Developing Cross-cultural Competence: A Guide for Working with Children and Their Families.

edited by Eleanor W. Lynch and Marci J. Hanson; 1992, Paul Brookes Publishing; $39.95 from Amazon.com

Over the past three years, I have been studying to be a labor assistant. While I began my training with the ALACE Labor Assistant program, I have expanded my course of study to include independent reading and a vocational training program at a local hospital. These additional learning experiences have brought home to me the importance of continuing education for professional labor assistants.

My sense of our field is that women who work as birth companions tend to have all sorts of related interests, and we continue our education naturally by pursuing them. Women go on to be childbirth educators, midwives, and massage therapists.

One supplementary area of study that I strongly recommend to other professional labor assistants and assistants-to-be, no matter what their personal interests, is cross-cultural studies. I found this topic to be particularly relevant to my work, as I live in an urban area with diverse ethnic and cultural groups.

As a biracial woman myself, I am keenly aware of the differences in customs, beliefs, and circumstances between cultures. While, in many cases, it is desirable to match provider and client based on language and cultural group, that is not always possible or necessary. I feel that all providers doing this kind of sensitive, intimate work with women and families should be trained in cross-cultural competence. I encourage birth companions to take a look at this interesting work.

Developed for early-intervention professionals, Lynch and Hanson's Developing Cross-Cultural Competence is a thorough, detailed introduction to its title subject. Filled with practical exercises and information, and well-structured and well-indexed, this book makes a good reference to read through and then consult as the need arises.

The material is laid out in an accessible and interactive way. The dense text of the chapters is paced by being broken down into subsections with clear headings; and each chapter ends with a summary and is immediately followed by its own references and appendices, eliminating the need to flip to the end of the book as you read. Tables, lists, and sidebars also help to organize the vast information into a useful, readable form, while a "Suggested Readings" section at the end offers further reference sources for readers.

The book's overall structure is a division into three sections. Part I discusses what culture is and introduces some general ways in which cultures can differ. Part I also explains why cross-cultural competence, defined as: 1) an awareness of one's own cultural limitations; 2) openness, appreciation, and respect for cultural differences; 3) a view of intercultural interactions as learning opportunities; 4) the ability to use cultural resources in interventions; and 5) an acknowledgement of the integrity and value of all cultures (Green, 1982) is important for professionals working with families.

Tools for self-awareness of one's own culture and consideration of cultural variation are provided. Discussion of the impact of immigration on American ethnic groups and cautions against overgeneralizing are also included.

Part II consists of chapters that provide condensed information on eight different major cultural groups of the United States: Anglo-Europeans, Native Americans, African Americans, Latinos/as, Asians, Philipinos, Native Hawaiian/ Pacific Islanders, and Middle Easterners. Each chapter is authored by an expert on the corresponding cultural group, usually also a member.

There is a lot of great, eye-opening information in this section. Topics such as language, history, major values and beliefs, and attitudes toward family life and childrearing are covered, as well as variations among cultural subgroups.

A nice feature is the inclusion of case histories in side-boxes. These examples show how the text applies to the real world. I found this section very useful--I learned concrete information that I can apply to my interactions with clients.

I actually read the section on Latino groups with great attention and learned things I hadn't known before about other Hispanic cultures. (In my area there is a large Latino population, but mostly with Caribbean and Central American origins; whereas my family is from South America. Although it is expected that I will find it easy to work with any Spanish-speaking client, I actually feel the need to learn more about these cultures!)

Further discussion of how and to what extent cultural identity is expressed in the United States' context appears in Part III, as well as more suggestions on using cross-culturally competent techniques in providing services to families.

Personally, I found Developing Cross-Cultural Competence an enriching read. I believe that the perspective it gave me helps me to serve clients with more understanding and less judgment. A., for example, was Jamaican and a single first-time mom getting her care through the city hospital where I was volunteering.

Because, when I discussed my line of work with Latina women, they would comment, "Oh, that's nice for the poor single moms who don't have anybody else to help them," I was prepared for a woman with no resources. The cultural assumption was that your family would give you labor support if they possibly could.

However, after talking with her, my impression was that privacy was important in Jamaican culture and, as an immigrant separated from the most appropriate caregivers (for example, her own mother), my client preferred a stranger even though she did have some family support.

Another client, T., was British. Because her culture values privacy regarding the body, she would minimize any physical symptoms she experienced. Thus, although she had a rapidly progressing labor, it was hard even for me with all my training to tell what was going on at first. Then my primary concern was to communicate to her housemates, who were not British and not trained in labor support, that she needed a ride to the hospital ASAP!

There are only two things that I would change about this book. First, I would like to see more coverage of African-American subgroups, such as Haitians and Jamaicans, in the informational Part II section. People from these cultures are numerous in my area and in many major East Coast cities, so a section covering these cultures would be much appreciated.

Second, while racism, colonialism, and their legacies have major effects on cultural patterns among United States ethnic groups, these issues are addressed only obliquely in Developing Cross-Cultural Competence. While acknowledging that cultural groups do not exist in a vacuum, and that our multiethnic, yet Eurocentric society produces such phenomena as culture shock, acculturation, cultural conflict, and bi- and multicultural individuals and families, the authors and editors stop short of recognizing that in fact cultural groups in the United States exist within a complex racial/ethnic hierarchy.

Perhaps they were trying to give "objective" information, or even honestly trying not to reinforce negative stereotypes, but I feel that any discussion of cultures and how they differ must include reference to social power dynamics, or it cannot produce a complete understanding. I would like to see, for example, in Part I, a section on "Race and Racism in the American Context," and more attention to racism, internalized racism, and the effects of colonialism as an explanation for some cultural characteristics in the chapters that make up Part II. Maybe next edition!

--Maria is a professional labor assistant, breastfeeding peer counselor, and mother. She has studied with ALACE, and works in the BirthSisters program at Boston Medical Center and the Breastfeeding Peer Counselor program at the Cambridge/Somerville Health Alliance.