American Indian Culture and Research Journal

As notions of cultural competency have risen to prominence in health care, some of our most powerful models and strategies come from successful tribal health care. In this chapter, we deconstruct notions of cultural competency, rebuilding this important aspect of medical practice under Bourdieu's model of reflexivity (1986). We outline a critical discourse of cultural competency based on a processual (and distinctively anthropological) model. In promoting several specific strategies for culturally competent care, we point to the assumptions regarding the boundedness and neutrality of culture within biomedical practice as well as the authority and power structures through which competency is determined. We offer two case studies: one, an examination of a community-based ambulatory care practice; the second, a consideration of both practitioners' and institutions' use of cultural capital in addressing the community they serve. We promote a reflexive form of culturally competent care that goes beyond "cookbook" uses of cultural capital to move toward an engaged and structurally flexible approach, one that allows the blending of biomedical paradigms with patient culture and history.