1. El Proyecto de Salud Indigena: A Culturally Competent Model for Working with Indigenous Mexican Migrants Rebecca J. Hester, Ph.D Post-Doctoral Research Associate Latina/o Studies University of Illinois at Urbana-Champaign

2. What is Cultural Competence? “A set of congruent behaviors, attitudes and policies that come together as a system, agency or among professionals and enable that system, agency or those professionals to work effectively in cross-cultural situations (T. L. Cross, et al., 1989).”

3. Cultural competence and racial disparities Cultural competency is promoted as a means to off- set the disparities that result from racism and discrimination within the health care context. These disparities are largely understood to be rooted in social and economic inequalities within society at large.

4. Operationalizing cultural competence Care that is compatible with beliefs, practices, and language (spoken and written interpretation) Representative staff Trained staff Institutionalized (policies, plans, evaluation strategies) Data collection (demographic and epidemiological profile) Partnerships with communities served

5. Centro Binacional para el Desarrollo Indigena Oaxaqueno Founded 1993 Interpretation Health Education Cultural Competence Leadership Civic Participation

6. Indigenous Migration Mexican migrants increasingly ethnically and linguistically diverse Racism Lack of documentation “Hierarchy of suffering” Malnutrition, hypertension, diabetes, obesity, high cholesterol, arthritis, dental issues, TB, etc

7. Proyecto de Salud Indigena Promotores model Provide Health Information to Indigenous Migrants Educate clinical and service providers Bidirectional Strategy

8. Indigenous migrants teach cultural competence Explain cultural practices, beliefs, cosmology Draw attention to the effects of structural poverty Describe legal challenges Emphasize the need for trained interpreters Presentation illuminates conceptions of indigenous rationality, their relationship with nature, life and death, with self and community Goal is to provide information and provoke empathy (fact-centered and attitude-centered)

9. And yet…. “Why should we change just to accommodate them?”

10. Cultural Safari “Disneyfied” version of culture-milktoast multiculturalism in which we learn that, indeed, “it’s a small world after all” “Culturalization” of difference operates like racialization Marks those subjects to be tolerated as inferior, deviant, and marginal vis-à-vis those practicing tolerance

11. Cultural competence is not attentive to the roots of inequalities Focus on individual attitudes and cultural “difference” takes focus away from power and foundations of inequalities Communicative competence and the “celebration of tolerance” does not address how racism (and other forms of dominance and neglect) in its various forms is produced historically, semiotically, and institutionally at various levels of society.

12. The limits and opportunities of authoritative knowledge Indigenous migrants can’t teach anti-racism because of a fear of backlash Medical schools and other healthcare stakeholders can teach it by asking students to ask tough questions, take risks, and commit themselves as public intellectuals

13. Insurgent multiculturalism “We must go further than the compensatory strategy of simply adding diverse cultural knowledge to the dominant curriculum…The ultimate objective is to seek the generalized diffusion throughout the whole system of counter-hegemonic knowledge based on the experiences of the disadvantaged” (McCarthy, 1994)

14. Conclusions Demographic changes are provoking us to find ways for dealing effectively with diversity Cultural competence is one strategy for doing this Yet, if we don’t re-think our epistemological and institutional approaches we risk reproducing that we are trying to undo This has life and death consequences for disadvantaged groups

15. Thank You! Rebecca J. Hester rhester@illinois.edu