Cross-cultural Rehabilitaion: An International Perspective.

Cross-cultural Rehabilitation: An International Perspective Leavitt RL, ed. Philadelphia, PA 19106, WB Saunders Co, 1999, paperback, 424 pp, illus, ISBN: 0-7020-2245-4, $39.95.

This book provides an eclectic view of cross-cultural rehabilitation and addresses a wide variety of topics from a cross-cultural or international perspective. A major theme of the book is that, for most people with disabilities, social, cultural, and economic constraints are more limiting than physical, sensory, psychological, or intellectual impairments. Many chapters in the book describe efforts of developing nations to implement community-based rehabilitation programs that, in some ways, parallel many of the public health activities in the United States. However, in most countries that have populations that are largely located in rural areas and are of low socioeconomic status, the biomedical model as we know it is not viewed as helpful in meeting the needs of persons with disabilities.

The introduction to the book sets the stage for the 5 sections of the book. It describes concepts of cultural competence and provides a continuum of cultural competence that spans the most basic stages of development (ie, an awareness that cultural differences exist) to the highest stages that rehabilitation professionals will need in clinical practice (ie, knowledge of the specific needs and differences of individual cultures).

The first section addresses the theoretical basis for developing cultural competence. The topics it covers include general concepts of culture and subcultures (including that of disability) and the role of societal values in contributing to cultural intolerance and the resultant forms of discrimination. The discussion of appropriate language to use when referring to disabilities and the presentation of guidelines for ensuring user-sensitive rehabilitation services are particularly noteworthy.

Although disabling conditions are universal, the meanings attached to disabilities vary considerably. An array of health beliefs and behaviors toward persons with disabilities are presented in the first section. It describes the positive and negative influence of religious belief on attitudes toward people with disabilities and the different links between poverty and poor health. This section provides a succinct overview of racial prejudice, discrimination, and racism in the contexts of physical therapy clinical settings and access to health care, and it describes the inseparable bond among language, communication, and culture. Several examples of differences in communication styles among various ethnic groups are depicted and suggestions are offered for achieving successful cross-cultural communication. Section 1 is relevant to students in professional and post-professional programs.

Section 2 focuses on a variety of practitioner issues related to cultural competence. The section begins with a comprehensive historical overview of rehabilitation services with specific emphasis on community-based rehabilitation. It contains a thorough description and discussion of the International Classification of Impairments, Disabilities and Handicaps (ICIDH). The section pays attention to assistive technology, including how to determine its suitability in the contexts of culture, function, environment, and aesthetics; the basic elements of epidemiology and its use in assessing disability; a collaborative learner--centered approach used in preparing rehabilitation workers to work with and teach people with disabilities and their families; and issues relevant to clinical educators when working with students from other countries and cultures. This section of the book does not target a single group of readers. Some of the content is appropriate for professional students, and other content is appropriate for postprofessional students or practitioners.

A variety of case studies are presented in section 3. Each case study introduces the country or patient population and offers an overview of its culture. Case studies illustrate the formation of community-based rehabilitation programs in Guyana and Nicaragua and community-based rehabilitation in South Africa in the context of its sociopolitical situation. Another chapter reports on a study conducted on a community-based rehabilitation program in Botswana, and it emphasizes the way in which these programs must be organized and implemented in order to be successful. Additional case studies cover rehabilitation services in Mexico that are oriented toward children and experiences with children in Romanian orphanages.

Other case studies provide cultural insights and advice to professionals working with American Indians and an overview of the culture and issues related to rehabilitation for Palestinians. An international program to improve physical therapy education and to garner greater degrees of inclusion of physical therapists in rehabilitation in Vietnam is also described. The last 2 case studies describe efforts to address the needs of persons with disabilities in need of orthotic and prosthetic devices in Bangladesh and the use of paper technology to create corner seats, chairs, and ear trumpets (hearing aids) in Zimbabwe. This chapter offers vivid depictions of adaptations by people with disabilities who are in poverty. The authors of these case studies emphasize the need to be attuned to the culture of those we serve and to ensure that appliances and adaptations are culturally and environmentally appropriate. This section would be of interest to students and practitioners. I found the case studies to be very informative and readable.

Section 4 includes examples of cross-cultural research. The research reported in the various chapters concerns health beliefs and behaviors of families with children who are disabled in Jamaica; the human barriers to community-based rehabilitation in Jamaica; the effectiveness of parent groups in Harare, Zimbabwe; factors of ethnicity that may affect early intervention services for children; and the comparison of professional development, personality, and self-esteem among Palestinian and Irish physical therapists. This section highlights the need for additional research and would be of interest to those conducting research that is cross-culturally or internationally oriented.

Section 5 focuses on cultural competence in the 21st century. The authors argue that rehabilitation workers should have broader perspectives that embrace primary health care and an enhanced paradigm of public health, which incorporates cultural considerations. Several suggestions are offered for helping rehabilitation personnel to become culturally competent through education curricula and through clinical practice. It is essential to recognize one's own cultural identity and to take the time and effort to learn about the cultural identities of our patients and clients. This section would be of particular interest to academic faculty.

This book is not directed toward any given group of readers, rather parts of the book would be of interest to different groups of readers. In general, it is an excellent reference for every academic and clinical department. It is a welcome addition to the literature in rehabilitation.

Beverly J Schmoll, PT, PhD, FAPTA University of Michigan-Flint Flint, Mich

Dr Schmoll is Professor in the Physical Therapy Department. Her research interests include clinical education, faculty development, and teaching and learning.