Final Project: “Let Me Get an Interpreter on the Phone / Linguistic Representation in Health Care”

Here is my final project.

Note: I started out with the intention to do a photovoice project, but this became more of a digital storytelling project instead, as the staff and providers I was working with were seemingly not comfortable with pointing out areas of weakness within the clinic in which I work. All of the photos that they shared were positive. Some of them are included within this project, however.

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[Group 4] The Boxing in of the Internet

Yesterday in lecture, our class had a wonderful discussion about systemic oppression and whether or not “working within a system” is a valid or effective way to change the system, or if one must completely reject a broken system and create an entirely new system for real change to happen. The general consensus was that it is both necessary to have those working within a system and those working from the outside to dismantle the system.

We talked about being “stuck inside a box” — a set of rules and parameters that we are expected to follow or face punishment.

As a long-time social media user and self-proclaimed internet-junkie, this week’s readings on the use of the internet to promote social justice seem to come at a particularly relevant time in American history: amidst the battle for Net Neutrality.

(This may seem like a divergence from this week’s topic, and perhaps speaking about Net Neutrality is going off into a bit of a tangent, but I will try to keep myself roped in.)

Net neutrality has long been on the Congressional chopping block, but what is it? Net neutrality is what stops Internet Service Providers (ISPs) like Verizon, Comcast or AT&T from messing with the content you can see when you access the internet. The largest current debate within the idea of Net Neutrality is that your ISP will be able to introduce “tiered internet service,” which would effectively mean your speed and online access would be dependent on how much money you are able to pay for your internet.

John Oliver does a great job summarizing Net Neutrality on this Last Week Tonight Segment:

The end of Net Neutrality would essentially mean that the internet will no longer a tool that we can use to spread messages of social justice if the ISP of those internet users we are trying to reach are against our social justice issue.

With the end of Net Neutrality, we would be putting our internet usage into a box that would limit what we’re able to see and do.

Consider the social media platform tumblr. Tumblr is particularly popular with teenagers and young adults, especially those who want more anonymity than Facebook can provide. There are significant groups of those who are interested in social justice issues, including (but not limited to) groups devoted to protecting Net Neutrality. Tumblr’s CEO, David Karp, was also an outspoken Net Neutrality supporter. Tumblr, previously an independent company, was bought out by Yahoo! in 2013. Last year, Yahoo! was bought out by Verizon, a big name in the ISP game. Since then, the once outspoken Karp has gone silent, but there are also reports that Verizon has been actively tweaking with the tag tracking system within tumblr to stop the spread of Net Neutrality related posts.

The plan to silence those who would oppose Net Neutrality shouldn’t be surprising– it will mean big money for those top Internet Service Providers.

So, how can we use social media to promote issues of diversity and social justice, like Net Neutrality, when our own social media platforms may be turned against us? The number one thing would be to fight back against Net Neutrality on a policy level.

But what else can we do? Using social media smartly, knowing how each social media platform is used, is key. Use the social media platforms yourself. Know how to use each, and when, as is described in Satariano and Wong’s article, Creating an Online Strategy to Enhance Effective Community Building and Organizing, 2012.

Social media is always changing, so it is important to keep with the times. I would argue that many young people no longer use Facebook as is described in the 2012 article, though it still remains a hugely important for those in their mid-twenties and early thirties. Know what platforms are relevant to your audience. Track your analytics.

As long as the internet is safe and free from censorship, social media can be used as an effective social work tool. Using a hashtag to garner interaction, to give those who are impacted by the issue that is being a voice and an opportunity to be part of the conversation, is something that helps a social justice movement succeed. Specifically, this was the case with movements like #BlackLivesMatter, #ICantBreathe, or #YesAllWomen.

I use twitter myself and make sure that posts concerning the freedom of the internet are marked #NetNeutrality. It’s my hope that more people interested in social justice will realize how important Net Neutrality is and do so, too, before America’s internet is boxed in forever.

[Group 4] Anti-Oppressive Social Work Practice / Being an Ally

Q: What are some of your thoughts around Mullaly’s anti-oppressive practices at the personal and cultural levels? How can you apply this to our social work practices and our every day lives?

Some of the anti-oppressive practices that Mullaly suggested be carried out on the personal level included:

  • raising consciousness (raising an oppressed individual’s awareness of the social causes of injustice and oppression; “develop political awareness, self-define a more genuine identity than the one imposed on them by their oppressors, develop the confidence to ‘come out’ and assert their more authentic identity, establish solidarity in order to take action against their oppression”)
  • assisting with the recovery of historical memory (in the words of Aboriginal / feminist activist Lee Miracle: “Before I can understand what independence is, I must break the chains that imprison me in the present, impede my understanding of the past, and blind me to the future.”)
  • linking the personal with the political (“treat public problems belonging to a sociaty characterized by oppression along such lines a classism, sexism, ageism, heterosexism, and racism.”)
  • practicing normalization (“dispel any notion that any particular difficulty an oppressed individual may be experiencing is unique and idiosyncratic to the person only when in fact the difficulty is a logical outcome of oppression being experienced by many members of that subordinate group.”)
  • using redefining and reframing techniques (“personal troubles are redefined in social or political terms, thus providing an alternative explanation. The troubles may be experienced at the personal level, but they come from a particular social and historical context.”)
  • creating dialogue (“uncovering people’s subjective reality and opening it to critical reflections.”)

As as future social worker, it is going to be critical that I am able to not only look at an individual’s problems on a personal level, but also be able to look at the bigger picture to understand how oppression and injustice from the dominant group effect that individual. Helping that individual to also see the big picture is also part of the healing process– while it is also important not to redirect all personal responsibility away from an individual, it is very important to allow an individual see at a systemic level why forces have driven him to arrive at his situation.

Mullaly emphasizes the importance of connecting oppressed individuals to groups of individuals with the same or similar identities, and empowering the individual or group to be the facilitators of their own change, instead of merely changing things for them. If I am able to do this as a social worker, this sometimes this might mean being excluded from the group myself, but I agree that it is important for people in places of power and privilege to allow themselves to be excluded while still remaining available if needed. I may not be welcomed into every space all the time, and that is okay.

Another point that he made that I felt to be important was the “horizontal exchange” (having the client and social worker be on the same level, as opposed to the social worker leading and controlling the conversation) when engaging with a client and having or creating dialogue.

I believe that all of these practices require skill and patience, and I know that I will not get everything right all of the time, but if I am able to incorporate them into personal practice, then I will be a better social worker whose effort, with the effort of others, can have a real impact on changing and healing our society.

Some of the anti-oppressive practices that Mullaly suggested be carried out on the cultural level included:

  • decentering or decanonizing culture (“denouncing all forms of cultural oppression, along with supporting, developing, bringing to light, and celebrating alternative cultures that have been suppressed by the dominant culture.”)
  • resisting (“‘take a stand in position of a belief, an idea, an ideology, a climate, a practice or an action that is oppressive and damaging to an individual as well as social well-being.'”)
  • developing alternative discourse (“be knowledgeable about existing alternative discourses and skilled in analyzing and deconstructing oppressive discourses as well as in developing (or assisting in the development of) alternative discourses”)
  • confronting stereotypes – (“counter negative stereotypes; draw upon or develop positive stereotypes”)
  • challenging the organization – (“assisting service users to navigate the system, promoting empowerment [skills to navigate the system], educating other service providers, educating service users, engaging authentically [creating a safe space for service users]”)

Considering that I decided to enter the field of social work partially because of the political climate and oppression of individuals in this country, I agree with all of the practices that Mullaly suggests in his book.

I will struggle to educate myself to help assist in the development of alternative discourse, just because there are so many different groups in the United States that I have not yet had the pleasure to learn about or try to understand, but as someone who genuinely appreciates learning and education, I believe that I will meet this challenge with an open mind.

My biggest concern comes with challenging the organization, especially since I plan to be working in a hospital setting, which usually equates to working for a large organization.

When working for an organization such as a hospital, I know that some of these practices will take a certain amount of finesse to accomplish without endangering my own employment and career– a thought that is already frustrating as I enter the field of social work.

But I find that especially with building strong connections, challenging the organization is possible. From my experience as an employee within a large hospital system, as I work within an organization as a social worker, I will need to be exceptionally good at my job and finding solutions to problems that are already recognized within the organization, then gradually be able to “push my agenda.” While gradual change can be frustrating, many times in big organizations especially, everything is accomplished in baby steps.

Q: How are these practices and being an ally related? Talk about times when you are an ally and when you haven’t been an ally.

There are many steps to being a good ally, and incorporating all of what is mentioned above is certainly important, but being a good ally really means putting in a lot of effort to assist with making social change.

Using a more bottom-up approach, actually going into a community and finding out what the community’s struggles are and helping to build programs from there, instead of a top-down approach where one studies data and decides what the community’s struggles are tries to “fix the problem” by creating a program oneself, is important.

In one of the video lectures in our online module, Dr. Rogério Pinto talks about his work with those with a history of incarceration and substance abuse, and using art to open up conversation and change social norms regarding those topics. He mentions that there is a struggle with finding grants that match up with community or group needs, and it takes sometimes time and always effort to start up a program, but that these programs tend to produce the best results.

Instead of putting a bandaid over a wound, an ally takes steps to help others repair from within.

Being an ally does not mean being a hero, either. Often the best allies are those who are strong enough to help gather resources, create programs and let the community lead while providing quiet guidance when asked. An ally’s job is to help others claim their voice, not to speak for others.

That being said, stepping back is difficult, especially when one is passionately engaged in wanting to help make a change.

Personally, I have not yet been able to be an “ally” on the level that Mullaly discusses in his work, mostly because I have been struggling a lot with finding my own voice and identity upon my return to the United States. Being aware and comfortable with oneself, I believe, is a quality of a good ally.

So right now, most of my experience as an ally is on a personal level with friends and colleagues, or at work with patients in a very specific way (helping patients to navigate the health system by providing them with information and the tools they need).

In these circumstances, I find that I am the best ally when I can talk things out with others and help them make informed choices. Networking and connecting people to other individuals who are in similar situations is something I try to do when I can, too, but my network isn’t very wide yet.

I hope that as I continue to live and work in the United States, and as I become a Social Worker, I can become a more effective ally.

[Final Project] Representation in Healthcare

For my final project for class, I want to create a Photovoice project that focuses on why representation matters when individuals receive healthcare.

Currently, I am employed at an ambulatory clinic at the University of Michigan. Our clinic is lead by a health care manager and a medical director who both greatly value the hiring of a diverse staff. Some examples of how our clinic is leading the way include: 1. Japanese Family Health Program site (we have three Japanese-speaking providers [PCPs], Japanese-speaking nursing staff, Japanese-speaking MAs, and Japanese speaking clerks). 2. Current creation of Spanish Family Health Program (have recently hired a Spanish-speaking provider). 3. Pilot site for transgender healthcare services.

I will be interviewing and using photos by several providers and other staff members about the reasons that it is important for our clinic to continue to promote social justice in the medical field by having a staff with whom our patients can identify.

When I lived abroad, in a country where I could not speak the language fluently yet, I got sick and had to navigate the healthcare system on my own. I did not have access to doctors who shared my cultural / linguistic background, and even though I was able to carry on daily conversations fluently enough at that time, being alone in the hospital and trying to make sense of what was happening was scary. I had to go to three different hospitals before I received a correct diagnosis– and my illness was something as simple as pneumonia!

As a clerk now for my clinic’s Japanese Family Health Program, I can empathize with how scary trying to navigate America’s complicated healthcare system is for a non-English speaking person who is used to a system which functions very differently.

When people are not comfortable in their doctor’s office, they tend to stop seeking out services, which means that illnesses can go undiagnosed, become out of control, and, in the worse case scenario, lead to untimely death.

Though I am not able to share any patient details, I can say that there have been several patients in our clinic who had previously been seen at doctors offices where their cultural identities were not represented, and were diagnosed immediately with serious health conditions when they came to our office. The fact that our doctors can reach out to people in another language and understand how to connect our healthcare culture to something familiar to patients has literally saved lives.

The Michigan Medicine system as a whole has a lot of areas it could improve on, however. Patients that we diagnose often get sent to specialty doctors within the Michigan Medicine system, and, because Michigan Medicine uses mostly telephone interpreters who are not necessarily medically trained, patients who visit specialties often call our office to try and make sense of what happened at their specialty visit. When they are in the room with the doctor, they do not feel they are able to ask too many questions, which means that crucial information that would help the doctor diagnose a problem can be easily missed.

I hope that my project can show that representation helps our patients live healthier, happier lives.

[Group 4] Discussion of Oppression at the Cultural Level / Microagressions

Strange – How a dreary world can suddenly change
To a world as bright as the evening star
Queer – What a difference when your vision is clear
And you see things as they really are

 

I used to be color-blind
But I met you and now I find
There’s green in the grass
There’s gold in the moon
There’s blue in the skies

I Used to Be Color Blind (Written by Irving Berlin, preformed by Ella Fitzgerald)

 

I think that when someone says they “do not see color,” they are trying to communicate that they do not stereotype or judge a person based off of what their race, cultural, or ethnic background is– that they are accepting of all people, that they are not racist or perpetrators of racist and otherwise oppressive actions.

What the actual implications of treating all people “impartially” however, are quite different.

When someone states that they are colorblind or impartial, really what they are effectively doing is erasing complete facets of the identities of another.  I believe that this is largely unintentional, considering the dominant group in the United States has to taught us that this is an effective way of expressing that one is against racism.

I have vivid memories of my 9th grade civics teacher using the mantra “as human beings we are all the same, do not see others in color, do not use differences to separate yourself from other people.” While I believe that teacher’s heart was in the right place– she wanted all of her students to be friends despite whatever differences we had– it is certainly a harmful frame of mind to have when trying to empathize with someone or to attempt to understand the context in which they are experiencing life.

When I was in 10th grade, I told a very close friend of mine, a friend who is a Latina woman of mixed-race and who spent most of her life in a teeny tiny town where she was the only person of color, that I did not see color. I told her this because it is how I was taught to let her know that I loved her and valued her as a human being.

I remember she looked at me, frowned, and told me, “Erin, that makes me so tired. Please do not ever say that to anyone again.” Sadly, at the time, I didn’t even understand why. I remember feeling angry with her– how dare she think that I thought of her as “different than me” when she was someone who I loved and cared for so deeply. How dare she?

Colorblindness encourages ignorance on the part of the dominant group and erases the experiences of marginalized populations. I was telling my friend that I didn’t care about who she was and that I wanted her to fit into the same mold as I came from– and it took me years to understand how painful and demoralizing having to feel like you must reconstruct who you are as a human being to fit into the dominant group.

When I lived in Japan, I experienced for the first time being part of the non-dominant group. (I will not say that I have ever experienced marginalization, however, because even in Japan, I still carried a certain global privilege for just being white and American.)

cropped-cropped-img_3828.jpg
Three Wise Monkeys” carving detail, taken at Tosho-gu Shrine in Nikko, Japan.

From day one my biggest desire was to fit in. I knew I would never be Japanese– it’s impossible for 外人 (gaijin; foreigner) to ever be considered Japanese. There is no “Japanese dream” comparable to the “American dream” (and I use that term with caution, because I really do believe it is only a dream) that says that immigrants can become acculturated and accepted as a citizen no matter what their ethnic or racial background. In Japan, because of a long tradition of the country being closed to immigrants, you are only Japanese or non-Japanese.

However, I was determined not to be that American– the one that was loud and opinionated, or would scrunch my nose when asked to eat 納豆 (natto; fermented soybeans) or 梅干し (umeboshi; pickled plum), or who was too fat to fit into regular-sized Japanese clothes, or who ate while walking, or who had body odor and a hairy upper lip, or expected everyone to speak English.

Even after ten years of trying every day, of living with a partner who was Japanese, having mostly friends who were Japanese, of living in a neighborhood where I was the only non-Japanese but being welcomed to by people who knew me, of passing the highest level on the national Japanese language fluency test, there was still that pang of shame I felt for not fitting in better, for not being able to be 内 (uchi; an insider).

I saw my differences not only when I looked in the mirror, I felt it when people avoided taking a seat next to me on the train even when I offered it, or when I was checking out at the grocery store and there was that moment of hesitation and flicker of anxiety in the cashier eye’s until I spoke to her in Japanese, or when no stores in the prefecture carried women’s shoes in my size. I felt it when I would be walking home after a long evening at work and men would approach me and ask “how much?” even though I was dressed in the conservative uniform of an Adidas track suit and a schoolteacher’s apron. I felt it when middle and high school kids would run up to me and ask to have their picture with at “real foreigner.”

I felt it when my partner would tell me, “this is the Japanese way. This is the right way.” What was being said to me was it was the only way.

お箸使えますか? (Can you use chopsticks?)
日本語お上手ですね! (You’re so good at speaking Japanese!)
日本人より日本人です! (You’re more Japanese than a Japanese person!)
あら、あなたはやまとなでしこみたいです! (My, you’re just like Yamato Nadeshiko [the personification of the idealized Japanese woman])
鼻高っ! (Your nose is tall! [Because typical Japanese beauty standards indicate that having a flat nose is undesirable])
頭ちっちゃい! (Your head is so small! [Because typical Japanese beauty standards indicate that having a larger head is undesireable])
足長い! (Your legs are so long!)
肌白っ! (Your skin is so white!)

It was demoralizing. I never felt like I was enough. I felt like I was being scrutinized at all times. I felt like almost everything I did was not the right thing.

I say this not because I feel that I was being personally affronted. I say it to put things into perspective for myself.

What I faced is only a tiny fraction of what minorities in the United States are experiencing every day. I never feared for my life. I never felt threatened– the police were never going to come after me with deadly force for being in the wrong place at the wrong time.

Other than a handful of more aggressive situations (usually on the level being told that non-Japanese should get out of Japan by older, drunken men who undoubtedly lived through a time when American soldiers occupied their country) my daily interactions with people were good. For the most part, no one intentionally set out to make me comfortable.

Japan is a beautiful country with a beautifully rich culture and I am so appreciative of the time I was able to spend there.

I am glad for my experience. I realize that this is not an privilege that most people are able to have– to be completely removed from their home culture. I feel that being an “outsider” for all those years has helped me to be a more empathetic person. I hope to use my own past thoughts and feelings in my role as a social worker.

I have to remember that I am never going to be perfect. I am never going to perfectly know any culture but my own. But I can be aware that people come from different backgrounds, try and understand the culture and context in which a person is experiencing life, be empathetic, and make approach problems and make decisions as a social worker that are not “blanket” solutions.

No matter what our best intentions, because of stereotypes and indoctrinated “common knowledge” we will all make mistakes and missteps. We will all have times when we unintentionally say or do something that is a microaggression. Apologizing for and reflecting on our mistakes is how we grow as social workers and as human beings.

I was thinking the other day at work, where the population is very diverse, about the effects of sneezing. In Japan, rarely anything is said after someone sneezes. (If it’s particularly bad, someone may ask “are you okay?”) Of course, in the United States, we usually say “bless you” and in some areas “gesundheit.”

Is saying “bless you” a bite-sized form of a larger Christian bias and cultural oppression in the American culture? Is it appropriate to say to someone who comes from a different religious background? I don’t personally even identify as a Christian, and yet in most cases this is how I respond after someone sneezes.

When I am being more mindful, I try and use gesundheit, as it literally means “health” in German and I don’t believe it carries any religious connotations, but not everyone knows what that means. Is using that word being elitist and Euro-centric? In the United States, if I don’t say anything at all, would it feel like I wasn’t sympathetic?

It is interesting to think about.

 

[On a side note, many of you are may not particularly interested about the experiences of Non-Japanese people in Japan, but for the past five-or-so years, the topic of microaggressions has been very much on the tongues of long term Non-Japanese residents in Japan. Debito Arudou is a non-native-Japanese citizen of Japan and is somewhat a forerunner in these discussions. While I personally take contest with the fact that Debito refuses to acknowledge his own white, male privilege, I will link the article that started up the discussions that was published in the Japan Times back in 2012: Yes, I can use chopsticks: the everyday ‘microaggressions’ that grind us down.)

【自己紹介】Mo’olele

Hi! I’m Erin L., and I am a teacher and a learner in this world. Let’s start with the easy stuff: I am a non-traditional student at age 33, am strongly bilingual (and not so strongly multilingual), and I am happy to be here.

I was born at an Ann Arbor university, started working for the same Ann Arbor university two years ago, and now am starting graduate school at that same university.

I suppose the thing that I want you to know about me is that I spent most of my adult life in Japan (Shiga Prefecture and Saitama Prefecture) teaching 3-year-olds to read, write and sign and riding my bicycle everywhere.

I came back to the States two years ago. I tried out interpreting in the auto industry for a little while and that wasn’t for me, so I got involved in clerical work for a family medicine clinic, where one of my major roles is help coordinate for the Japanese population that our clinic serves. That job decision gave me the direction (and support!) that I needed to get interested in social work and so here I am in Social Work 504 learning about Social Justice and Diversity in Social Work.

 

The title of this blog is Diversity SW”I”SH. It took me forever to think of something that fit me, and it needs a little explaining. SW”I”SH can be broken down in the following way: S(ocial)W(ork)+I+S(hakai)H(oshou). The “Social Work” part is pretty straightforward. “Shakai hoshou (社会保障)” is the Japanese word for social work. In the middle of those is “I.” Or, should I say “I” am in the middle of the English and the Japanese words for social work. I feel like this is represents me in real life, stuck between the cultures of the East and the West.

I hope that made sense…

I am looking forward to getting to know everyone in SW 504!
Let’s have fun learning together this semester.