Cultural Humility (complete)

"Cultural Humility: People, Principles and Practices," is a 30-minute documentary by San Francisco State professor Vivian Chávez, that mixes poetry with music, interviews, archival footage, and images of community, nature and dance to explain what Cultural Humility is and why we need it. The film describes a set of principles that guide the thinking, behavior and actions of individuals and institutions to positively affect interpersonal relationships as well as systems change. These principles are:
• Lifelong learning and critical self-reflection
• Recognizing and changing power imbalances
• Developing institutional accountability

More than a concept, Cultural Humility is a process of communal reflection to analyze the root causes of suffering and create a broader, more inclusive view of the world. Originally developed by Doctors Melanie Tervalon and Jann Murray-Garcia (1998) to address health disparities and institutional inequities in medicine, Cultural Humility is now used in public health, social work, education, and non-profit management. It is a daily practice for people who deal with hierarchical relationships, changing organizational policy and building relationships based on trust.

The film tells stories of successes and challenges, and the road in between for those working to develop partnerships among community members, practitioners and academics. It encourages us to realize our power, privilege and prejudices, and be willing to accept that acquired education and credentials alone are insufficient to address social inequality. The first segment introduces Cultural Humility and features interviews with Melanie Tervalon and Jann Murray-Garcia. The second clip offers the context and setting, poetry readings by San Francisco State public health students and an analysis of privilege and power. The third segment is about Community Based Participatory Research and Education; it features the work of the Chinese Progressive Association academic partners and critical educators/students. The last segment brings closure with a reflection on peace, embodied images of nature and a quote by Audre Lorde.

Audiences who might find this documentary helpful include professionals, students, providers, organizers and policy makers in public health, social work, medicine, psychology, nursing, education and more.

M. Tervalon, J. Murray-Garcia (1998). Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education, Journal of health care for the poor and underserved, Vol. 9, No. 2. (May 1998), pp. 117-125.

Vivian Chavez © 2012, Creative Commons license: Attribution-NonCommercial-NoDerivs 3.0 Unported (CC BY-NC-ND 3.0) http://creativecommons.org/licenses/by-ncnd/3.0/http://creativecommons.org/licenses/by-nc-nd/3.0/

[ Music ]

One word to describe
cultural humility

for me is love actually.

If I had to encapsulate
cultural humility,

the whole concepts
of cultural humility,

it doesn't do it
justice, but the word

that I think of is essence.

Escuchar.

Being.

You.

Opening.

Receive.

Compassion.

Love.

The principles of cultural
humility offer one more

framework to contribute
to what has got

to be our ultimate goal, yes.

Our ultimate goal is that there
will be a sense of equity,

a sense of equality
and a kind of respect

that we are driving forward.

[ Music ]

Cultural humility is a
multidimensional concept.

And certainly Melanie Tervalon

and I conceptualized
three dimensions.

The first is lifelong
learning

and critical self- reflection.

And in that critical
self-reflection it is the

understanding of how each of
us, every singe one of us,

is a complicated,
multidimensional human being.

Each of us comes with our
own histories and stories,

our heritage, our point of view.

You are looking at me now.

I am very fair skinned.

When I was a little
girl my hair was blond.

My eyes are blue.

People often tried to call me
anything but African-American.

I have a history.

My identity is rooted
in that history.

My parents gave me the knowledge
of my own social identity,

and my own experience in
life has created that.

I get to say who I am.

The second tenet
after self-reflection

and ongoing lifelong learning
and development is this notion

that we must mitigate the
power imbalances, to recognize

and mitigate the
power imbalances

that are inherent often
in our clinician patient

or clinician client for service
provider community dynamics.

And then finally the piece
that I would offer that Jann

and I feel people often either
don't read or don't like.

And the institution has to
model these principles as well.

[ Music ]

An African-American
nurse caring

for a middle aged Latino
woman several hours

after the patient had
undergone surgery.

A Latino physician

on a consult service
approached the bedside

and noted the moaning
patient commented to the nurse

that the patient appeared
to be in a great deal

of post- operative pain.

The nurse summarily dismissed
his perception informing him

that she took a course in
nursing school in cross-

cultural medicine and knew
that Hispanic patients over-

express the pain that
they are feeling.

The Latino physician had a
difficult time influencing the

perspective of this
nurse who focused

on her self-proclaimed
cultural expertise.

It was curious to this
Latino physician who first

of all was Latino,
not like all --

in his case not like
all Mexican-Americans,

know everything there is to know
about Mexican-American patients.

That wasn't it.

But he might have
been a resource

for that African-American
nurse in that moment

that she didn't feel
like she needed, again,

because she had bought into
this notion of competence,

of cultural competence.

The distinction
between cultural humility

and cultural competence was
that we were in a process

and a relationship that had
many other layers to it,

and that we were less
comfortable with even the term

of competence in a way that I
think people understand well.

And that it implies especially
for people who are providers

and are trained in academia

that you are then all
knowing and all powerful.

And we felt like that was
not what was happening for us

as we were learning from
community and understanding

in a very practical way
how families were coming

to the hospital and feeling

as if they really were not being
heard from their own heritage

in history, and how that
impacted what they came

to the hospital with that we
didn't know anything about,

hadn't even a clue about.

For us this is part of
the humility piece of it,

getting to understand that.

Not trying to humiliate you,
not trying to make you feel bad,

trying to help us all understand
that life is like this.

And that in a certain
sense you're really happy

about not knowing.

In April of 1992 in the wake

of the Los Angeles riots
following the initial not guilty

verdict of the police officers
accused of beating Mr. King,

the Children's Hospital open
community was compelled to meet

in a series of highly
charged sessions to expose

and critique our own patterns
of institutional racism,

injustice and inequity.

My name is Dr. Melanie
Tervalon, and I am Direct

of Multicultural Affairs here
at Children's Hospital Oakland.

I want to thank
everybody for coming

to what is a celebration
for me of this year.

>> Jann and I had the good
fortune really to be together

in the same place when
this work was evolving.

Jann and I while we were
several years difference

in age are both African-American
women.

And we were both raised by
women who were teachers.

And we come out of that -- and
fathers who were working men,

who come out of that
southern tradition

and who participated fully
in the civil rights movement

in a way that meant that
they made sacrifices

and their children made
sacrifices, and they taught us

about those sacrifices
and raised us each in ways

to understand that we
were here to serve.

[ Music ]

Patty.

Hey.

How you doing?

How are you?

It's good to see you.

It's so good to see you.

It's been a long time.

I know, yeah.

How have you been?

Pretty good.

Good. Thank you
for having me.

I'm invested in children
and in that population

because I've been
there for so, so long.

Since we were residents.

And I'm seeing like second
generation of my families now.

The multicultural curriculum
program really started

in about 91- 92 as a pilot.

When was Rodney King,
I thought that was 90 --

It was provoked in 92.

92, yes.

The Rodney King
incident that people saw all

over the world really at
Children's meant that we started

to talk again about what
we called our own private

Rodney Kings.

The circumstances
where families felt

as if they were not being taken
care of in a respectful way.

That was a big part of
our work, being certain

that we were living
up to the principles

that had clearly
been established

through the conversations
already in the hospital.

That given the composition
of the faculty at Children's

and given the composition of
the patients we were taking care

of that the faculty could really
not teach about the issues

of culture and race and
difference in time and the like.

And so we spent a lot of time
working with community groups

and families to actually
come in and teach.

When I think of the two
terms, cultural competency

versus cultural humility, for me
cultural competency implies kind

of a subject, a topic, you know.

And people do feel like I
need to know this or not,

and if I don't know this
I'm not smart or whatever.

Whereas for me cultural
humility is a philosophy,

it's an approach, it
is a tool, you know.

So it's not something to be
I'm going to master it or not.

It's my approach, it's how
I will handle the situation.

>> Last year I was
the coordinator

of the student support
team which are the meetings

that families have with teachers

when their kids are
having trouble.

And it was quite interesting
to just try to navigate that,

those meetings in
a way that worked

with the principles
of cultural humility.

Just to really try to say

to my colleagues let's hear
what this parent is experiencing

and what this parent hears
about from their child.

And let's try to talk about that
as a starting point rather than,

you know, your kid is XYZ.

One of the things that
helped me out a lot to be able

to also kind of make
peace with not knowing is

that for a long time
I mistook not knowing

for lack of intelligence.

And a dear friend of mine
pointed out to me once

when I was having a conversation
about this, he said it's not

that you're not intelligent,
it's that your fount

of knowledge in this particular
area you don't have it.

So it doesn't take away
from your intelligence

by any stretch of
the imagination.

You don't know because
no one has told you

or you haven't asked
that question.

And it allowed me to be able
to ask a million questions

because now I didn't feel
like I was saying to the world

or to the person
or to the patient

or to the community I'm stupid.

I was happy just saying
I just don't know.

And the same way with
the fount of knowledge

with medicine there's no way

for you know something
unless you learn about it.

But in no way, shape or
form does it take away

your intelligence.

So once I could distinguish the
difference I was comfortable

with not knowing anymore.

>> The article gets written
but not published right away

about what we learned from all

of this work working
with communities.

And this is the cultural
humility piece

that people have now
used in many venues,

not just in medicine
but in education.

Many nonprofit organizations use
the cultural humility principles

in their work.

The principles are not just

about individual
activity and behavior.

Institutions have got
to be self-reflective.

Lifelong learners have to really
believe that the communities

that are being served really
do know what they want

and what they need, right, and
they're in the best position

to let us know what that is.

[ Music ]

People living in poverty
have the least access to power

to change the structure
of policies of poverty,

and are often denied
effective solutions

to combat the violations
to their human rights.

And I care about this issue

because my brother is an
innocent man with special needs

who has been held in what
I call modern day slavery

for two years now for a
crime that he did not commit.

And I come to you because the

so called justice
system is not designed

to benefit my community.

And I can hear the voice of
the oppressed that echo, no,

you don't deserve
to have rights.

Just us. You don't have
a history, just us.

You don't have the strength
to control your mind, just us.

You don't remember what
the fight is about.

Just us.

There are these moments
that grab everybody's attention

that we can take advantage of.

And I think the Rodney
King, more of the response

to Rodney King, is what inspired
a lot of conversation and a lot

of soul searching and a
lot of people seeking ways

that we could have
these conversations

with better result.

And then it fades.

[ Music ]

The three police officers
facing felony criminal charges

were among a group of 15

who stopped a 25 year old
Black man last Saturday night,

then beat him, kicked
him and clubbed him.

At WHAT Radio host Mary
Mason fielded scores of calls

from members of the
Black community angered

by the verdict, shocked by
the violence that followed.

We need love and
respect for one another.

We need [inaudible].

In 2010 Arizona passed a law
that authorized local police

to check the immigration status
of anyone of whom they suspect

of being an illegal immigrant
to the United States.

Who has the right to call
another human being illegal?

Most of these illegals are the
ones working in the fields,

cleaning homes, landscaping
at jobs that have the right

to pay lower than minimum wage.

There are things that
are difficult to hear,

and there are things that
are just plain hard to see.

So how it is a fish
doesn't see water.

It's very hard when you benefit

from great privilege
to see it as that.

And I would say it takes
constant reminding.

And I certainly don't
see it all the time.

And each time I'm
reminded of it I'm reminded

that I'm reminded of it.

That why do I have to be
reminded of it, oh but I do.

I heard the white woman
behind us say you foreigners

have no manners.

My initial reaction was
anger and confusion.

Anger because I felt
discriminated

against and judged.

Confusion because she was an
older woman, so hadn't she been

around long enough to know
that she is not a native

of this country either?

We are constantly bombarded
by subliminal messages

that light skin is superior.

Immigration policy is
continuously debated

in the White House, while
brown men are hoping

to land a side job
outside of Home Depot.

How does cultural
humility come to life

at Berkeley Media Studies Group?

I have to credit Tony
Borbone [phonetic].

Bony Borbone, may
he rest in peace,

was a violence prevention
advocate par excellence

who I met early in our years in
working on violence prevention

when we first started the
Berkeley Media Studies Group.

And Tony just confronted me and
said you live in California,

how many of your
staff speak Spanish?

And I had to say none.

And Tony in I was
going to say loving,

it wasn't in a loving way, it
was in a confrontational way.

I mean we grew to love each
other and each other's work

and had great respect
for each other I think

as our relationship blossomed.

But he had no fear about
saying what was important.

[ Music ]

It's really important
to show up.

Take the time from your
life and show that you care

about the community
and be there.

So the workers were
participating in actions

to bring pressure on
a poultry market owner

who owed her workers wages.

The workers were going
out with picket signs,

and I went with them, too.

In that way I felt nervous.

You do kind of feel exposed.

You're in the environment
that's very different from some

of the other things
that I'd done.

[ Music ]

So when we had these
meetings everybody

on the project was
really experienced

in doing community research.

But there's a dynamic.

When you're in a
professional culture you're used

to participating in meetings
and trying to get in your word.

And then on top of all

that we're conducting
all these in English.

And so the other two staff

from the Chinese Progressive
Association were interpreting

for the non-English
speaking staff member.

And so they're not fully
able to participate.

And then everything is happening
so fast, people are talking

over each other,
that for the non-

English speaking staff member
it was hard for her to sort

of get a word in edgewise.

We did reflect on this
and people noticed it.

Then we started to conduct
the meetings in Chinese.

And then all the English
speakers wore the headsets

with simultaneous
interpretation.

The native English
speakers were quieter,

and that changed
the dynamics a lot.

But the workers were
still quiet.

In terms of cultural humility
we were really challenged

to think I think a
little bit more deeply

about what culture is and
how it doesn't mean thinking

about a list of traits that
you can ascribe to people.

But that it's actually
that it involves you

and your assumptions and how
you project your assumptions

onto somebody else versus what
is their actual experience

of who they actually are.

[ Music ]

I first heard about
cultural humility

when I was a graduate student
in the master's program here

at San Francisco State.

But I feel like I first
understood cultural humility

as a concept a lot
earlier in my life.

It came from a place of
invisibility, a place of kind

of suppressing who I
was as a woman of color

and now has completely
transformed as an educator,

realizing who I am,
where I stand

in the classroom,
what my privilege is.

But also what my voice
means in the world

and what it means
as an educator.

It came from trying to fit
in, to do whatever I could

to be Indian at home and
not out in the world.

And not express that, and it's
become this marker of identity

that I knew was always there

that I could never
really express growing up.

And now it's saying
who that person is

and acknowledging both my own
power and privilege in I've got

to check myself kind of way.

In the same respect it's also
saying I am a woman of color,

I have something important
to say and here I am.

I think as long as
power and privilege exists

in society we will always being
struggling with being too humble

as women of color,
as women who come

from working class
backgrounds, as women who come

from low income backgrounds

or under resourced
backgrounds, right?

As long as there's
power and privilege

in society I know I will
always be struggling with that,

and I struggle with
that on a daily basis.

[ Music ]

I examined [inaudible] here

to see how inclusive
our current policies

and programming are toward
transgender students.

And I was just reflecting

about how it's actually
very relevant

to the topic this evening
of cultural humility

because we're talking
like transgender culture

or peer culture at [inaudible]
and how it's respected or not.

Right.

And how like the institution
can be culturally relevant

or humble or respectful of
the experience of transgenders

when they come to this place.

The health educators
that I work

with are all transgender
females.

And literally the second day of
my job I walked into a meeting,

and it was a committee
advisory board

of all transgender females.

And I was so uncomfortable

but at the same time they
made me feel so comfortable.

They started asking me questions
like they noticed, and they were

like so where are
you from, you know?

And I was like I'm Iranian.

Oh, we know this Middle
Eastern transgender girl,

do you know her?

And I was like no.

So my definition of cultural
humility is to be open

to learning all the time.

So what I want from you guys is
to go around, introduce yourself

and tell us what cultural
humility means to you.

I first became passionate
about cultural humility

as an undergraduate
student I was interning

with an organization.

And they were holding a
cultural competency training

for Pacific Islanders
and working

with Pacific Islander
communities.

And as a biracial Pacific
Islander woman I was really

excited and anxious to attend
the training and to really learn

about the material that was
going to be sort of discussed

and how others were going
to learn, myself included,

about Pacific Island culture and
working with Pacific Islanders

around health issues that were
important to the community.

And I think after attending the
training I realized there was a

sense of achievement
and completion

for those who participated.

And I then was introduced
to cultural humility

as an undergraduate
student in the class,

just so happened
around the same time.

And I realized that a sense of
achievement and accomplishment

and competence and understanding
sort of limits your learning.

I can't really tell you what
cultural humility means to me.

I feel like I practice
it and that's how I know.

The one thing that I think about

or that I can practice is
cultural humility is --

Poder hablar el idioma en el que soy

en el que me puedo expresar mejor, y

El idioma donde encuentro palabras

de poder contarle a alguien

exactamente como me estoy sintiendo.

Coming from a background
in science and coming

into public health and not
ever hearing cultural humility

in the sciences was
very telling for me.

Because culture is
something that's emphasized,

it's not something that's
talked about in a relevant way.

There have always been
very clear barriers present

for particular minorities
in science.

You can see it when you're
in the science classes.

You can see it when
you're in study groups.

You can see it when you're
looking at your professors.

And I'm not just talking
about racial minorities.

I'm talking about a lot of
under represented minorities

in the sciences,
like race is a factor

but gender, sexual orientation.

I learned cultural
humility in two places,

by my own culture being
Cambodian and Southeast Asian.

Not knowing anything about
it my folks roasting me

about I'm not speaking well.

And then after going to
college and learning about it

in anthropology and
interviewing my parents

about their experience
it opened my eyes.

One of the things that I
have learned in the past couple

of years I want to say is just
listening to what I'm saying.

And I mean like seriously
listening to what I'm saying.

And one of the things that I
have learned to listen to is

when I say I, I believe this,
I do this, and listen how

that is very different
from the we.

We I hear a lot in the
news, we Americans, right?

Like we, who is the
we speaking about.

It's to think about and listen
to when we use the I and the we.

Growing up I was like
always interested in culture

and other religions and just
really learning about things

from other backgrounds.

And so I just figured that
made my culturally humble

because I had an interest.

And so after studying a year in
West Africa I came back like,

oh my God, I don't know
anything, I don't know anything

about Black people, I don't
know anything about Africans.

I mean it just list
shifted my world.

Peace. I think when I am
sitting in a place of humility

that there's a quiet and a
spaciousness and an okayness

and ease that is just
close to peace with being

with another person
that I can imagine.

If I have to think about it

as a road then I think I would
think about I would think

about it as a road that spirals.

And a spiral actually doesn't
-- to me in a dance context,

a spiral that comes up
has to come down as well.

It's sort of a continuous loop.

And along the continuous
loop many things happen

and many forces may
change the shape of it

or the depth and reach of it.

Cultural humility is
definitely a journey for me,

and it's definitely a journey
that I know there's going

to be come challenges
and I'm ready for those.

And I know every challenge
I'm going to learn from.

And I think it's a process that
I have to go through every day

and that I'm okay
with going through.

And it actually makes
me stronger and smarter

and I hope wiser
than I was yesterday.

[ Music ]