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Street Journal, Sept 9, 2011 : Learning to Speak Iowan: Corn, Pigs, Cyclones and Hawkeyes
By Miriam Jordan
MASON CITY, Iowa—When Aileen Prabhakaran took a job in Iowa, the young doctor from India expected a land of icy winters, cultivated fields and quiet living. One thing the 31-year-old, whose entire schooling was in English, didn't expect: a communication barrier.
Foreign doctors take a class in Iowa's traditions—including farming. Pictured, Paul Harris cultivates a field in Mason City.
Then last year, she enrolled in a cultural-competency course at the hospital where she is a resident in family medicine. "It enabled me to understand Iowa and Iowans better," she says.
The 90-minute sessions are taught by two social scientists once a month and are required of all foreign medical residents at the hospital, Mercy Medical Center here in Mason City. About 30 physicians recently attended "Topics for Small Talk With Iowans."
In another session, "An Intro to Working Effectively With White Europeans" in Iowa, the professors dissected "the Iowa character."
The students—doctors in white coats—took notes as they learned about Iowa's history and traditions, crops and climate.
They looked amused when told by a professor never to "underestimate the importance of the University of Iowa Hawkeyes" and that "Iowa women can do what men can do with a bow and arrow," a reference to female involvement in hunting.
About a quarter of all medical doctors in the U.S. are foreign-born, with the percentage often higher in rural areas. In Iowa, where 63% of the counties have a shortage of physicians, according to the federal government, foreign doctors provide the backbone for many communities.
Mason City, a northern Iowa town of 30,000 whose claim to fame is that it inspired "The Music Man," the Meredith Willson musical, enlists physicians from Egypt, India, the Philippines and other countries.
The doctors are multilingual, cosmopolitan and well-trained, says David Little, a pediatrician at Mercy Medical, which serves 14 counties. But, "they don't know a darn thing about Iowa," he says. Also, Iowa may not know a lot about them.
Some Iowans question the qualifications of foreign-trained doctors who they don't always understand and who don't always understand them. "There are misconceptions on both sides," says Adel Makar, an Egyptian pediatrician with 26 years of Iowa under his belt. "It's good we start to talk about it openly."
An Iowa farmer can be university educated, worth millions of dollars and know all about grain futures. But a rural, small-town feel permeates the culture. It's a place where patients are used to knowing their doctors well, down to the pew their families occupy in church on Sundays, Dr. Little says.
"In Iowa, we have our uniqueness. It's something about growing up on a farm," says Paul Lasley, a rural sociologist at Iowa State University.
Sweet-corn stands pop up in July. Tourists can buy postcards featuring pigs and corn, together or alone. It helps an Indian doctor to learn to look beyond stereotypes.
Dr. Prabhakaran hails from the city of Chennai, once known as Madras. It is home to twice as many people as there are in all of Iowa. She says she had never met a farmer before moving there.
Thus, Dr. Little worried there might be "no social or emotional connection" between patients and international physicians at a time when the hospital was increasingly recruiting foreign doctors. It has about 100 in a staff of physicians numbering nearly 300.
He pored over medical books, journals and the Internet to find a template for developing an acculturation course. He came up empty.
So the hospital hired two University of Northern Iowa professors who study immigration to design a course. Mark Grey, an anthropologist, co-teaches with Michele Devlin, a public-health researcher.
Before beginning the lecture on topics for small talk, Mr. Grey warned the doctors that he and his colleague would assume "none of you know anything about Iowa."
In case they hadn't noticed, for example, Iowa's landscape is covered with soybeans and corn, which—just like the state's hardy people—must endure harsh weather.
"One topic you can never go wrong with is the weather," said Ms. Devlin. Spring ushers in the beginning of severe-weather season, she told them. The manifold manifestations of Mother Nature on the prairie produce gigantic hail, flooding and, of course, tornadoes, which she flashed up on a screen.
In practicing medicine, it is vital to take into account that "life in Iowa is closely tied to the harvesting cycle," Mr. Grey told the class. Patients refuse surgery or bed rest until after the harvest, he told the doctors, drawing nods from around the room.
"Corn is a cultural icon," said Mr. Grey. It's at least "knee-high by the Fourth of July."
The scholars urged the doctors to participate in traditional celebrations and eat tater-tot casseroles and pork tenderloin sandwiches, however unhealthful they might be.
"You have to promise me you'll go to the State Fair," Ms. Devlin told the doctors, something she deemed essential "for you to understand the state."
"That's on my to-do list," said student Furkhan Kachhawala after the class.
In the "Intro to Working Effectively With White Europeans" session, Ms. Devlin explained that Iowa's population is overwhelmingly Caucasian—91.3%, according to the Census—despite the arrival of African, Asian and Latin American immigrants in recent years. In some circles, she said, a mixed marriage refers to a University of Iowa Hawkeye tying the knot with an Iowa State University Cyclone.
"Iowa nice" is about bashful hospitality—respecting rules and being modest, polite and understated, the professors said. So Iowans are likely to underreport pain, the doctors were told. "What isn't said can be as important as what is said," Mr. Grey observed. There were quizzical stares all around.
The culture classes also attract Americans. A recent transplant from Washington, Shahed Samadi, was baffled when a girl showed up dehydrated at the hospital after spending the day in the fields "detasseling," the job of removing by hand the pollen-producing flower from the top of a corn plant. "I was like, 'Say what?'" recalls Dr. Samadi.
Thanks to the lessons, Nupur Mody of Mumbai says she used conversations about farming to break the ice with new patients, asking: "Do you raise hogs? Are you planting soybeans or corn?"
Dr. Mody says she mastered Iowa culture and came to love Iowans, but faced a different challenge: Iowa's winters. "I had never worn a sweater in my life," she said. In July she moved to California.
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