. As this case study illustrates, it is challenging to craft culturally appropriate health care programs which adhere to biomedical efficiency and practice norms and attend to the varied medical problems experienced by German minority populations.

Key words: ethnicity, infertility, cultural competence, stigma, German Turks

Introduction

In this ethnographic paper, I examine cultural competence as a clinical strategy to improve health care delivery to ethnic minorities, particularly German Turks,1 at a fertility clinic in Germany. Marginalized populations across the globe suffer health deficits both in regard to their vulnerability to disease and the quality of medical treatment they receive (Farmer 1999; Kawachi and Kennedy 1999; Marmot 2004; van Ryn and Burke 2000). Interkulturelle Kompetenz (intercultural competence), kulturelle Kompetenz (cultural competence), kultursensible Pflege (culturally sensitive care), and kulturkompetente Pflege (culturally competent care) programs have been adopted in some German medical practices in response to this growing awareness of health disparities among Germany's ethnic minorities (Bühring 2002; Razum et al. 2004; Richter 200 1 ). These programs are modeled after American culturally competent health care systems, which seek to:

Acknowledge and incorporate - at all levels - the importance of culture, assessment of cross-cultural relations, vigilance toward the dynamics that result from cultural differences, expansion of cultural knowledge, and adaptation of services to meet culturally unique needs (Betancourt et al. 2003:294).

Ideally, cultural competence is an ongoing process in which "the health care provider continuously strives to achieve the ability to effectively work within the cultural context of the client" (Campinha-Bacote 2002:181).

My research suggests that operationalizing ethnicity in medical practice both improves and compromises fertility treatment. The acknowledgment of culture as a clinical variable helps to increase understanding of minority perspectives and provide more effective health care to marginalized patients. However, the very "culturally sensitive" guidelines used to improve uneven health care practices also reify Otherness, perpetuate formulaic approaches to ethnicity, and obfuscate the heterogeneous needs of marginalized populations. As this case study illustrates, it is challenging to craft culturally appropriate health care protocols which adhere to biomedical practice norms and attend to the varied medical problems experienced by German minority populations.

I argue that tensions surrounding the reproduction of ethnic Others in the fertility clinic illuminate larger cultural anxieties regarding the reproduction of the nation in an increasingly diverse Germany. The social contradictions embedded in German cultural competency programs throw hegemonic constructions of Otherness into relief and reflect Germany's enduring ambivalence toward "foreigners." Through this "self-conscious engagement with dominant, normative discourses, and representations" of ethnic Others, I hope to create "oppositional analytic and cultural spaces" (Mohanty 1989:185) of anthropological inquiry. …

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