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/

>> [Background Music] One word
to describe cultural humility

for me is love actually.

>> If I had to encapsulate cultural
humility or the whole concepts

of cultural humility, it
doesn't do at justice,

but the word that I
think of it is essence.

[ Foreign Language ]

>> 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--

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 single 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 skin.

When I was a little
girl, my hair was blonde.

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

or 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,

which is-- and the institution has
to model these principles as well.

[ Music ]

>> An African-American
nurse is caring

for a middle-aged Latina
woman several hours

after the patient had
undergone surgery.

A Latino physician on a consult
service approached the bedside

and noting the moaning
patient, commented to the nurse

that the patient appeared to be in
a great deal of postoperative pain.

>> The nurse merely dismissed
his perception, informing him

that she took a course in nursing
school, in cross-cultural medicine

and knew that Hispanic
patients overexpress 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,

in a relationship that had
many other layers to it

and that we were less
comfortable with this--

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
and history and how

that impacted what they came to
the hospital with that we could--

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 there--

that life is like this and
to-- 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 Oakland
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 director

of multicultural affairs here
at Children's Hospital Oakland.

>> Well, I 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're
several years difference in age,

are both African-American
women and 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 the 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 & Noise ]

>> Patty.

>> Hey.

>> How are you doing?

>> How are you?

Good to see you.

>> I'm good.

It's so good to see you.

It's been so long.

>> It's been a long time.

>> Yeah.

>> How have you been?

>> I'm pretty good.

>> 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.

>> Oh, and the residents.

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

>> Wow, OK.

>> The multicultural
curriculum program really started

in about '91, '92 as a pilot and--

>> So, then-- when
was the Rodney King?

Wasn't that-- I thought
that was '92, right?

>> It was provoked by the--

>> Yes, '92.

>> '92.

>> Yes.

>> The Rodney King
incident that was--

people saw all over
the world, really.

And 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

after the principles that
had clearly been established,

did a conversation is
already in the hospital,

that given their 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
and income 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 this 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 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.

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 though I was having
a conversation about this.

He said, it's not that
you're not intelligent,

it's that you don't have, you
know, your fund of knowledge

in this particular
area, you don't have it.

So, it doesn't take away
from your intelligence

by any stretch the imagination,
you just you don't know

because no one has told you or
you haven't asked that question.

And, they allowed me to be able
to ask a million a question

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 actually saying, "I just
don't know," and the same way

in front of knowledge with
medicine, there's no way for you

to know something unless
you learn about it.

But in no way, shape or form
to 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 form all of
this work working with communities

and this is the cultural humility
piece that people have now used

in many than used not just
in medicine but in education,

many non-profit organizations use
still 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 oppressor echo me,
"No, you don't deserve

to have rights, just this.

You don't have a history,
just this.

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

You don't remember what your
fight is about, just this."

>> 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 in--

with better result and
then, you know, it fades.

[ Music ]

>> The three police officers facing
felony criminal charges were among

a group of 15 who stopped the
25-year-old black man last Saturday

night then beat him,
kicked him, and clubbed him.

At WHAT radio, host Mary Mason
filled it scores of calls

from members of the black
community angered by the verdict.

[ Inaudible Remark ]

Shocked by the violence
that followed.

>> We need to love and
respect one another.

We need to--

>> 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

and who has the right to call
another human being illegal.

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

cleaning homes, landscaping,
our jobs that have the right

to pay lower the minimum wage.

>> There are a things
that are difficult to hear

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

So, you know, how it is,
a fish doesn't sea 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 don't --

I certainly don't
see it all the time.

And each time, I'm reminded of it,
I've reminded that I'm reminded

of it that why do I have to
be reminded of it 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 how did she been

around long enough to know
that she is not a native

of this country either.

We are constantly bombarded
by supplemental messages

that light skin as 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 Borbon.

Tony Borbon, 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 then, you know, and said,

"You live in California.

How many of your staff
speaks Spanish?"

In hand, I had to say,
"None," and Tony in a--

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 ]

>> [Background Music] It's
really important to show up.

Take a time from your life and
show, you know, that you care

about the community and
be there and, you know,

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, and in that way,
you know, I felt nervous.

Yeah. You do kind of feel exposed.

You're in this environment that's
very different from, you know,

some of the other
things that I've done.

[ Music ]

So, when we had these meetings,

everybody on the project was
really experiencing doing community

research but there's this dynamic.

When you're in a professional
culture,

you're used to participating
in meetings

and trying to get in your word.

You know, and then on top of all
that, we're conducting all of 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, you know,

it was hard for her to sort
get a word in edgewise.

We did reflect on this
and people noticed it.

Then we start to conduct
the meetings in Chinese

and then all the English
speakers wore their headsets

with simultaneous interpretation.

The native English
speakers were quieter

and that changed the
dynamics a lot,

but the workers were still quite.

In terms of cultural humility, we
were really challenged to think,

I think a little bit more
deeply about what culture is

and how doesn't mean thinking
about a list of traits

that you can ascribe to people.

But that it's actually,
you know, that involves you

and your assumptions and,
you know, how you project,

you know your assumptions
on to somebody else and then

versus what is their
actual experience

and who they actually are.

[ Music ]

>> [Background 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 privileges

but also what my voice
means in the world

and what it means as an educator.

It came from trying
to be to fit in,

to do whatever I could do 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 get

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 in here I am."

>> I think as long as power
and privilege exist in society,

we will always be struggling with
being too humble as woman of color,

as woman who come from working
class background, as woman who come

from low-income backgrounds or
under resource backgrounds, right?

As long as there's power
and privilege to society,

I know I will always be
struggling with that.

And I struggle with
that on a daily basis.

[ Music ]

>> I examine as I've stayed here

to see how inclusive our current
policies and programming are

for 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 about like
transgender culture or fair culture

as I've stated, and how
it's respected or not.

>> Right.

>> And, how like the institution
can be culturally relevant

or humble or respectful of
the experiences of trans folks

when they come to this place.

>> The half 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 community advisory
board, all transgender females.

And, I was so uncomfortable
but at the same time,

they made me feel
me so comfortable.

They started asking me questions
like they know it is, do you know

and they were like so,
"Where are you from?"

You know, and I was
like, "I'm Iranian."

"Oh, we know this Middle East
transgender girl, do you know her?"

And I was like, "Hello."

So, in 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 in 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 and myself included

about Pacific Islander culture
and working with Pacific Islanders

around health issues that were
important to the community.

And I think after
attending the training,

I realized that 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.

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

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

But one thing that I think about

or that I can practice
is cultural humility is--

[ Foreign Language ]

>> 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 not
something that's emphasized.

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

There've 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 lot of
underrepresented minorities

in the sciences like
that raises a factor

about gender sexual orientation.

>> I learned cultural humility
through-- I'm in two places,

by my own culture which being
Cambodia and South East 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 believe this.

I do this."

And listen how that is very
different from the "we."

We, I hear that 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", the "we," the "you".

>> Growing up, I was like
always interested in culture

and other religions and
just really learning

about things form
other backgrounds.

And so, I just figured

that [Background Music]
made me culturally humble

because I had the 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 Africa.

I mean, it just like
shift my world.

[ Music ]

>> Peace. I think when I am-- I
feel always sitting in a place

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

and ease that is this
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 it as a road that spirals.

And, a spiral actually doesn't--
actually about in a dance context.

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

That's sort of continuous loop.

And along the continuous loop,
you know, many things happen

and many forces may change
this shape of it

or the depth and reach of it.

>> A cultural humility, it's
definitely a journey for me.

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

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

That I know every challenge
I'm going to learn from

and I think it's a process that
I have to go through everyday

and that I'm OK with
going through it

and that actually makes
me stronger and smarter

and I hope wiser than
I was yesterday.

[ Music ]