by Kirsten Brown

The son of a coal miner, Richard Greenlee, Ph.D., grew up in Southeastern Ohio in the midst of the Appalachian countryside. Now the chairman of the Ohio University Department of Social Work, he travels across the state of Ohio educating child welfare agencies to the culture of his childhood memories. Similarly, Greenlee will discuss with OU-COM’s future doctors  how to better treat Appalachian patients through a better understanding of their culture in his presentation, “Appalachian Cultural Competence,” Tuesday, April 18, from noon to 1 p.m. in Grosvenor West 111. His presentation is a part of Minority Health Month.

Greenlee cites Daniel G. Bates and Fred Plog’s definition of culture as “the use of shared beliefs, values, customs, behaviors, and artifacts that a member of a society use to cope with their world and with one another, and that are transmitted from generation to generation through learning.”

This definition also specifically applies to Appalachian culture.

“I want to talk about Appalachian beliefs, values, customs and behaviors that are passed down and how Appalachians use them to cope with their world,” he explains.

An Appalachian upbringing also affects attitudes toward professionals, such as medical and counseling professionals.

“I will explain how that affects the way physicians work with Appalachian families,” Greenlee says. “I will talk about the styles of parenting, traditions, the roles that fathers and mothers play and some of the challenges that Appalachian youth face.”

To address this issue, physicians should have a firm appreciation of what cultural competence entails, Greenlee says.

“Cultural competence would be the notion that, first, you have to be self-aware of your own culture and how you interact with others,” he explains. “Everyone comes in with their own cultural perspective. It is important that they understand their own and how that will fit or not fit with other people’s cultural perspective. This enables a professional to demonstrate the skills needed to operate cross-culturally with other individuals and families.”

The manner by which medical professionals work with Appalachian patients can help facilitate or hinder a good working relationship between them, Greenlee says.

“The rapidity of the medical personnel sometimes creates a sense of alienation on the part of the Appalachian,” he says. “The client can feel like they are not being treated like a human being.”

Some Appalachian core cultural values include perspectives on independence, individualism, personalism, familism, a religious world view, neighborliness, a strong sense of place and avoidance of conflict.

One particular relevant example of avoidance of conflict depicts a scenario in which an Appalachian patient outwardly agrees to follow his doctor’s instructions, despite inward reservations. As a result, the Appalachian politely consents but leaves his doctor’s office without any intention of sticking to the prescribed orders.

“So that is a problem, because you think that they are onboard with you,” Greenlee says. “The physician has to create a very trusting relationship in which the patient can tell how he or she really feels.”

To establish this trust, professionals should use certain intervention approaches and practice considerations, Greenlee says.

“In fact, a physician might want to call to check in with the patient and say, ‘Are you sure you really feel comfortable with this? Because you can tell me if you aren’t, and we will work something different out for you,’” Greenlee suggests.

Physicians should also understand the importance of the core value personalism in dealing with their Appalachian patients, Greenlee says.

“If the patient feels like they are just another number, they will not like working with the physician,” he explains, “so I think it is even more important to ask these patients about their personal lives.”

Greenlee currently serves as president of the Ohio chapter of the National Association of Social Workers and served as president of the Tri-County Mental Health and Counseling Services Board from 2001 to 2003. He has received several awards, including the 2004-2005 Presidential Teaching Award and the 2003 Rita Gillick Mental Health Advocate Award. His research interests range from rural poverty and communities to substance abuse and mental health.

Drawing from this extensive research, Greenlee’s lecture will shed some light on the strengths and stereotypes surrounding the culture of the Appalachia.

“There are unfortunately a lot of negative stereotypes,” he says. “So I will spend a lot of time trying to get people to walk in the shoes of Appalachian people.”

The Minority Health Month series continues April 26 with Cora Munoz, Ph.D., Department of Nursing at Capital University. The final speaker in the series will be Ronald Myers, M.D., founder, president and medical director of Myers Foundation Christian Family Health Centers. Myers will present “The Challenge of Providing Health Care to the Poor” April 28.