It’s a Tuesday morning and Cynthia Paige, MD, assistant professor at New Jersey Medical School (NJMS) in the Department of Family Medicine has been lecturing 170 first year students for an hour on “Beliefs and Culture: Diverse Approaches to Healthcare.” Via slides, films, rotating professors and even visiting patients, in 18 formal class hours, the students learn that there is no cookbook approach to treating a diverse population, especially in New Jersey with its 1.2 million immigrants from all over the world, including Africa, Asia, the Pacific Islands, China, Korea, Vietnam, Mexico, South America, the Caribbean and Eastern Europe.

“View your patients in the context of their lives. Everyone is different,” Paige says. “Get their story. Recommend treatment with the patient’s culture in mind and only then, negotiate agreement.” In fact, the emphasis here is on the word negotiate, not dictate.

A perfect picture of medicine’s new multicultural dynamics, with family roots all over the globe, the future doctors in Paige’s class are products of their beliefs, values, customs, genders, races, ethnicities, sexual orientations, religions, socioeconomic status, disabilities, literacy levels, language, geography and heritage. A key to their becoming compassionate physicians in the future lies in their ability to tap into their own lives and histories. Every family has its own culture, in fact. Classroom discussions move from race and geography to everything from using lemon juice for diabetes, garlic for blood pressure, raw potato slices for chest congestion, the therapeutic power of honey as well as the medicinal might of saffron and chickpea flower but especially to what motivates patients. One of the most dramatic examples of a culturally based family cure belongs to student Roger Rivera and his Nicaraguan grandmother’s lizard soup.

Says Roger, whose family roots lie in Nicaragua, “My father was a practicing pediatrician in Florida but it didn’t matter. Whenever any of us would get sick, my grandmother would get a lizard and make her soup.” They would have to eat it.

“In most cultures, the power of a grandmother can trump a doctor’s advice,” explains NJMS professor Linda Boyd, DO, director of the Physician’s Core Course, a key piece of the school’s new Jubilee curriculum. “Cultural competency is now an essential skill for the practice of compassionate, humanistic care of patients.”

What Boyd, Paige and the designers of this UMDNJ course know is that the cost of not being culturally aware is too high. In March, 2005, the state of New Jersey passed a law that mandates cultural competency training for all physicians in order to be licensed. The law recognizes that when health-caregivers and/or medical institutions are biased, prejudiced and too quick to stereotype, patients are mistreated, undiagnosed, unnecessarily hospitalized and in danger of dying.

This class captures the essence and diversity of the entire UMDNJ
community and our passionate commitment to growing a culturally competent institution, poised for the future of good medical practice. In fact, it was Robert C. Like, MD, MS, director of the Center for Healthy Families and Cultural Diversity at Robert Wood Johnson Medical School (RWJMS) and internationally recognized for his dedication to cultural competence in healthcare, who prepared the NJMS faculty for teaching the course. “The development of cultural and linguistic competence is a journey and not something that happens overnight,” according to Like. “Every encounter is a cross-cultural encounter.”

“When I went to medical school 20 years ago, there was no training in cultural competency,” says Boyd. “I had to learn the hard way.” Back then, she discovered how something as simple as a handshake could alienate patients. “I remember taking care of a Malaysian woman in labor and trying to shake hands with her husband.” He kept backing away from her outstretched hand and she soon learned that Malaysians, as well as many Muslims and Orthodox Jews, prefer not to be touched by a woman outside their families. Now, programs, workshops and classes in all of our schools address such issues.

That UMDNJ should be a passionate leader in this journey is no surprise. Our University has one of the most diverse student bodies in the nation. A new UMDNJ Center for Cultural Competency will be established on the Stratford campus of the School of Osteopathic Medicine (SOM). Within all eight schools, signs of how UMDNJ is tapping into our unique multicultural strength can be seen in hundreds of initiatives, activities, programs, courses, lectures, web pages, conferences, research studies and interdisciplinary events — all aimed at reducing prejudice, promoting inter-group understanding, fostering comprehensive systemic change and preparing graduates to work and live in an increasingly diverse society.

From the celebrations during Latino American Heritage Month, sponsored by the Office of Multicultural Affairs, to the experiences of second year RWJMS residents rotating through homeless shelters, botanicas, bodegas, and local soup kitchens in Middlesex County, cultural competence at UMDNJ requires that faculty, staff and students value diversity, conduct self-assessment, manage the dynamics of difference, acquire and institutionalize cultural knowledge, and adapt to diversity and the cultural contexts of the communities our University serves.

To develop cultural competency standards for faculty, staff and students and to incorporate these principles into our institution, the New Jersey Campus Diversity Initiative, funded by the Bildner Family Foundation in partnership with the Association of American Colleges and Universities, has been working for the past three years. One of the results of this team’s efforts is the UMDNJ Cultural Competency website, which leads visitors into a treasure trove of information about efforts in education, research, healthcare, community services and products.

Positioning UMDNJ as a leader in cultural competency education and practice are myriad programs like University Behavioral HealthCare’s “Crossing Cultural Bridges,” the Office of Affirmative Action’s “Competencies for Medical Interpreters,” the Institute for the Elimination of Health Disparities at UMDNJ-School of Public Health’s “Spiritual-Based Intervention for African-American Women with Breast Cancer,” and hundreds of training programs designed by staff at the Center for Healthy Families and Cultural Diversity at RWJMS.

The Cancer Institute of New Jersey (CINJ)’s Office of Community Outreach is always increasing awareness, education and access to cancer clinical studies with particular emphasis on minority communities. In 2004, CINJ expanded these efforts through a series of Technical Assistance Programs funded by Novartis Outreach and Education Project (NOEP) grants. In Monmouth County, Tiempo Para Cambio (Time for Change), aimed at heightening awareness in Hispanic women with breast and cervical cancer, is just one example of NOEP’s support for culturally sensitive collaborations with community organizations.

New Jersey ranks fifth in the nation in the percentage of foreign born residents. As Maria L. Soto-Greene, MD, NJMS vice dean, says, “It is our responsibility to prepare culturally competent healthcare providers and to provide them with educational programs to keep abreast of the knowledge, skills and attitudes they need to care for New Jersey’s diverse populations.”