Bridging cultural gaps in repats

ITIJ 213, Assistance and Repatriations Review, October 2018
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Lauren Haigh spoke to industry experts to hear their thoughts on the best ways to tackle cultural differences when dealing with medical assistance cases

Intercultural communication can prove challenging, whatever the scenario. But, imagine a situation that involves a sick or injured person thousands of miles from home who needs urgent care. Here, communication is paramount and could even mean the difference between life and death. Beyond the ability to communicate, elements key to providing optimal care include an understanding of the local culture and environment. So, what are the best ways to bridge cultural divides when dealing with medical assistance cases and ensure seamless care and a smooth repatriation?

First, let’s explore some of the challenges presented by medical assistance cases in different countries and cultures. Brenda Durow, General Manager of South Africa-based international assistance group MSO International, told ITIJ that some of the key issues that MSO International commonly faces are differing views with respect to death, burials, cremation and funerals, and significant differences in how people relate to serious illness and end-of-life events. “Some cultures are embracing of less active medical care toward the end of life, while others will wish to be very aggressive in management right up until death has occurred,” she said. “We must be very sensitive here to avoid offence and even legal risk.”
We need to demonstrate acceptance and respect for their beliefs even if we may not share those beliefs 
As Durow highlighted, without sensitivity and understanding, not only do medical assistance companies risk causing offence, but they also run the risk of incurring legal repercussions. This is because countries have their own sets of rules and legal frameworks. Saudi Arabia, for example, is a country deeply rooted in laws that stem from religion and tradition. Indeed, women are not allowed to interact with men to whom they’re not related or make major decisions without male permission. These types of considerations must be kept in mind, Durow says: “In a society that is strongly patriarchal, one may find it is more effective to have a man making arrangements with regards to guarantees of payment or contracting. If the society values women as nurturers, then having a female nurse discussing care arrangements may be seen a more acceptable than a male nurse. We need to demonstrate acceptance and respect for their beliefs even if we may not share those beliefs.”
ITIJ spoke to Takaaki Chiyo, Executive Officer and Head of the Network Division at Emergency Assistance Japan (EAJ), a Tokyo-based Japanese medical assistance company with subsidiaries and branch offices in England, the US, Thailand, China, and Singapore, about some of the challenges EAJ faces when dealing with medical assistance cases in different countries and cultures. He highlighted the fact that, for a medical assistance company, the medical provider’s willingness to co-operate is crucial and good relationships are essential. “In comparison to some Western countries, Japan is highly culturally sensitive, and people may tend to be cautious towards people from different cultural backgrounds,” Chiyo explained. “Given such conditions, many foreign assistance companies struggle to obtain medical information from Japanese medical providers, even if they employ Japanese staff themselves.” Chiyo said that EAJ is successful in obtaining such information for its foreign clients due to its strong understanding of Japanese customs and long-term efforts to maintain trusting relationships with medical providers. Again, we hear the importance of learning about and being respectful of different cultures and customs, but also the importance of building bridges and forging relationships over a long-term basis. In addition to maintaining regular relationships with local medical providers, such relationships can be forged via regular in country visits, establishing local business units, partnering with in-country assistance partners and networking with industry. Durow at MSO International also values establishing relationships and said that, as a Core Partner in the International Assistance Group (IAG), her company has great opportunities to do so. “We participate in bi-annual forums and the annual IAG Training Academy, which brings assistance agents from across the globe together to share their experiences and discuss similarities and differences when providing services in their countries,” she said. “This fosters an atmosphere of acceptance and puts a face to the different cultures we work with.” 
 
Mindfulness and meticulousness
Chiyo said that EAJ believes that there are three elements to be mindful of when dealing with medical assistance cases in different countries and cultures: “First, meticulously organising the planning and simulation of the assistance co-ordination; second, conducting briefing and debriefing among the operation team members to ensure the necessary information is shared and, lastly, decisions and actions are made in an accurate and prompt manner.” For EAJ, planning, sharing and timely actions are the ingredients for success in medical assistance cases in other countries. Similarly, James Page, Chief Administrative Officer and Head of Assistance and Claims for travel insurer AIG Travel in the US, believes in the importance of sharing to ensure all members of a team are up to speed and able to deliver care appropriate to the country and culture. “Having a team with a thorough understanding of the culture and environment of each major destination around the world is critical to ensure there isn’t any disconnect or misinterpretation about what the customer is experiencing,” he said. “While it seems obvious, it is important to recognise that every health system in every country is different and, therefore, a one-size-fits-all approach to delivering global medical assistance is simply untenable.” Page said that one example of this is that in China, public medical facilities do not have nursing staff; therefore, if a patient is admitted to a public facility, they will need to rely on family or friends to assist with the tasks that nursing staff might usually handle in other countries.
When it comes to delivering a smooth care pathway for a patient, Durow highlighted the importance of managing patient expectations. “Managing patient/client expectations is always important but especially so if one is dealing with patients and care givers from different cultures,” she said. “Accessing care may be impacted by the culture or religion of the recipient of the care – e.g. if a female patient cannot be seen alone by a male medical practitioner – and this would need to be taken into consideration when making any arrangements. When one understands the culture of both your patient/member and your provider it is easier to anticipate potential issues and proactively manage them.”
For EAJ, Chiyo said that collaborations with local interpreters help to effectively facilitate assistance. “We think that having interpreting services on-site is a very important factor in delivering a smooth care pathway for the patient. The travelling patient’s anxiety from the differences in the medical environment can be reduced by providing explanation,” he said. "At EAJ, that is done by not only our operation team but also our network interpreters, and such necessity occurs especially in the time of seeking medical attention when the anxiety peaks, in order to prevent subsequent anxiety-related problems from occurring.” An additional tool for ensuring a smooth pathway, said Chiyo, is the collection of local information by facilitators behind the operation, which includes ensuring the accuracy of the information held at EAJ. 
 
Knowledge is power(ful)
For Page, having a team that possesses a deep and thorough understanding and knowledge of the market a customer is travelling in is the most important factor when it comes to ensuring a smooth care pathway for a patient. “For AIG Travel, we address this critical need through ensuring that our eight dedicated service centres, strategically located in key regions across the globe, are equipped with a mix of local and international staff trained to provide the highest quality of service and advice (both medical and travel-related). These teams will speak the local language and are experienced with how the location’s medical system works,” he said. “Staff must be able to quickly direct a customer to the best and closest medical facility where treatment can be provided; in some cases, this could involve also arranging or communicating with family and friends back in the patient’s home country to advise them on what has happened. Once at a medical facility, our doctors and nurses on staff who are familiar with the location, speak the language, and aware of any other cultural nuances will contact the treating physician to ascertain the condition of the patient.”
Page also highlighted how important it is for medical assistance teams to be, and indeed stay, informed of what is doing on in different markets to ensure that they can provide customers with the best advice possible. “Whether due to political unrest, economic uncertainty or other global factors, developments and advancements are constantly happening all around the world,” he said. “Depending on the circumstances, a location that was once unsafe might now be home to a high-quality medical centre or vice versa.”
 
A case of understanding
For travellers, resources such as the World Health Organization, US Centers for Disease Control and Prevention and local government websites can be very useful in terms of education around what to expect from medical systems around the world. “Resources and tools that provide critical information to travellers about the legal, cultural and medical differences can go a long way toward mitigating potential issues when traveling to different countries,” said Page, who considers education and research to be key for travellers. “All travellers should be prepared by researching their destination and considering travel insurance,” he said. “Research is even more critical for those travellers who have underlying medical conditions. Take some time to put a plan in place to mitigate potential risks that may occur while travelling. That way, less time will be spent worrying about what might go wrong, leaving more time to enjoy the trip.”
Chiyo of EAJ said that the essential points and principles when it comes to bridging the gap between different cultures when dealing with medical assistance cases are: understanding the environmental situation and culture in depth, from as many perspectives as possible; finding new partners and continuing to expand relationships with trusted partners in order to receive useful and effective local advice; forwarding all necessary information to the parties involved; and paying costs and collecting incurred fees as soon as possible. 
Durow of MSO International said that when it comes to bridging the gap, her company is fortunate to have staff with a diverse array of languages cultures and religions. “This helps a great deal in assisting us to be more sensitive to diversity within our client base,” she explained. She also said that MSO International employs local network managers in 11 key countries to ensure that when it is negotiating with providers or assisting patients, it has ‘feet on the ground’ who understand local business and cultural practices. I think most of us would agree that face-to-face communication is king and the most effective way of ensuring that messages do not become mixed or misinterpreted.
Having a team with a thorough understanding of the culture and environment of each major destination around the world is critical
From this, we can take that the three pillars of bridging cultural divides in medical assistance cases are understanding, education and respect; understanding a culture and a country, in terms of rules, tradition, religion and language are paramount. There is also a fundamental need for those involved to educate themselves and ensure they remain in the know when it comes to developments. Additionally, it is necessary for team members across the board to have access to the same information and knowledge to ensure consistency. 
Finally, and perhaps most crucially, having respect for those encountered during medical assistance and repatriation cases, and working together to keep all parties informed via clear communication. ■