Getting acquainted with your client
This is a topic on which I can only advise you and share my experiences
working with people new to the United States. I come from very European lineage
- English, Irish, and Welsh. I have a very colleen face and the red hair of my
The best thing I can tell you about working with people with visual impairments who come from other countries is to not make assumptions. Each culture has its own attitudes towards disability and blindness. As I said in one of my early lectures in some cultures visual impairment does not have the stigma it does here in America. In other countries people who are blind are shunned. Some of this generates from religious views and some of it has to do with how the society's culture is structured.
In either Mexico or Spain (I think it's Spain) people with visual impairments control the gambling industry. This is a source of income, which maintains the blind citizens of the country and is a very defined role for blind people. Other places expect blind people to become massage therapists. Every culture has its own way of addressing the disability of visual impairment.
When assessing the self-esteem of a person from another culture you will have
to take his or her social relationships into consideration. It is o.k. If you
don't know anything about the culture, but if you don't know how the social
roles are established in a given cultural group you will be better off if you
spend some time learning what are the acceptable social roles in the culture of
When visiting a client and his or her family for the first time it is always a good idea to dress very conservatively. This is particularly true for us women. Long sleeve blouses and dresses or skirts below our knees can help a lot to show respect in the household of your client from another culture. I don't want you to go against whom you really are, but covering your arms and legs can help open communication a lot of the time.Most of the time families from other countries and cultures don't expect that you know what is appropriate. If you communicatethat you want to be respectful and honor the family's societal norms you may be accepted more easily.
One of the biggest issues TVIs and O/M counselors face when working with
someone from another country (after the possible language differences) is
determining what an appropriate rehabilitation plan of action is. A man from a
culture where his sense of personal pride is tied to his sense of independence
may not be responsive to a woman teaching him personal life skills because of
the social roles women hold in his culture.
A woman from a country where females do not work outside the home will not necessarily do well mastering employment skills and may resist mobility lessons, which would allow her to leave her home. Some cultures expect blind people to remain at home out of sight and suggesting that an individual learn how to cane travel may not be greeted with enthusiasm.
Rehabilitation professionals can get very frustrated when they feel that their efforts toward rehabilitation are being resisted. This is where you have to discern when a person is resisting learning something which will help foster their adjustment to blindness or if what you are asking is offensive to them culturally.
Here are some general things for you to consider when meeting with a client from another culture. How does your client think about time? In some countries showing up for a 10:00 a.m. appointment means that they may arrive at noon. They are not deliberately choosing to be late to your meeting. It is just that in their culture time is not assessed the same way it is here in the United States.
Also in many cultures it is not polite to discuss money. If you have to discuss money you may want to feel out the family members and suggest that you meet privately with whichever family member is responsible for the family's finances. Money is a touchy issue for several reasons and it is important to be careful about talking about it. Also some of your clients will have family members who are in the United States illegally. This comes up a lot when the parents of a visually impaired child are here illegally, but their child was born here and is entitled to receive your services. Just know that the child is entitled to services and you can provide them for the youngster in ways, which do not affect the parents.
Even family members who are here legally may not understand your role in your client's rehabilitation. You may get some nervous questions about where the information they give you will be sent. This has to do with a concern about reporting the information you gather to government agencies such as the I.N.S or the Social Security Administration.
Illegal aliens receiving rehabilitation services Another thing, which may be helpful for you to know, is that someone from another culture who does not have a green card can receive rehabilitation services from most state agencies. They are not eligible for vocational counseling, but the rehab. Services are possible. A lot of people don't know this when they haven't been living here very long. If your agency employs language interpreters you can ask the person you are working with for any pointers he or she may have about how to communicate with your client or your client's family. If there is no interpreter often a family member is recruited to do the translating.
I have never had to work with a family member, but what I have been told is that it is often difficult to work with a family member because the person interpreting may be translating through his or her own agenda. I don't know how true that really is, but the catch for you is that if you don't speak the language of your client you can't assess how well what you are discussing is being communicated. It also helps a lot to learn a few phrases in the language of the people you are seeing. I usually learn how to say hello, thank you, and my name in their language. I also learn to say that I only speak English. I do this when I travel to other countries and it works well.
Physical touching is another area where you want to be conscious of the social code. I notice this a lot when I shop in smaller stores, which are owned by people from other countries. Since I request assistance in these stores I often find that I want to be very sure I am touching a man or woman respectfully when I am going sighted guide with them. I also alter how I hold someone's arm depending on my instincts on how comfortable the person is with me. . Most of the time someone in the shop is assigned to me and I try to get to the store when I know the individual is working.
A lot of the time the men in the store speak better English than the women so a man often helps me. If I am in a grocery store I usually suggest that I hold the back of a shopping cart so that the man doesn't have to go sighted guide with me. If it is the kind of store where I want to go sighted guide I explain what I want to the manager and some kind of agreement is made to assist me. It may be that I stay in one place and have the items brought to me instead of going around the store.
In some cultures men are not to touch women they are not related to whether the woman is sighted or not. You will run into this in some form in your work particularly if you are training to be an O/M instructor.
I think the easiest way to get acquainted with your client and his or her
family is by making the initial visits in teams. A male and female team is best
if you can find a colleague to go with you. Once you get to know the family
system you can go back by yourself more easily.
The reason I keep mentioning the family is because in many cultures an individual may not be in charge of decision-making for him or herself. There may be a patriarch or matriarch who makes the decisions for the younger members of the families. This is a very different system than we use here, but it is how a lot of family units operate. Also remember that there are many families born here in the U.S. who operate in the same system, so don't assume that if the family is American that your client will be making decisions.
If there is a family decision-maker you can get your points across by addressing your comments to both your client and the family head. Another thing to be mindful of when you are meeting with clients is that eating and gift giving may be part of the culture he or she is from. Hospitality is very much a part of many cultures and no business is conducted without eating first. If you are offered something that doesn't look very appealing at least take a bite if you can. To outright refuse may be insulting. Gift giving is a little harder for us to address since we usually do not accept gifts. Some cultures regard gift giving to be both a sign of respect and also may allow your client to accept your services more easily. They can receive services because they have exchanged something with you.
There are also cultures were services are not provided unless some sort of bribe has been offered. Please don't take this personally if you feel that is what is going on. Just remember that your client comes from a very different culture than you do and his or her survival depended on bribes where they come from. Use your judgment when accepting the gift.
Also if you feel thwarted in your efforts to provide services it may be because the people you are dealing with have an existing system for caring for their disabled members. In some cultures it is not acceptable to turn the care of a family member over to an external institution like vision services. Turning someone's care over to you may be regarded as shameful because it would be seen as the family not living up to its responsibility. In this kind of case what you can do is offer assistance to the family in providing adaptive aids and other services. That may be as far as you get in rehabilitating your client. If you are having a really hard time working with your client and his or her family the last thing you can do is contact one of the client's community leaders.
This could be a religious leader or the head of the local immigration agency. Most groups of immigrants settling in New England form associations to support re-settlement. By contacting a community leader you can get information on how to approach the client or the family as well as possible assistance. At least you will get clear information on whether or not to pursue your rehabilitation goals.
The last thing I want to alert you to is how the phrase, "vision rehabilitation" may be heard by people from other countries. Vision Rehabilitation is a misnomer. It sounds like people can get their sight back and sometimes they do, but we understand it more to mean that someone will become adjusted to their remaining visual impairment. I have had people from other countries say to me that they know a community member will never be sighted again so they will not apply for services. This kind of literal understanding of the phrase should always be kept in mind so that you can be sure the people you are speaking with understand what vision rehabilitation is.