'The+Truth+Hurts'+Intercultural+Perspective+of+the+Administration+of+Pain+Relief


 * Name:** Jake Gage
 * Student Number:** n8311871
 * Tutorial/Time:** Katie Page Friday 11am-12pm

Are we as a part of Western Culture too quick when it comes to administering these prescription Drugs? Why are Collectivist cultures more reluctant to administer pain relieving medication? What can be done to tackle the barrier of inequality amongst patients from different cultural backgrounds?

**Public Health Issue:**
It is of no surprise that there are distinct intercultural differences in the expression and relief of pain across different cultural backgrounds, however it seems that Western cultures are far more likely to administer pain relieving medication and in much higher doses. This becomes an issue as Australia being a nation with a vast number of different cultural backgrounds, increases the likelihood of intercultural communication between patients and primary emergency services. With medical services within Western culture so quick to administer pain relieving medication whether it is during labour, for treatment of burns or treatment for trauma, it is inevitable that certain barriers will arise creating an unideal environment between patients and medical service providers across different cultural backgrounds. .

**Cultural Artefact:**
The chosen artefact is a piece of work that demonstrates how individuals within society are having their bodies filled with prescription drugs and other pills. The artwork clearly shows a person made entirely of prescriptive pills ready to ingest yet another dose of medication. The painting portrays an ugly truth within Western culture that there is a prescription pill for everything from antidepressants for mental health to a number of prescription drugs for a migraine and muscle soreness. This artefact also demonstrates how in Western culture people are encouraged to accept pain relieving medication which is not the case in many other cultures.

**Analysis of Cultural Artefact:** This artefact represents the views of Western Culture and reinforces the idea that it has become a normality to ingest pain relieving medication at the slightest sign of a migraine or mild muscle soreness. These drugs were originally designed to aid society in coping with pain, however it appears that Western society is becoming more and more dependent upon medication and medical service providers are now administering powerful pain relieving medication at far higher doses than many other cultures around the world. This is contributing to a number of barriers which are arising between intercultural communication between patients and medical service providers. As different cultures perceive and express pain in a variety of ways medical service providers need to be aware of these cultural differences so that they are able to examine and treat the pain more accurately while maintaining equality among patients. Equally it may not be culturally accepted to administer pain relief in certain situations and this may lead to barriers between doctor patient relationships. This is evident as medical service providers in Western cultures are far more likely to administer pain relief and in much higher doses. Overall this is resulting in cultural inequality amongst patients from different cultural backgrounds to their medical service provider.

**Literature Review:** Intercultural differences in relation to the administration and treatment of those in pain can differ substantially. Within Australia alone there are a number of cultures who experience and express pain in various ways. It is therefore essential that medical service providers are made aware of these social differences and are able to effectively examine and treat patients offering alternative treatments for those who may be culturally obligated to refuse medical treatment. Refusal often occurs as a result of deeper spiritual and religious beliefs that need to be understood (Sullivan, 2003). It is also important to note that the treatment of pain in not limited to physical discomfort but also includes mental health such as trauma or even spirituality and medical service providers need to be informed on how to deal with patients from a variety of cultural backgrounds. It is also evident that the expression of pain can be greatly diverse across different cultural backgrounds, thus creating another barrier between patients and medical service providers, which is why the administration of pain relieving medication must be handled with extreme care.

There are many ways in which pain can be administered depending upon different cultural backgrounds and beliefs. For example many Australian Indigenous populations still hold traditional spiritual values passed down from their ancestors. These spiritual values are considered highly important to the health and wellbeing of an individual. Therefore an individual of Indigenous Australian heritage may refer to illness or pain where there is an imbalance of their spiritual state, connection with their land or their kin (Fenwick 2006). Equally a person of Indigenous Australian background may associate pain with emotionally traumatic events such as the stolen generation (Fenwick, 2006). It is therefore evident that pain can be expressed in a variety ways and it is important for medical service providers to take the time to closely examine each patient which may require intercultural understanding when dealing with patients from different cultural backgrounds.

There are also a variety of cultural customs which depict the way in which pain is to be expressed by different individuals in certain situations. In Middle Eastern culture it is socially required for a woman to vocally express her pain during childbirth even if it is not a reflection of the pain she is experiencing (Birth, 2009). This is considered to be normality in Middle Eastern culture as the women is to demonstrate the pain she is experiencing so that she can be supported through the process of giving birth. This is substantially different in Japanese and Bedouin culture where the woman is to show as little emotion as possible despite experiencing high levels of pain and discomfort (Briggs, 2008). Equally a study of African American, Irish, Italian, Jewish and Puerto Rican patients in response to facial pain found that there were significant differences in the way in which these patients expressed their pain (Lasch, 2002). Therefore it is a necessity that medical practitioners have adequate knowledge of different cultural customs, which will assist in administering an acceptable dose of pain reliving medication to each individual patient.

Medical service providers should also exercise caution when administering pain relief as certain religions including Christianity may advise against the use of pain relief in certain situations. Certain religions including Christianity advise against the use of pain reliving medication during childbirth as it is seen as a natural process the way God intended it (Birth, 2009). Other religions such as Hinduism may see pain and suffering as a positive outcome as it leads to progress upon their spiritual path. Some followers of Hinduism may embrace pain and suffering as a test from the ultimate God to both learn and understand the concepts of attachment and detachment (Sarah & Whitman, 2007). Hinduism suggests that pain and suffering is a form of karma from the ultimate God for inappropriate actions in either the present or past life and that to truly achieve detachment one must not seek immediate pain relief as ones goal should be to become neutral in the face of either outcome (Sarah & Whitman, 2007). It is imperative that medical service providers are aware these religious beliefs so that they are able to treat their patients effectively while limiting any emotional or spiritual distress.

There are also distinct differences in the perception and response to physical pain across cultures which are contributing to an inconsistent administration in certain types of pain relieving medication. A study of femoral fractures in patients of two US hospitals and three comparable Vietnamese hospitals found that patients in Vietnamese hospitalised received a far lesser dosage of morphine than their US counterparts (Lasch, 2002). Vietnamese patients received a dosage of 0.9mg on average compared with 30.2mg in the average US hospital. More intriguing was the fact that only 8% of Vietnamese patients reported having received inadequate pain relieving medication in comparison to 80% of American patients. This highlights a drastic difference in treatment and relief of pain between Western cultures and collectivist cultures such as Vietnam and reinforces the importance placed upon medical service providers to assess and accurately administer pain reliving medication.

It is also important to note the differences in preferred coping techniques when addressing physical pain. A study of African Americans and Caucasian patients of rheumatoid arthritis found that African American patients were more likely to employ such coping techniques as praying, hoping and distracting themselves from their pain, while Caucasians were more likely to simply try to ignore the pain and discomfort (Lasch, 2002). It is also evident that some patients who have an Indian cultural background may be more likely to employ such techniques as prayer, meditation and yoga to assist in achieving detachment (Sarah & Whitman, 2007). Overall it is evident that each individual will employ their own set of coping techniques to help deal with painful situations and it is the role of the medical service provider to assist their patients in coping with their pain the best way they can.

Overall pain is subjective and it can be difficult to accurately diagnose the level of pain an individual is experiencing especially when dealing across a cultural barrier. Considering pain can be expressed in various ways it depends on the interpretation and diagnoses of the medical service provider to identify and treat the pain as accurately as possible. Therefore it is imperative that the primary emergency service providers must be informed on how different cultures express and relieve pain if they are to accurately identify and treat patients across a cultural barrier.

**Cultural and Social Analysis:**
As countries such as Australia become more multicultural the need for medical service providers to have an in depth knowledge of different cultural backgrounds continues to grow. When administering pain relieving medication medical service providers need to be educated in both intercultural communication and understanding. As pain is both expressed and treated in various ways across different cultures it is imperative that medical service providers develop a vast array of skills. These skills will enable medical service providers to both diagnose and administer pain relief to their patients while having a thorough understanding on how to remove any potential barriers in cross-cultural communication and treatment.

In order to tackle the barriers in cross-cultural communication and treatment of patients in pain, medical service providers must be trained to have an in depth knowledge and understanding of a vast array of cultural backgrounds (Weissman, Gordon & Bidar-Sielaff, 2002). Although basic cross-cultural communication in required in order to diagnose and treat patients from different cultural backgrounds, a greater depth of knowledge and a well developed skillset will assure an ideal supportive environment for patients of different cultural backgrounds. At present barriers involving cross-cultural treatment and understanding of pain is a major concern within Australia. Considering that medical technology is advancing at a rapid rate, it is up to the skillset of the medical service providers to tackle these barriers. This may require offering alternate medical assistance and pain relieving therapies for individuals of different cultural backgrounds or religion.

In order to establish a strong supportive environment for patients and address any barriers resulting from inadequate pain management, medical service providers must be culturally competent. Though having an in depth knowledge of a vast array of cultural backgrounds will assist in relieving any inequality of cross-cultural pain management, it is still important for medical service providers not to become too generalised in their assumptions of an individual’s culture and expression of pain (Weissman, et al, 2002). General assumptions of a cultures expression to pain may create another barrier preventing ideal practice where patients may not be receiving the same quality of care as individuals who share a common cultural background with their medical service provider. Equally to achieve culturally safe practices it is important that the health care provider is able to establish trust within this relationship (Fenwick, 2006). Therefore to challenge these barriers of inequality communication between patients and medical service providers must be strong and ideally patients should have access to medical personal who share a common cultural background as themselves

Overall the degree of inequality experienced by various cultural backgrounds within Australia is of a grave concern. It is imperative that these barriers of inequality are addressed so that the patients will be exposed to ideal public practice. Equally if these barriers of inequality of cross-cultural treatment between patients and their medical service providers are not removed and ideal practices are not met we will continue to see a decline in patient satisfaction and the outcomes of this would be severe. It is crucial that patients and medical service providers of Australia lead the revolution of addressing these inequalities and removing these barriers creating and ideal environment for all Australians regardless of their cultural background and beliefs.

media type="youtube" key="rutaQT7xukc" height="251" width="448" align="center"
 * Be Part of the Revolution **

View the entire video at: @http://www.zocalopublicsquare.org/

**Wiki Reflections:**
**Wiki Page:** Cultural Sensitivity, can health services 'feel'? **Discussion Title:** A great insight into the importance of Cultural Communication I found your article provided great insight into the importance of cross-cultural communication between patients and medical services as well as the need to tackle the barriers of inequality in regards to treatment of different cultural backgrounds. I agree with your stance on introducing a greater variety of courses into the curriculum for health care professionals and believe incorporating a larger diversity of health care professionals from different cultural backgrounds may also assist in tackling the barriers of cross-cultural communication. Overall I thoroughly enjoyed your article.
 * Comment:**

http://healthculturesociety.wikispaces.com/message/view/+Cultural+Sensitivity%2C+can+health+services+%27feel%27%3F/45605660
 * Link:**

**Wiki Page:** Anything you can do, I can do BETTER! **Discussion Title:** Interesting Article I found your article interesting as it provided a number of different views on the topic of the inequality of women in sport. The artefact you used was a clever inclusion and provided a great basis for your argument. Although I do not entirely agree that women should receive the same degree of media coverage as their male counterparts, due to current social views and spectator interest I do see the significant advantages for increased media coverage of female athletes and the effect this would have on the female population. I also found it frustrating the thought that Australia was losing female athletes to other Nations due to more lucrative sporting contracts and this is definitely something that needs to be addressed. Overall I thought your article was interesting and well written. . http://healthculturesociety.wikispaces.com/message/view/Anything+you+can+do%2C+I+can+do+BETTER!/45667142
 * Comment:**
 * Link:**

Sullivan, M. (2003). Spirituality and Voluntary Pain. Retrieved October 11, 2011 from []
 * References**

Fenwick, C. (2006). Assessing Pain Across a Cultural Gap. Retrieved October 9, 2011 from []

Birth. (2009). Cultural and Religious Beliefs. Retrieved October 11, 2011 from []

Briggs, E. (2008). Cultural Perspectives on Pain Management. Retrieved October 11, 2011 from []

Lasch, K. (2002). Culture and Pain. Retrieved October 9, 2011 from []

Sarah, M., & Whitman, M.D. (2007). Pain and Suffering as Viewed by Hindu Religion. Retrieved October 14, 2011 from []

Weissman, D., Gordon, D., & Bidar-Sielaff, S. (2002). Cultural Aspects of Pain Management. Retrieved October 28, 2011 from []

**Cultural Artefact:** The chosen artefact is a piece of work that demonstrates how individuals within society are filling their bodies with prescription drugs and other pills. The artwork clearly shows a person made entirely of prescriptive pills ready in ingest yet another dose of medication. The painting portrays an ugly truth within Western culture that there is a prescription pill for everything from antidepressants for mental health to a number of prescription drugs for a migraine and muscle soreness and how in Western culture people are encouraged to load up on medication to relieve their pain and discomfort. **Analysis of Cultural Artefact:** This artefact represents the views of Western Culture and reinforces the idea that it has become a normality to ingest pain relieving medication at the slightest sign of a migraine or mild muscle soreness. These drugs were originally designed to aid society in coping with pain, however it appears that Western society is becoming more and more dependent upon medication and medical service providers are now administering powerful pain relieving medication at far higher doses than many other cultures around the world. This is contributing to a number of barriers which are arising between intercultural communication between patients and medical service providers. As different cultures perceive and express pain in a variety of ways medical service providers need to be aware of these cultural differences so that they are able to examine and treat the pain more accurately. Equally it may not be culturally accepted to administer pain relief in certain situations and this may lead to barriers between doctor patient relationships as when medical service providers in Western cultures are far more likely to administer pain relief and in much higher doses. **Literature Review:** Intercultural differences in relation to the administration and treatment of those in pain can differ substantially. Within Australia alone there are a number of cultures who experience and express pain in various ways. It is therefore essential that medical service providers are made away of these social differences and are able to effectively examine and treat patients offering alternative treatments for those who may be culturally obligated to refuse medical treatme **Public Health Issue:** It is of no surprise that there are distinct intercultural differences in the expression and relief of pain across different cultural backgrounds, however it seems that Western cultures are far more likely to administer pain relieving medication and in much higher doses. This becomes an issue as Australia being a nation with vast number of different cultural backgrounds, increases the likelihood of intercultural communication between patients and primary emergency services. With medical services within Western culture so quick to administer pain relieving medication whether it is during labour, for treatment of burns or treatment for trauma, it is inevitable that certain barriers will arise creating an unideal environment between patients and medical service providers across different cultural backgrounds. Intercultural differences in relation to the administration and treatment of those in pain can differ substantially. Within Australia alone there are a number of cultures who experience and express pain in various ways. It is therefore essential that medical service providers are made away of these social differences and are able to effectively examine and treat patients offering alternative treatments for those who may be culturally obligated to refuse medical treatment. It is also important to note that the treatment of pain in not limited to physical discomfort but also includes mental health such as trauma or even spirituality and medical service providers need to be informed on how to deal with patients for a variety of cultural backgrounds. It is also evident that the expression of pain can be greatly diverse across different cultural backgrounds, thus creating another barrier between patients and medical service providers, which is why the administration of pain relieving medication must be handled with extreme care. There are many ways in which pain can be administered depending upon different cultural backgrounds and beliefs. For example many Australian Indigenous populations still hold traditional spiritual values passed down from their ancestors. These spiritual values are considered highly important to the health and wellbeing of an individual. Therefore an individual of Indigenous Australian heritage may refer to illness or discomfort where there is an imbalance of their spiritual state, thus causing them pain. Equally a person of Indigenous Australian background may associate emotionally traumatic events with the stolen generation. It is therefore evident that pain can be expressed in a variety ways and it is important for medical service providers to take the time to closely examine each patient which may require intercultural understanding when dealing with patients from different cultural background. There are also a variety of cultural customs which depict the way in which pain is to be expressed by different individuals in certain situations. In Middle Eastern cultures it is socially required for a woman to vocally express her pain during childbirth even if it is not a reflection of the pain she is experiencing. This is considered to be normality in Middle Eastern culture as the women is to demonstrate the pain she is experiencing so that she can be supported through the process. This is substantially different in Japanese culture where the woman is to show as little emotion as possible despite experiencing high levels of pain and discomfort. Therefore it is a necessity that medical practitioners have adequate knowledge of different cultural customs, which will assist administering an acceptable dose of pain reliving medication to each individual patient. <span style="display: block; height: 1px; left: -40px; line-height: 200%; overflow: hidden; position: absolute; top: -25px; width: 1px;">Medical service providers should also exercise caution when administering pain relief as certain religions including Christianity may advise against the use of pain relief in certain situations. Certain religions including Christianity advise against the use of pain reliving medication during childbirth as it is seen as a natural process the way God intended it. Other religions such as Hinduism see pain and suffering as a positive outcome as it leads to progress upon their spiritual path. Some followers of Hinduism may embrace pain and suffering as a test from the ultimate God to both learn and understand the concepts of attachment and detachment. Hinduism suggests that pain and suffering is a form of karma from the ultimate God for inappropriate actions in either the present of past life and that to truly achieve detachment one must not seek immediate pain relief as ones goal should be to become neutral in the face of either outcome. It is imperative that medical service providers are aware these religious beliefs so that they are able to treat their patients effectively while limiting any emotional or spiritual distress. <span style="display: block; height: 1px; left: -40px; line-height: 200%; overflow: hidden; position: absolute; top: -25px; width: 1px;">There are also distinct differences in the perception and response to physical pain across cultures which are contributing to an inconsistent administration in some pain relieving medication. A study of femoral fractures in patients of two US hospitals and three comparable Vietnamese hospitals found that patients in Vietnamese hospitalised received a far lesser dosage of morphine than their US counterparts. Vietnamese patients received a dosage of 0.9mg on average compared with 30.2mg in the average US hospital. More intriguing was the fact that only 8% of Vietnamese patients reported having received inadequate pain relieving medication in comparison to 80% of American patients. This highlights a drastic difference in treatment and relief of pain between Western cultures and collectivist cultures such as Vietnam and reinforces the importance placed upon medical service providers to assess and accurately administer pain reliving medication. <span style="display: block; height: 1px; left: -40px; line-height: 200%; overflow: hidden; position: absolute; top: -25px; width: 1px;">It is also important to note differences in preferred coping techniques when addressing physical pain. A study of African Americans and Caucasian patients of rheumatoid arthritis found that African American patients were more likely to employ such coping techniques as praying, hoping and distracting themselves from their pain, while Caucasian were more likely to simply try to ignore the pain and discomfort. It is also evident that some patients who have an Indian cultural background may be more likely to employ such techniques as prayer, meditation and yoga to assist in achieving detachment. Overall it is evident that each individual will employ their own set of coping techniques to help deal with painful situations and it is the role of the medical service provider to assist their patients in coping with their pain the best they can. <span style="display: block; height: 1px; left: -40px; line-height: 200%; overflow: hidden; position: absolute; top: -25px; width: 1px;">Overall pain is subjective and it can be difficult to accurately diagnose the level of pain an individual is experiencing especially when dealing across a cultural barrier. Considering pain can be expressed in various ways it depends on the interpretation and diagnoses of the medical service provider to identify and treat the pain as accurately as possible. Therefore it is imperative that the primary emergency service providers must be informed on how different cultures express and relieve pain if they are to accurately identify and treat patients. <span style="display: block; height: 1px; left: -40px; overflow: hidden; position: absolute; top: -25px; width: 1px;">As countries such as Australia become more multicultural the need for medical service providers to have an in depth knowledge of different cultural backgrounds continues to grow. When administering pain relieving medication medical service providers need to be educated in both intercultural communication and understanding. As pain is both expressed and treated in various ways across different cultures it is imperative that medical service providers develop a vast array of skills that will enable them to both diagnose and administer pain relief to their patients while having a thorough understanding on how to remove any potential barriers in cross-cultural communication and treatment.

<span style="display: block; height: 1px; left: -40px; line-height: 200%; overflow: hidden; position: absolute; top: -25px; width: 1px;">In order to tackle the barriers in cross-cultural communication and treatment of patients in pain, medical service providers must be trained to have an in depth knowledge and understanding of a vast array of cultural backgrounds. Although basic cross-cultural communication in required in order to diagnose and treat patients from different cultural backgrounds, a greater depth of knowledge and well developed skillset will assure an ideal supportive environment for patients of different cultures. At present barriers involving cross-cultural treatment and understanding of pain is a major concern within Australia with medical technology advancing at a rapid rate, it is up to the skillset of the medical service providers to tackle these barriers which may require offering alternate medical assistance and pain relieving therapies for individuals of different cultural backgrounds.

<span style="display: block; height: 1px; left: -40px; line-height: 200%; overflow: hidden; position: absolute; top: -25px; width: 1px;"> In order to establish a strong supportive environment for patients and address any barriers resulting from inadequate pain management medical service providers must be culturally competent. Though having an in depth knowledge of a vast array of cultural backgrounds will assist in relieving any inequality of cross-cultural pain management, it is still important for medical service providers not to become too general in their assumptions of an individual’s culture and expression of pain. General assumptions of a cultures expression to pain may create another barrier preventing ideal practice where patients may not be receiving the same quality of care as individuals who share a common cultural background with the medical service provider. Therefore to challenge these barriers of inequality communication between patients and medical service providers must be strong and ideally patients should have access to medical personal who share a common cultural background as themselves.

<span style="display: block; height: 1px; left: -40px; line-height: 200%; overflow: hidden; position: absolute; top: -25px; width: 1px;"> In order to establish a strong supportive environment for patients and address any barriers resulting from inadequate pain management medical service providers must be culturally competent. Though having an in depth knowledge of a vast array of cultural backgrounds will assist in relieving any inequality of cross-cultural pain management, it is still important for medical service providers not to become too general in their assumptions of an individual’s culture and expression of pain. General assumptions of a cultures expression to pain may create another barrier preventing ideal practice where patients may not be receiving the same quality of care as individuals who share a common cultural background with the medical service provider. Therefore to challenge these barriers of inequality communication between patients and medical service providers must be strong and ideally patients should have access to medical personal who share a common cultural background as themselves. <span style="display: block; height: 1px; left: -40px; line-height: 200%; overflow: hidden; position: absolute; top: -25px; width: 1px;"> Overall the degree of inequality experienced by various cultural backgrounds within Australia is of a grave concern. It is imperative that these barriers of inequality are addressed so that the patients will be exposed to ideal public practice. Equally if these barriers of inequality of cross-cultural treatment between patients and their medical service providers are not removed and ideal practices are not met we will continue to see a decline in patient satisfaction and the outcomes of this would be severe. It is crucial that patients and medical service providers of Australia lead the revolution of addressing these inequalities and removing these barriers creating and ideal environment for all Australian regardless of their cultural background and beliefs. <span style="display: block; height: 1px; left: -40px; overflow: hidden; position: absolute; top: -25px; width: 1px;">Cultural Sensitivity, can health services 'feel'?

<span style="display: block; height: 1px; left: -40px; line-height: 200%; overflow: hidden; position: absolute; top: -25px; width: 1px;"> Intercultural differences in relation to the administration and treatment of those in pain can differ substantially. Within Australia alone there are a number of cultures who experience and express pain in various ways. It is therefore essential that medical service providers are made aware of these social differences and are able to effectively examine and treat patients offering alternative treatments for those who may be culturally obligated to refuse medical treatment. Refusal often occurs as a result of deeper spiritual and religious beliefs that need to be understood (Sullivan, 2003). It is also important to note that the treatment of pain in not limited to physical discomfort but also includes mental health such as trauma or even spirituality and medical service providers need to be informed on how to deal with patients from a variety of cultural backgrounds. It is also evident that the expression of pain can be greatly diverse across different cultural backgrounds, thus creating another barrier between patients and medical service providers, which is why the administration of pain relieving medication must be handled with extreme care. <span style="display: block; height: 1px; left: -40px; line-height: 200%; overflow: hidden; position: absolute; top: -25px; width: 1px;"> There are many ways in which pain can be administered depending upon different cultural backgrounds and beliefs. For example many Australian Indigenous populations still hold traditional spiritual values passed down from their ancestors. These spiritual values are considered highly important to the health and wellbeing of an individual. Therefore an individual of Indigenous Australian heritage may refer to illness or pain where there is an imbalance of their spiritual state, connection with their land or their kin (Fenwick 2006). Equally a person of Indigenous Australian background may associate pain with emotionally traumatic events such as the stolen generation (Fenwick, 2006). It is therefore evident that pain can be expressed in a variety ways and it is important for medical service providers to take the time to closely examine each patient which may require intercultural understanding when dealing with patients from different cultural backgrounds. <span style="display: block; height: 1px; left: -40px; line-height: 200%; overflow: hidden; position: absolute; top: -25px; width: 1px;"> There are also a variety of cultural customs which depict the way in which pain is to be expressed by different individuals in certain situations. In Middle Eastern culture it is socially required for a woman to vocally express her pain during childbirth even if it is not a reflection of the pain she is experiencing (Birth, 2009). This is considered to be normality in Middle Eastern culture as the women is to demonstrate the pain she is experiencing so that she can be supported through the process of giving birth. This is substantially different in Japanese and Bedouin culture where the woman is to show as little emotion as possible despite experiencing high levels of pain and discomfort (Briggs, 2008). Equally a study of African American, Irish, Italian, Jewish and Puerto Rican patients in response to facial pain found that there were significant differences in the way in which these patients expressed their pain (Lasch, 2002). Therefore it is a necessity that medical practitioners have adequate knowledge of different cultural customs, which will assist in administering an acceptable dose of pain reliving medication to each individual patient. <span style="display: block; height: 1px; left: -40px; line-height: 200%; overflow: hidden; position: absolute; top: -25px; width: 1px;"> Medical service providers should also exercise caution when administering pain relief as certain religions including Christianity may advise against the use of pain relief in certain situations. Certain religions including Christianity advise against the use of pain reliving medication during childbirth as it is seen as a natural process the way God intended it (Birth, 2009). Other religions such as Hinduism may see pain and suffering as a positive outcome as it leads to progress upon their spiritual path. Some followers of Hinduism may embrace pain and suffering as a test from the ultimate God to both learn and understand the concepts of attachment and detachment (Sarah & Whitman, 2007). Hinduism suggests that pain and suffering is a form of karma from the ultimate God for inappropriate actions in either the present or past life and that to truly achieve detachment one must not seek immediate pain relief as ones goal should be to become neutral in the face of either outcome (Sarah & Whitman, 2007). It is imperative that medical service providers are aware these religious beliefs so that they are able to treat their patients effectively while limiting any emotional or spiritual distress. <span style="display: block; height: 1px; left: -40px; line-height: 200%; overflow: hidden; position: absolute; top: -25px; width: 1px;"> There are also distinct differences in the perception and response to physical pain across cultures which are contributing to an inconsistent administration in certain types of pain relieving medication. A study of femoral fractures in patients of two US hospitals and three comparable Vietnamese hospitals found that patients in Vietnamese hospitalised received a far lesser dosage of morphine than their US counterparts (Lasch, 2002). Vietnamese patients received a dosage of 0.9mg on average compared with 30.2mg in the average US hospital. More intriguing was the fact that only 8% of Vietnamese patients reported having received inadequate pain relieving medication in comparison to 80% of American patients. This highlights a drastic difference in treatment and relief of pain between Western cultures and collectivist cultures such as Vietnam and reinforces the importance placed upon medical service providers to assess and accurately administer pain reliving medication. <span style="display: block; height: 1px; left: -40px; line-height: 200%; overflow: hidden; position: absolute; top: -25px; width: 1px;"> It is also important to note differences in preferred coping techniques when addressing physical pain. A study of African Americans and Caucasian patients of rheumatoid arthritis found that African American patients were more likely to employ such coping techniques as praying, hoping and distracting themselves from their pain, while Caucasian were more likely to simply try to ignore the pain and discomfort (Lasch, 2002). It is also evident that some patients who have an Indian cultural background may be more likely to employ such techniques as prayer, meditation and yoga to assist in achieving detachment (Sarah & Whitman, 2007). Overall it is evident that each individual will employ their own set of coping techniques to help deal with painful situations and it is the role of the medical service provider to assist their patients in coping with their pain the best they can. <span style="display: block; height: 1px; left: -40px; overflow: hidden; position: absolute; top: -25px; width: 1px;"> Overall pain is subjective and it can be difficult to accurately diagnose the level of pain an individual is experiencing especially when dealing across a cultural barrier. Considering pain can be expressed in various ways it depends on the interpretation and diagnoses of the medical service provider to identify and treat the pain as accurately as possible. Therefore it is imperative that the primary emergency service providers must be informed on how different cultures express and relieve pain if they are to accurately identify and treat patients across a cultural barrier.

<span style="display: block; height: 1px; left: -40px; line-height: 200%; overflow: hidden; position: absolute; top: -25px; width: 1px;"> As countries such as Australia become more multicultural the need for medical service providers to have an in depth knowledge of different cultural backgrounds continues to grow. When administering pain relieving medication medical service providers need to be educated in both intercultural communication and understanding. As pain is both expressed and treated in various ways across different cultures it is imperative that medical service providers develop a vast array of skills. These skills will enable medical service providers to both diagnose and administer pain relief to their patients while having a thorough understanding on how to remove any potential barriers in cross-cultural communication and treatment. <span style="display: block; height: 1px; left: -40px; line-height: 200%; overflow: hidden; position: absolute; top: -25px; width: 1px;"> In order to tackle the barriers of cross-cultural communication and treatment of patients in pain, medical service providers must be trained to have an in depth knowledge and understanding of a vast array of cultural backgrounds (Weissman, Gordon & Bidar-Sielaff, 2002). Although basic cross-cultural communication in required in order to diagnose and treat patients from different cultural backgrounds, a greater depth of knowledge and a well-developed skillset will assure an ideal supportive environment for patients of different cultural backgrounds. At present barriers involving cross-cultural treatment and understanding of pain is a major concern within Australia. Considering that medical technology is advancing at a rapid rate, it is up to the skillset of the medical service providers to tackle these barriers. This may require offering alternate medical assistance and pain relieving therapies for individuals of different cultural backgrounds or religion. <span style="display: block; height: 1px; left: -40px; line-height: 200%; overflow: hidden; position: absolute; top: -25px; width: 1px;"> In order to establish a strong supportive environment for patients and address any barriers resulting from inadequate pain management, medical service providers must be culturally competent. Though having an in depth knowledge of a vast array of cultural backgrounds will assist in relieving any inequality of cross-cultural pain management, it is still important for medical service providers not to become too generalised in their assumptions of an individual’s culture and expression of pain (Weissman, et al, 2002). General assumptions of a cultures expression to pain may create another barrier preventing ideal practice where patients may not be receiving the same quality of care as individuals who share a common cultural background with their medical service provider. Equally to achieve culturally safe practices it is important that the health care provider is able to establish trust within this relationship (Fenwick, 2006). Therefore to challenge these barriers of inequality communication between patients and medical service providers must be strong and ideally patients should have access to medical personal who share a common cultural background as themselves. <span style="display: block; height: 1px; left: -40px; overflow: hidden; position: absolute; top: -25px; width: 1px;"> Overall the degree of inequality experienced by various cultural backgrounds within Australia is of a grave concern. It is imperative that these barriers of inequality are addressed so that the patients will be exposed to ideal public practice. Equally if these barriers of inequality of cross-cultural treatment between patients and their medical service providers are not removed and ideal practices are not met we will continue to see a decline in patient satisfaction and the outcomes of this would be severe. It is crucial that patients and medical service providers of Australia lead the revolution of addressing these inequalities and removing these barriers creating and ideal environment for all Australians regardless of their cultural background and beliefs <span style="display: block; height: 1px; left: -40px; overflow: hidden; position: absolute; top: -25px; width: 1px;">As countries such as Australia become more multicultural the need for medical service providers to