UpDate - Vol. 15, No. 10, Page 6
November 2, 1995
Larry Purnell examines health care during his travels

     The world is Larry Purnell's textbook, and he has learned how
other people live, how other cultures function and how health care
varies through firsthand observation from South America and Africa and
to Europe and Asia.
     Wherever his travels take him, he visits clinics and hospitals,
both formally and informally, and observes how culture affects the
practice of medicine and nursing.
     As a result of his worldwide travels, the associate professor of
nursing, whose fields are emergency care and administration, has
developed an expertise in transcultural nursing and is involved in
helping health care professionals understand, appreciate and deal with
cultural differences in patients.
     Because of his interest in transcultural nursing, Purnell, who is
a member of the Transcultural Nursing Society, was invited to present
a paper on the topic in Zhuhai, China, this past summer.
     "It was adventurous visiting China as an independent tourist," he
recalled.
     Even getting a visa was a cliffhanger, he said, as it did not
arrive until two days before his scheduled departure. His itinerary
had to spelled out in detail in advance: "No hotel, no visa," he said.
     His first stop was Beijing, where he visited former UD nursing
faculty member Linda Matocha, who is now teaching at Beijing Medical
University, and her husband. "That part was easy," he said. "I had a
driver, interpreter and got around easily."
     During his stay he gave a lecture on emergency triage to the
faculty of Beijing Medical University and went on clinical rounds with
students, nurses, physicians and faculty, visiting the intensive care,
surgical and medical units.
     Chinese medicine combines Western medicine with practices that
have been ongoing for centuries, such as acupuncture, herbal therapy,
acupressure (massage) and moxibustion where hot metal cups are applied
to the body to draw out excess heat, Purnell said.
     Visiting Xian, site of the famed terra-cotta warriors that have
recently been excavated, and Guangzhou in southern China was more of a
challenge than visiting Beijing, Purnell said.
     "They don't list flights in the airports, so I would read
people's tickets and if they were like mine, I followed them to the
plane. It worked.
     "At the hotels, only a few of the staff spoke English. They would
write down in Chinese where I was going, but then the trick was to
find someone who could read.
     "If that didn't work, I showed people pictures of what I wanted
to see, and they gave me directions through sign language and
gestures," he recalled.
     Purnell took buses to the country, carefully noting their Chinese
number and location so that he could catch the bus back again.
"Legally, as a foreigner, I was supposed to stay in the city limits,"
he said, "but I wanted to see the countryside and how people lived,
and buses provided that opportunity."
     In general, Purnell said he found everyone friendly and helpful
although the police watched him carefully and occasionally stopped
him.
      His last stop was Zhuhai, for the conference which included an
international group of 400 physicians and nurses, mostly Chinese, but
others representing 15 countries from Europe, Asia and North America.
     Purnell's current project is a textbook, Transcultural Health
Care: A Culturally Competent Approach, which he is editing with Betty
Paulanka, dean of nursing. Publication is scheduled in 1996.
     The focus of the book is a diagram, "Purnell's Model for Cultural
Competence." The model is a circle, with the outlying rim "community,"
followed by another rim "family" followed by an inner rim named
"person."
     The interior of the circle is cut into 12 pie-shaped wedges
dealing with such issues as nutrition, death, pregnancy, high-risk
behaviors and family organization, which all societies and humans
share.
     For example, in the field of nutrition, it is important for
health-care professionals to understand different ethnic groups,
Purnell said. When a physician prescribes a special diet for diabetes,
the dietitian should develop a diet that adapts to the client's
cultural and religious backgrounds. "People whose heritage is Jewish,
Asian or Hispanic eat quite different foods, and if this is not taken
into consideration, the patient frequently will not follow the diet,"
Purnell said.
     The book has chapters written by representatives from different
cultures that address these common concerns. Purnell is writing the
chapters on Appalachian residents, Mexican Americans and Italian
Americans.
     In the meantime, Purnell's travels continue.
     His next journey is to Australia in February, to present a paper
on his model for cultural competence at the International Images of
Health multidisciplinary conference. He is familiar with Australia,
having visited there in 1992-93 to conduct research on emergency care
and to serve as a consultant on emergency triage.
     Purnell, a member of the UD faculty since 1988, received his
B.S.N. from Kent State University, his M.S.N. from Rush University and
his Ph.D. in health services administration from Columbia Pacific
University.
                                                   -Sue Swyers Moncure