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Negotiating Cultural Diversity: An Ethnographic Portrait of Framing Clients and Culture in a Community Health Center in the Canadian Prairies by Manju P. Acharya (1st edition); Publisher: VDM Verlag, Germany; Publication Date: August 28, 2009; Pages 188; Format: Softcover; ISBN-10: 3639191072; ISBN-13: 9783639191073; Price: $ 97.00

Reviewed by Saikat K. Basu

Guyana Journal, December 2011

Culture is an important aspect of human civilization, and more so cultural perception, a modern anthropogenic attribute in our ever evolving social landscape. Culture and cultural perception in some way or other shape our faiths, beliefs, social, political and economic activities, and even strongly regulates our ethical, emotional and professional behavior. This is a complex process in our social evolution. In a multicultural and polyethnic society this process could be seen and accounted for in almost all types of social organizations ranging from politics to economics and education to health care. The difference in cultural perceptions and practices is present in some form or other in every society and therefore needs serious exploration and investigation by scholars to understand its deeper roots and its possible impacts (both positive and negative) on our social landscape.

Over the past four decades, in Canada, the universal healthcare services have undergone tremendous transformations. One of the significant outcomes of the process was accepting the fact that healthcare professionals need to understand the cultural belief systems and practices of their immediate clients and accordingly provide appropriate health services. Several factors have contributed to this shift: rapid changes in Canadian population dynamics; changes in Canadian politics; adoption of multiculturalism in Canadian Constitution in 1982; the rising cost of health care system; morbidity and mortality profiles at local, regional and global levels; and overall cultural awareness. The current book by author Manju P. Acharya nicely shows how cultural diversity has been integrated into the western healthcare systems through an ethnographic approach. Her research focuses around the cultural biodiversity experiences of the healthcare professionals in a Community Health Center/CHC (a primary health care delivery system in the prairie region of Western Canada).

The volume is divided into seven major sections followed by an exhaustive Bibliography and Appendices at the end. The first section provides a nice Introduction into the Canadian healthcare system, its relevance and its connection to cultural diversity. The author also provides a framework of the remaining sections in the introduction and its relevance and opportunities for future understanding of this complex and challenging social process. The next section entitled Canadian Cultural Diversity and Health Care Delivery Systems is self explanatory extensive review work. The author through her painstaking research reflected on the changing population dynamics of Canada over time, and traced social, economic and political history to understand the factors that contributed to fundamental changes in the population dynamics. She also nicely illustrated the Canadian universal healthcare system in this section with some highlights on the pros and cons of the system. In the third section, named Theoretical Frameworks for the Study of Health Institutions as Cultural Systems, the author has provided the background and theoretical skeleton of the discourse on culture and institutional culture, study of institutional center and medical institution as an interactive cultural system. The fourth section on Methodology highlights how the research was conducted and what approaches and strategies were adopted in the collection of data, interview processes, resources used, and lastly analysis and interpretation of the data collected. Several of the factsheets and interview questionnaire are included as supplementary information under the Appendices. The fifth section is an interesting reading, entitled Charter, Structure and Everyday Practice at a Community Health Centre. This section mostly deals with the identity of a community health centre, its hierarchical social structure and perceived problems and organization responses to cultural diversity. The sixth part entitled Framing Client and Culture provides an in-depth coverage client identification in the CHC, moral responsibility with respect to client differentiation in the healthcare system and ambiguous roles of healthcare professionals (nurses) with respect to client diversity. The final section on Conclusion summarizes key findings and provides some future recommendations.

The book is an excellent piece of scholarly work with in-depth research investigations of important cultural questions plaguing western healthcare systems with respect to cultural diversity of clients. The nice linkage and connectedness provided by the author between different sections and sub-sections deserves special mention. The simplicity of the language and the personal story telling fashion of the presentation has been added bonus to the excellent piece of work. The author has been instrumental in personalizing the important concepts and major findings in a reader friendly manner and deserves special credit for that. It would have been even better if more word diagrams and schematic flow charts were provided in delivering the key concepts as a reader friendly visual aid. There have been some repetitions of information within the volume; however, those were always within the context of the relevant sections and sub-sections. Some images and graphics showing changes in population dynamics and demography statistics would have been appreciated and can be explored in future editions.

From a personal perspective, this book has been an eye opener for me and my understanding of the institutional cultures such as the character of primary healthcare delivery system located in a small urban center in Western Canada. It personally reflects on my own experience of using the healthcare system and helps me to understand how important it is to realize and appreciate cultural diversity. We sometimes do not realize the significance of cultural practices and characteristics that are so much related to our personal wellbeing and interpersonal relationships. This work clearly confirms that cross-cultural contact and a culture-friendly healthcare system could be mainstream in the everyday Canadian healthcare service delivery system The most important reflection from this work translates to the fact that how could we take the recommendations and apply them to empower our valuable healthcare professionals through appropriate training programs, and also mainstreaming the cross-cultural health services. The real emphasis should be that our healthcare professionals are capable of delivering their best possible services with a cultural consciousness.

Overall this volume is an exemplary piece of scholarly work with excellent information that would be valuable for reviewing some of the shortcomings of Canadian universal healthcare system in the pretext of cultural diversity. The volume critically inspects the strategies and methods employed by current healthcare professionals in a CHC setting while dealing with the challenges of cultural diversity. The most significant outcome of this research has been the excellent recommendations suggested by the author that could help healthcare policy makers to redesign the involvements and participation of CHC in delivering more client oriented cross-cultural services. This will be even more important as the Canadian population dynamics and client diversity changes in the near future. This book will be extremely useful for students and researchers related to disciplines such as Medical Sociology, Community Medicine and Practices, Social Anthropology, Health Sciences, Social Science and Medicine, Comparative Sociology, Applied Anthropology, Community and Social Sciences, Social Work and Medical Anthropology.

Saikat Kumar Basu
School of Agriculture and Life Sciences, Center for Applied Arts and Sciences, Lethbridge College, 3000 College Drive South, Lethbridge, AB Canada T1K 1L6