By Virginia Regan
College of Health Professions

"Diversity is important." I think everyone on the planet has heard this statement at least a hundred times before they enter into the professional field. We say it, we preach it, we harp on it, but do we ever actually stop and get it? What exactly is diversity, and more importantly, why is it so essential? Sure, you could go to trusty Webster, or in this day and age, dictionary.com to look up an applicable definition of a word used so frivolously, but that doesn't help you to understand it, to grasp it, to appreciate what diversity is, and what diversity can do. Diversity does not just extend to races, or ethnicities, or countries of origin- it extends beyond that and into traditions, practices, experiences, and beliefs. The world is merely a box of Crayola colors, no two are exactly alike, but you can see the blending of the colors and origins of one when it stands next to another of a similar hue. I believe that I am a salmon-colored crayon: not too pink, but definitely not stark orange. I am eternally optimistic, a little louder than what society deems "normal", roots embedded in tradition, but my eyes look skyward for what is yet to come, what is possible, to not only what can be, but moreover what should be. As much as I treasure finding other salmon-esque paints to share experiences with, the truth remains that I cannot learn very much from individuals who are, like myself, close blends of pink and orange. I learn more from the blue crayons, the see-things-how-terrible-they-truly-are, the realists, those who don't dream simply because they find it a waste of time to get lost in ones thoughts that are not, by lack of a better term, "reality."

What about all the other colors? Well, they come from all over the world, naturally. You have the lime green Jehovah's Witness, a first-year medical student who explains to me for the umpteenth time that the patient in bed 634 does not accept whole-blood transfusions. The attending on-call hails from Delhi India, a classic yellow crayon, who explains to me that the female patient refusing palliative care is Hindu, and that her decision stems from the unwavering belief that one should embrace the concept of samsara, or rebirth into the next afterlife, rather than take any measures to dull pain and suffering in the present. The patient sees pain as expunging of sins during this lifetime, and embraces such an experience in the hopes of moving forward into the next life. I see the RN on the floor, a fire-engine red, who recently completed a medical missionary in Uganda explain that the irritable Ugandan patient in the ER does not understand why it was so imperative to go to the hospital for treatment. While normally, Americans would become frustrated trying to explain to a patient why seeking medical care is so important, this particular RN understands that in Uganda, the hospital is the last option, and most health care occurs in volunteer clinics and/or the stash of IV fluids that are stocked up in neighbors' pantries. Without exposure to these cultures, these beliefs, I would be lacking in my ability to provide adequate health care for patients seeking care. These patients are the very same that come into the clinic or hospital with trust that we, as care-providers, are going to understand them, help them, and better their overall health. To think, even for a second, that you can do that alone is quite possibly the most detrimental conclusion one could draw. If you think you can do it alone, here's a newsflash for you: You can't.

Each individual is a different color, a seemingly simple concept to understand. It's equally simple to understand that a particular color may be the best fit for treating a patient in a similar color family. The difficult part, or parts rather, rests in understanding when it's not about treatment, and when one color isn't enough.

What on earth do I mean, "When it's not about treatment"? We are soon-to-be health care providers. That is what we do: we provide health care.

I beg to differ.

Sure, I will collect urine and run a urine analysis to find out if the patient I am seeing has a UTI, and I will undoubtedly collect CBC panels to check the blood levels on the patient undergoing her third round of chemotherapy. Let us not forget, however, that we are not always there to provide treatment, for when that patient undergoes her third battle with ovarian cancer and decides that her quality of life is far more important than the length of it, and opts cease aggressive therapy and solely use palliation - our jobs are not over. In some ways they are merely beginning. We are healthcare providers, not health-treatment providers. Care is the root of that distinctive differentiation. Let us not forget to care, even if we can no longer cure. How does diversity affect this? Simply put: at the end of life, a variety of different beliefs come into greater play than they do in health. Religious backgrounds, beliefs and perceptions of an afterlife predominates the patient's thoughts at times, and without a staff that is knowledgeable on the different aspects of worldly cultures and beliefs, then this woman who has valiantly battled cancer for so long, will slip through the cracks at her most vulnerable point. This is when you need diversity most, not least. You need the different training, cultures, races, religions, beliefs, goals, aspirations, personalities, and thought processes. When you sit on the tumor board and you are surrounded by a room full of amazingly intelligent individuals who have made it their life mission to help people, you need diversity. You need these different belief systems because not only is your way not the only way, it also may not be the best way for a particular case, a particular person.

Have you ever seen a painting done solely with shades of red? I have. Let me tell you, it was by far the ugliest painting I have ever seen, and while I understand this is my opinion, it was still quite ugly. You cannot have a ten-foot-by-five-foot canvas painted with only one shade of red and call it art. So what do you do? You throw in some blue, and magically now you have three colors: blue, red, and purple. So you have the ardent red, the steadfast and strong RN from Uganda who understands a culture that is fearsome of hospitals, and she works alongside the realist blue physician, and while the two would otherwise normally clash, you end up with a blend of purple which is the perfect treatment for the Ugandan patient in the ER.. It is not our choices who define us as individuals nor is it our abilities; it is our past experiences. Our past experiences have interwoven to become an intricate, delicate web that creates us into the individual that we are. I need yellows, blues, greens, and reds in my life in order to not only be the best care-provider, but moreover the best person I can be. Diversity, and the lessons that you learn from such exposure cannot be taught in a classroom. Sure, you can study world religions, beliefs, and traditions but you never will truly get it. You will get it, rather, when you've been diligently and frustratingly patient with the Ugandan woman as you try to explain repeatedly for two hours why she must stay in the hospital without prevailing and then the red RN waltzes in and in a matter of five minutes explains everything you've been trying to for the past two hours.

So I say this: open your eyes and soak up every last ounce of this big, beautiful world. The seemingly unimportant trivial parts of day-to-days are full of learning opportunities for growth and development. Don't ever fall into the trap of believing you've "learned it all", because I promise you haven't. Respect others not only for where they have been, but also for what they can bring to the table. Know when you are not the right person for the patient, and don't let pride get in the way when it's time to step away. At the end of the day, remember that while a yellow and a blue may clash in close proximity due to zero commonalities, after all, they are on the opposite sides of a color wheel, they can be blended together may make a unique blend of green that is just right for the situation at hand. Sometimes, the most beautiful of combinations isn't the finished product: it's the pallet. The scrap piece of wood where brush strokes blend different shades to not only create new colors, but also to create shades of these same hues. This pallet needs to be present in all clinics and hospitals; this pallet is integral, and is, well…art.

By Lauren Wengerd, OTS

It was my second day of observing an occupational therapist in my small hometown. When the second patient of the day came in for his therapy session, the therapist I was observing told me that this may not go as the previous sessions I observed had. A little confused about what she was referring to I smiled optimistically and was preparing for a rare medical case or a different type of therapy- what I didn't realize was that what she was referring to had nothing to do with the patient's medical condition, but would teach me a lesson far more valuable than any form of therapy could. The patient was a Muslim who was hesitant to do therapy or make public appearances for fear of being judged for his prayer rituals. The occupational therapist became aware of this at his first session and did some research, asked questions to a Muslim friend of hers, and did her best to educate herself so that she was sensitive to the issue. It came as no surprise to the therapist that half way through his session he needed to dismiss himself for prayer, to which the therapist was accommodating and even asked if he would like to go to a private room concerned that he would be uncomfortable if others viewed this as strange. Her genuine desire to accommodate his individual needs and learn about his culture made it even more evident to me that I was choosing the right field, and furthermore taught me the importance of educating myself on the cultures of others. She told me the greatest mistake I could make as a future occupational therapist would be to treat everyone the same, because the reality was until you learn the values and beliefs of others you cannot give them the best service they deserve.

Cultural diversity in the United States has been a topic of conversation for many decades and is now gaining even more importance with the demographic trends of the U.S. quickly shifting. By 2050, the U.S. census projects that our country will have tripled the number of Hispanic and Asian populations and doubled the number of African-Americans (Byrd, & Salisbury, 2006). The white population as a majority will soon be a thing of the past and in order to best serve these changing populations, it is imperative that the medical fields diversify their workforce. In order to add value to the services the healthcare industry provides Americans of differing races, genders, religions, and ethnicities, we must increase cultural competence and build a business model that better serves both the patients and healthcare providers.

When looking at the role of diversity in the healthcare workforce, cultural competence is a key element to successfully treating patients of differing backgrounds and beliefs. Cultural competence is the knowledge, skills, attitudes, and behaviors one must demonstrate when working with people of differing cultural and ethnic backgrounds (Putsch, 1985). I feel that American culture currently demonstrates "cultural blindness" (Putsch, 1985) on the cultural competence scale by emphasizing that all patients should be treated the same while inadvertently meeting the needs of the dominant population (white Americans) over others. This cultural blindness is evidenced by patient satisfaction being much lower when the patient feels that the provider is different from them and thus out of touch with their individual beliefs and values (Cohen, Gabriel, & Terrell, 2002). I feel strongly that students entering the medical field should be educated on both individualistic and collectivist cultures, different religions and how those could impact their medical decisions, and most importantly be exposed to these different beliefs as to have sensitivity to them in the future. In the medical field verbal and nonverbal communication play an important role in the care provided, and something as simple as a handshake to say hello in our culture may be offensive to others (Putsch, 1985). By diversifying the students and medical professionals entering the workforce, we will not only educate ourselves for the better but will also increase the quality of care provided to patients by providing different outlets, opinions, and resources to turn to.

Another area of importance when looking at diversity in the healthcare workforce is the research conducted. Evidence suggests that people in medical research fields tend to do research on the diseases and problems that affect their populations. As a result, it comes as no surprise that the majority of medical research conducted in our country is on white males- the same demographic as the professionals conducting the research (Cohen, Gabriel, and Terrell, 2002). White Americans are healthier in general than people of differing ethnic backgrounds. African-Americans have a lower life expectancy, a higher infant mortality rate, are less likely to receive adequate pain management, and are less likely to be put on HIV medications when diagnosed than white Americans (Cohen, Gabriel, and Terrell, 2002). Without diversifying the healthcare workforce we will be unable to properly and effectively treat these patients, thus leading to a less healthy American population in the long run.

As a student in a medical field, I see the value of diversity every day. I am excited about the opportunity to make changes in the way Americans view health care, expand my own knowledge of different cultures and beliefs, and become a well-rounded and culturally educated therapist. Something in particular I am excited about as a student occupational therapist is the American Occupational Therapy Association's efforts to create a national model for diversity employment in conjunction with Homeboy Industries, a gang-intervention organization based out of Los Angeles. Homeboy Industries works to get those involved in gang related injuries back into the workforce by working with teams of diversified therapists and doctors in order to better add value to the services they provide (Clark, 2011). This concept has proven for over a decade that a diverse team working with a patient increases satisfaction and positive outcomes better than therapists and doctors of one belief system working together (Clark, 2011).
Increasing cultural competence of healthcare providers in the United States is not only important, but imperative, if we want to keep healthcare in America strong. I feel strongly that the key to increasing diversity in the healthcare workforce starts at the educational level and the lessons I learn as a student today will come not only from lectures and textbooks, but perhaps more importantly from the diverse group of students and faculty I interact with every day. I can only hope that the lessons I learn as a student at the Medical University of South Carolina will teach me not only the mechanics and procedures of being an excellent occupational therapist, but also the cultural competence and knowledge the occupational therapist taught me when working with a Muslim patient so many years ago.