Multiculturalism - by Dr. Srishti Dutta
“As a descriptive term, multiculturalism refers to the co-existence of people with many cultural identities in a common state, society, or community. As a prescriptive term, it is associated with the belief that racial, ethnic, and other groups should maintain their distinctive cultures within society yet live together with mutual tolerance and respect.”
My lived experience of multiculturalism in the last 40 years goes well past this academic description.
I must admit having been born in and spent my childhood and youth in India, one of the most religiously and ethnically diverse countries in the world , I may well have taken the existence of a multi-cultural society for granted. A realisation that dawned on me every time when outside India I was asked the question ‘Do you celebrate Christmas?’. You see, in India I celebrated every religious festival there was; it may have been with varying levels of participation, but it never felt like there were people who were excluded from the celebration. I remember even as junior doctor in hospitals having friends bring in sweet treats for Eid, and asking my Mum to get me sweets I could take to my non-Hindu friends at Diwali. In hindsight, that was what inclusion felt like and it was something I realise I took for granted.
It was also a different time, when the current universal wave of nationalism was not sweeping in its effects. What does make that experience different from subsequent ones was that I belonged to the majority religious and ethnic group in the country - so I do question whether my experience would have been mirrored by my friends who were from diverse minority groups. Possibly not. I was brought up in a religiously moderate and politically liberal household which made it more likely that I assumed this was the state of affairs everywhere in my country - and remember, this was all viewed at the time with the inherent self-absorbedness of a child and teenager.
On the contrary I was in for a bit of a surprise when at 24 years I landed in UK. At the face of it, arriving at Heathrow and travelling to Wembley should have been reassuring, given there was a large South Asian population at both those locations. However, what struck me was a sense of homogeneity, if not in terms of racial mix then in terms of language, attire and interactions. In my naivety I assumed this was what the ‘developed world’ looked like, somehow assuming that fitting in was the way forward. I doubt I would be the only immigrant (medical or not) who would have come to this conclusion. Over the next decade or so I moved every 6 months from one hospital, one city to another, and during my training I did notice some diversity. The accents, the foods, the stories that people had to tell were like the colours in a rainbow-uniquely beautiful yet even more spectacular as a whole. Being in medicine was a privilege even in UK as you were privy to many of these stories- Jewish people who had moved from Poland after WW2, Irish people who moved to build the roads and become teachers in English schools, the South Asian shop owners and cabbies… if you looked past the racial diversity, there was cultural diversity too and a sense of pride and belonging.
As my independence, thoughts and inquisitiveness grew; so did my realisation that I was now 'different' but still a part of the melting pot of one of the biggest economic hubs in the world. Things such as acceptance, inclusion and a voice - that until now I had taken for granted - would now have to be earned, and I learned to value even more what I now didn't have. As a doctor, my experiences with patients were largely positive, but I was aware there was whole generation of South Asian doctors who had come ahead of me paving the way for inclusivity and acceptance. There was plenty for me to learn to be able to practice the art of medicine - names and rivalries in English premier league, or particular foods a region was famous for - whether it was the Cornish pasty or Bakewell tart. As far as communication skills go I recall early on practising for clinical exams with a patient simulator who commented that it was a two way street; if I was struggling because he had an accent, I should be mindful that for him I had an accent too. Add to that the fact that the average person speaking English would be going at 80-100 words per minute, whereas Indians will tend to be around 180-200 words per minute, my work was cut out for me in the world of communications skills in medicine. It was indeed a stroke of good fortune that my GP supervisor was a professor for communication skills at Manchester University Medical school and I did become a full-fledged GP under his guidance and tutelage.
Then after a decade of having lived in UK I moved to Australia - halfway across the world, a continent just unfamiliar enough and exotic enough that I was keen to explore it. Mentally I am unsure what I expected, having watched the usual culprits on televisions - crocodile Dundee, Neighbours and the Rabbit Proof Fence. Having decided to work in Brisbane, my second-hand knowledge of life in Melbourne that my paternal uncles and cousins had provided seemed non-contextual. I knew there were plenty of theme parks on the Gold Coast, I knew Melbourne was famous for its unpredictable weather. I was still unprepared to arrive in Brisbane and face the vastness of this country - something that felt strangely reassuring, having lived in another geographically diverse and sizeable country before (India). With it came the realisation though that arriving in Australia and having been a UK trained GP I had the distinct privilege that I did not have to work in a rural or remote are (unlike other overseas trained doctors that come to Australia). Much like India it was not surprising to see a disparity in medical service provision between urban and rural areas - the UK seemed logistically so much less challenged in this regard. There was something novel in my experience in this country though - I noticed the Pommie veneer I had acquired did make me more acceptable and less foreign to people. Somehow I knew the conversations were easier when the question ‘So where have you moved from?’ was answered with with ‘England’ as opposed to ‘India’. This led to further discussions about how things were different - what we missed and what we didn't - yes you know the answer, no one misses the English weather! The fact that it was a comparable health system to the one I had moved from made the professional transition smoother as well. Despite this, there was still much local knowledge for me to acquire, regarding both medical services and patients expectations.
Inevitably, when I met Indians who had moved to Australia they would ask me which I thought was better - Australia or UK? This I shall leave for another day. There was a whole different set of cultural paradigms to learn about: why was Australia Day not a celebration for everyone? How were some states of Australia much more diverse than others? what did it mean when you were asked to bring a plate (i.e. food to a party)? I learned that chips (like India) came in packets and what came with fish was in fact fries! At an age close to 40, my capacity to absorb more sporting information was finite so I haven’t yet made an attempt to learn more, but I do know as a QLD resident I support the Maroons. I do recognise that moving with a family meant the parameters I used to compare my move to UK as opposed to my move to Australia were very different, and it was to be expected that I would thus notice disparities. However, it felt like arriving in a country that was younger and had grown on the foundation of aspirations of generations of immigrants that came before me - I had arrived, it was time to belong (with arrogance) and find my voice too.
Human beings and illnesses remain universally similar, as is the desire to remove suffering and heal as far as medical professionals goes. What makes things unique as a doctor who has now worked on several continents is the differences and similarities in the provision of this care. At a system level if one works in a country or area where the patient to doctor ratio is high, the provision is much more transactional - it’s relatively unidirectional communication, as opposed to low-ratio areas where it is much more relational and patient centred. The latter requires an emphasis on different set of skills - communicating well, building rapport and awareness of cultural diversity. Much of this is now formally a part of medical training in the developed world, to allow for both better quality and efficiency of delivery of care. It was something I had to adapt to, having studied medicine in a very paternalistic environment where the acquisition of knowledge and procedural skills trumped all other skills required in practicing medicine well.
As for similarities, I now recognise that both social and health inequities exist universally too- the extent may vary as does the social and political will to address these inequities. At an individual patient interaction level, the ability and desire to remain curious and be able to connect appears to exist in all three places. Patients see doctors at times when they feel most vulnerable, some may seek a person that appears familiar, others may seek a human that understands irrespective of their diversity - to me this no longer is something I question, it is something I accept. Their gratitude shows they value your input - whether it was my earliest experience of receiving mangoes as an intern in India or the bottles of lemon curd my patient in Brisbane brings. Over this journey I have grown and still remember as I left India my aunt said- you are destined to touch the lives of many more people, I doubt she had envisaged it would span 3 continents and so many tribes.