Introduction

Is it possible to heal, sustain, or guide the soul and spirit of persons whose culture and world view is different from my own? This has been the theme of most of my professional endeavors.

I lived in an intercultural context for fifteen years in Bangladesh, India, and Thailand. When I came back to graduate school, my clinical work was done in the University of Louisville in Louisville, Kentucky. I focused on families of African American trauma patients. With the help of African and African American pastors we surveyed eight families. I had been the chaplain for these families while their loved-one was in our trauma center. Out of this study we found six principles effective for meeting the spiritual needs of most African Americans. The principles provide understanding and guidance in a time of crisis. They are misapplied as a technique only.

Using "hindsight" over the past ten years I see there is something more important than techniques or cultural specifics. It is internal qualities of the caregiver and the receiver, which make it possible for intimacy and spiritual care to happen.

Principles

Here are the six principles:

1. Guiding effective intercultural care with African American families demands understanding how they make value judgements. Some cultures decide their values based on whether something is "good or bad". Other cultural groups base their judgements on their view that something is "right or wrong". African Americans use both of these, but their main approach to value judgements is based on the question, "Is it fitting?" If they are faced with the question of donating organs the question usually arises, "Does this fit our family; our culture?" When a family decides to withdraw care, their approach will be, "are we taking away our loved-one's opportunity to come out of the coma?" The concept of "fit" has allowed many African Americans to improvise, adapt, and sustain themselves through almost two centuries of marginization and oppression. The spiritual care giver must understand the strengths and process of this value system.

2. Spiritual writings, sayings, and motifs percolate through African American neighborhoods. These may take the form of "street proverbs", scriptures, and sayings, which reflect the bedrock attitudes, core beliefs, or functional worldview of African American clients. The belief that whatever crisis comes can be dealt with is reflected in the proverb that the creator "will not put any more on us than we can bear." This is further expressed when a family member says, "God is in charge; He will work everything out for the good." A case in point is a burn patient who was told the doctors would have to remove her leg to save her life. She responded, "Try to save the leg for God will make a way." She clung to "God will make a way" for the four days of crisis. In her belief, she found strength to endure until the leg was salvaged.

"What goes around comes around," is another motif communicating street wisdom that God places a limit on injustice. Justice will eventually prevail because the Creator is just. Equality of all people is expressed in the motif of the brotherhood or sisterhood of all people. It is of no surprise that the emphasis on community and brotherhood is a strength of African American Muslims and Christians alike. Equality is expressed in the street saying, "No big I, no little you."

Life is full of suffering but trouble doesn't always last, because life and creation are viewed as good. For that reason the African American community sees itself as gracious, celebrative, and worthy of respect.

3. Use familiar religious ritual, such as prayer, with African Americans. This helps comfort. A referral may be made for this to happen. Prayers can be based on the above scriptural images or on a "street theology" commonly voiced in proverbs: "God knows and cares." "God will not put any more on us than we can bear." "We are passing through." "We will overcome." "We are one family."

4. The family structure of African Americans includes numerous relatives. Practicing care out of an awareness of the extended family is the fourth principle for spiritual care. Often in health care our approach is only to include the immediate next of kin. Siblings, parent's siblings, local church leaders, and childhood "friends" often are related closely in a culture which uses the extended family system. It is imperative that caregivers respect and acknowledge those whom the client counts as relatives. An African American family's channel of authority may extend through several households to the outside community. It is important for the persons offering spiritual care to a family to learn the strengths and character of the extended family. The strengths of the extended family, which I have observed, include:

• The division of labor occurs along generational lines.

• Personal needs are met by a larger group and lowers demands on the spouse.

• Decision making authority is not based in the marriage but on a dominant pair of respected individuals such as the grandmother and her oldest son, resulting in less conflict in the marriage over major decisions.

• Conflict is managed also by respected persons in the extended family.

• Married couples are not isolated individuals. They find identity and welcome intervention by a family community in troubled times. They do not respond well to attempts at beginning support groups, probably because the extended family provides the support which is needed.

5. Making referrals is the fifth principle of intercultural care. In a case with a single mother of a high school student who was a pedestrian struck by an automobile, I inquired about a pastor or community leader who needed to be informed. I assisted in contacting the pastor. This made providing care for her an intercommunity and interdisciplinary effort. I was not alone in caring for her. I gained credibility with her community. The referral acted as a catalyst for mobilizing multiple resources in and out of the hospital. Since that case, part of my assessment with a family is to talk about their community and the spiritual leaders available in the community for them to call or for me to make a referral.

6. The sixth principle is that communication begun in a crisis creates opportunities for intimacy and close friendships sometimes referred to as "follow-up." When I have become a part of their community, I am counted as a friend for the weeks following the crisis. With a few families, I have been privileged to be counted as a brother. I continue to be available to walk with them during the recovery and transition.

Reflection

After ten years working with these principles I have concluded that the attitude of the caregiver is more important than techniques. First, we need to ask if the caregiver actually cares. Care means treating another person as we want to be treated. I experience compassion fatigue at times. Some individuals strike me negatively. In an intercultural case we deal with our own ethnic pride ahead of time. We deliberately seek to be aware of biases and prejudice. In short the ability to care not only means being aware of the other person but also includes self-awareness.

Second, the person offering care needs the ability to be holistically "present." The spirit, emotion, intellect, and physical presence are all engaged. Many of the students whom I mentor agitate for the "right question,"" the right words," or the appropriate scripture responding to each circumstance rather than actively listening to the other person. Part of training for "presence" is tuning one's intuition to focus on the other person.

Third, as care givers we need to be nurturing our own spirits. If our spiritual well runs dry, where will the water come for others? Spiritual self-nurture means paying attention; we attend to the inner life, live simply, attend to each moment of the day, and attend to relationships we value most, pray and meditate with a mind tuned to the Creator. To assist someone of another culture to come through a crisis to maturity and spiritual growth, I must be aware of my own struggle for wholeness of spirit.

An editorial postscript:

We wish to enrich the context out of which Chaplain Kirkpatrick calls us to nurture "internal qualities" for offering spiritual care. With his permission, we share his prayer, dated October 11, 1999.

A Prayer: Two Weeks After Diagnosis

Thank-You Lord for my Parkinson's Disease

It is bringing me to a clarity of spirit.

Suddenly petty things trouble me little.

Other person's suffering is understandable.

It is as though you opened a well of compassion within me.

I thank you for the desire to simplify my life.

Help me dispose of the clutter of non-essentials in my

Life.

Teach me to praise you for each precious day in

Which I can still communicate LOVE and receive LOVE.

I now appreciate being still. You have slowed me down.

Thanks for being able to talk. My voice may give out tomorrow.

I'm glad I can still write - even in small spaces.

I'm thankful I can walk - even though I stumble.

You continue to give me clarity of mind, at least I think so.

You have returned music to my soul.

You make me treasure those who care for me.

You have caused me to live one day at a time while

being aware that I may have twenty years of life to

fill with meaning.

Thanks for my army of researchers and physicians who

are battling for my future. Give them inspiration,

wisdom, and results.

Thanks for my fellow Parkinson's pilgrims who offer

encouragement and advice.

Thanks God, for my Parkinson's

that makes me more aware of life.

Thanks God for being here for me.

(O God, it would have been nice if I could have become this without the Parkinson's.)

AMEN

-- Thomas Kirkpatrick 10/11/99

References

Augsburger, David W. Pastoral counseling across cultures. Philadelphia: The Westminster Press, 1986.

Imperative reading for any serious scholar or student of Cross-Cultural studies, particularly for those interested in the spirituality of other people groups. Augsburger worked for thirteen years with an international mission board, traveling, consulting and working in at least fourteen countries in the third-world. He is now Professor of Pastoral Counseling at Fuller Theological Seminary. He successfully pulls together insights from psychology, cultural anthropology, theology, and psychotherapy. He sets each major discussion in context of an international folk story. This book challenges care-givers to balance their understanding of spirituality, theory of families, world view and counseling theory -- creating "radically varied forms of care-giving."

Mitchell, Henry H. & Cooper-Lewter, Nicholas. Soul theology: The heart of american black culture. San Francisco: Harper & Row, 1986.

I love this book. Henry Mitchell, a trained theologian, professor and dean of the School of Theology of Virginia Union University has formed an interdisciplinary team with psychotherapist, Nicholas Cooper-Lewter, to share how African Americans' core beliefs/common sense spirituality sustain them in overwhelming stresses. For those of us who deal with families in physical, emotional, or spiritual crises, this book has a lot to teach us about how an individual's value system and view of the world affects their ability to sustain quality of life in anxiety producing circumstances.

Culminates ten years of research in which Mitchell led teams of students to survey the common conversations in the streets and shops in the African American community for the core beliefs and wisdom sayings of "ordinary folk" The first section of each chapter discusses a single such idea. The second part of the chapter gives three or four case studies from a therapy setting. The point is to consider the "nourishing spirituality" of folk faith.

Van Beek, Aart M. Cross-cultural counseling. Minneapolis: Fortress Press, 1996.

A good start for anyone beginning counseling people of other cultures. Van Beek draws on his experiences in many cultures to present cases illustrating each concept and counseling issue. The author is of Dutch extraction, educated in the United States, and is presently professor of Pastoral Care and Counseling in Jakarta, Indonesia. He challenges us to integrate the world view of our clients into our counseling.