Intercultural Communication

Service Learning Paper

Submitted by:

Haley R, Neusch

December 7, 2017

Submitted to:

Sarah Bellington

COMM 2150-351

Department of Communication

Salt Lake Community College

Project

There is a problem with how the middle and upper class communicate with the homeless

and needy community. Using the Proxemics Theory in correlation with my service learning

project, I will be addressing how to overcome the challenges of communication with someone

from a homeless background. With my experience volunteering at Fourth Street Clinic is

important to understand that with this broad theory there are some challenges when it comes to

different cultures. Defining these subtle differences and using proper communication techniques

will be more effective when communicating with this particular culture.

For many homeless Utahns, Fourth Street Clinic is their first and only chance at a

diagnosis and treatment. The clinic provides free to limited cost access to primary care for the

homeless population and provides financial assistance and resources to help end homelessness

for their patients. The mission statement of Fourth Street Clinic is to help homeless Utahns

improve their health and quality of life by providing high-quality health care and support

services.

For my project, I was assigned to observe the communication between healthcare

workers and patients. I helped employ the techniques of communication from the proxemics

theory. I intend to address the limitations of the proxemic theory when applied to the homeless

population by using my experienced providers at the Fourth Street Clinic. The homeless culture

is extremely variable, the Edward Hall theory of Proxemics was designed to be applied to

individuals from the white middle class. So attempting to define specific guidelines for

communicating with the needy can be difficult.

Cultural Groups

I worked with many individuals from different cultural backgrounds during my service

project at the Fourth Street Clinic. One interaction was with a 10- year-old child named Josh who

was from a Hispanic background. Josh came to Fourth Street Clinic searching for assistance for

malnutrition and dental hygiene. Another patient who caught my attention was a transgender

male named Max. Max came to the clinic for multiple reasons- a cyst drainage, assistance with

methamphetamine abuse.

I also worked with a patient named Jasmine. Jasmine is a Muslim refugee with two

children under the age of four. Jasmine came in with her two children who were vomiting and

having fevers. Jasmine did not speak any English so communicating was difficult.

* Names have been changed for HIPAA purposes.

Challenges

I found the biggest challenge was mistrust; most people didnt feel comfortable talking

about these sensitive subjects. I would ask someone about their culture or if theyd call living on

the streets a culture at all. I found that most people didnt like talking about the way they live or

what it took to survive. They would often get defensive if I tried to probe further about their

experience on the street. I would explain the reasoning as to why I was asking these questions, to

write a paper about communicating with the homeless population in order to improve how

people view and communicate with the less fortunate. When I explained this in a more detailed

manner people, were more willing to express the appropriate dialectic approaches to the

Proxemics Theory in their own way.

After I was able to understand the varying backgrounds of these patients, I moved on to

the next challenge of this project: having to deal with the emotional impact of their stories.
Listening to their stories, how they had become homeless and what it means to live in a homeless

culture was a difficult subject to think about. Hearing of their struggles before living on the street

and the ongoing difficulties with being homeless, I was able to find out more about the Dos

and Donts about communicating with the homeless. Clearly, from someone who comes from

a somewhat stable background with employment and relative wealth, I learned how to engage

with these individuals without being considered as an outsider.

I would often find that I wasnt communicating with the patients I saw at Fourth Street

effectively. I would use too much medical jargon to explain what procedures we would be

performing. At times, this would often lead to misunderstandings which resulted in defensive

responses. My preceptor mentioned that I wasnt using eye contact effectively and my body

language was showing disinterest. In reality, this was probably a representation of my discomfort

with dealing with smell and decay within the clinic. Another challenge of clearly communicating

was my inability to look past the lack of hygiene.

There as a lack of communication between the medical staff and the patients. The

patients would often hide the true reasons about what had happened or why they were in need of

medical assistance. This was problematic. I would get a different story than the nurse or the

physician would. This would complicate our overall team effort to helping the patient's needs by

wasting time trying to piece together what the real story was. Understandably, the root of these

lies was to avoid police attraction. This challenge was easily addressed by explaining the goal of

the clinic: to provide healthcare for these individuals. Once I was able to reassure these

individuals that I was not interested in the legal aspect of their encounter, we were able to

communicate more freely about the purpose of their visit.

 Personal space became an issue during examination. When a patient checks in to be seen

usually there is a physical examination that needs to take place to find medical abnormalities.

this involves listening to heart and lungs, checking reflexes and examining the abdomen. The

homeless community that would come into Fourth Street would usually object to the physical

contact during the evaluation. This may have been out of fear of security or because of past

sexual abuse. This leaves the providers and medical staff without vital medical information

needed to help these patients. I overcame this barrier by explaining exactly what I was doing and

why it was necessary for the patient. If a patient was uncomfortable with this, the physician and I

provided other options such as a private room. Most patients granted us permission after

understanding the medical need for those evaluations.

Theory

Proxemic space is defined as what humans consider to be intimate, personal, social and

public space. These measures include posture, the extent of people facing each other, distance,

touch, eye contact, thermal heat, smell and vocal loudness. Here, the theory discusses the

personal spaces in detail;

Intimate space is for people who you are very close to. In this case, you're probably less

than a foot away and you might even be touching the other person. This is the space

you're in with a romantic partner, for example.

Personal space is even further. In this case, you're probably about 1 - 4 feet away from

someone. This is reserved for talking to friends or family.

Social space means we're getting a little further away, about 4 - 12 feet. This is the kind

of space you're probably in if you're talking to a colleague or a customer at work.

 Public space is the space that characterizes how close we sit or stand to someone, like a

public figure or public speaker. So, if you are at an event listening to a professor give a

lecture, you are probably about 12 - 25 feet away.

Personal space differs from culture to culture. For instance, a non-context culture such

as Germany, England, Norway, Japan, Southeast Asia, India, Pakistan and the United States are

found to be averse to casual touch and resent the spatial intrusion involved with touch. They

value space and individualism; invading this space is considered rude and very

unwelcoming. Examples of contact cultures would be Arab, Latin American, French, Italian

and Turkish- they tend to touch more, position themselves closer to one another, face more

directly and hold a gaze longer than non-context cultures.

Analysis

Beginning with the use of personal space as a hepatic code I have concluded that the

homeless community doesnt like to be touched without permission as it can trigger a defensive

mechanism called fight or flight. This is due to the unimaginable abuse they may have

encountered and the horrible, yet likely occurrence, of rape seen in members who live on the

street. Although I cant speak for all of the homeless community, an article entitled No Safe

Place by Lisa A. Goodman states 92% of a large, racially diverse sample of homeless mothers

had experienced severe physical and/or sexual violence at some point in their lives. Thirteen

percent of another sample of homeless women reported having been raped in the past 12 months,

and half of these women were raped at least twice. These people have been through a lot and

are not used to others in close proximity. A good definition of the appropriate level of distance

for personal space is about two or five feet for interaction.

 Given that homeless people are usually sleeping on the street or in a crowded shelter

public space varies between very close 1.5 feet to 30 feet or more. I found that Jasmine, a patient

I evaluated with a physician, was continuously in a very intimate level of space with her children

as a protective measure. Communicating with her was difficult because she didnt speak English.

Her children adored me, she was happy that I was giving them attention by playing and coloring

with them, especially because they were sick. She also said she hadnt seen them smile in a

long time. I was able to convey to her safety for both her and her children by cautiously

approaching their personal space and demonstrating kind acts.

Max had a different definition of Proxemic space. For example, Max was very touchy

and encouraged reassurance through intimate personal touch. As he defined himself as a male

and not a female I thought that he would have a larger personal space circumference but he

seemed more comfortable the closer we were to him. In addition to addressing his

methamphetamine abuse, he was there to get a cyst drained from excessive use of intravenous

drugs. When asked how these came about he at first lied and said that they just happened. Then

during the drainage, he mentioned his drug abuse, I dont know what made him change his mind.

I could only guess it was because we established somewhat amount of trust. Later that day Max

checked into a clinic for detox after he and I had a personal discussion about drug abuse.

Im excited to talk about Joshs case because Josh is very shy and bold 10 year old. I was

shocked to see a homeless child alone show up to the clinic for malnutrition assistance. He

wanted to know all the places where he could get food for him and his little sister. He was so

quiet I could barely hear what he was saying. He wouldn't give me any eye contact and he

refused to let anyone touch him for examination. He was scary-skinny and we decided that he
was going to be transferred to Primary Childrens Medical Center to be observed and cared for

until his health improved.

After police showed up to make a case for Child Protective Services, Josh didnt want to

speak to anyone. He was upset and crying, asking if he could leave to try to find his aunt. I sat

next to Josh and told him Im worried about him, and that I wanted to give him and his sister

care. Once he understood that he and his sister wouldnt be separated, he gave me a huge hug

and he asked me to come with him. I worked with Josh and his little sister for the rest of the day.

Josh clung to me and didnt want me to leave after we transferred him to Primary Children's

Medical Center.

I use Josh as an example to the theory because once I established trust with him his level

of space changed. At first he didn't want near to any communication, he used a lot of space to

define this. When he knew he was safe and concluded that I was trustworthy his level of social

distance turned into an intimate distance according to Edward T. Hall's definition of proxemic

space by giving me hugs and sitting close to me.

Reflection

The issue with applying Edward T. Halls theory of proxemics to my service learning

project is that his theory was conducted only on white-middle class Americans. Whereas, my

project was with the homeless and needy who have a variety of different cultures. The difference

may be only subtle but what I concluded was that people with a homeless background tend to

appreciate much more space, up to a couple additional couple of feet to the original theory. I also

noted that people in an unmanageable lifestyle like theirs dont use much eye contact. They

usually look down at the floor and angle their gaze in the same direction with an occasional

glance up to the other communicate. Those subtle differences make up for a lot. Knowing how to
communicate with people is important. Knowing who to give a little extra space is essential to

making someone with a homeless or needy background feel safe, comfortable and at ease.

No matter the person you are communicating with, you should never make anyone feel

uncomfortable. Keeping this theory in mind and adding a little bit more distance to this particular

group will go a long way. I am very pleased with my volunteer work at Fourth Street Clinic and

Im excited to continue volunteering for my community.

How did you feel about this project at the beginning of the semester?

At the beginning of the semester I thought that this service learning project was going to be a

waste of time. I was under the impression that I was pretty well versed in the diverse culture of

Salt Lake City.

What were your apprehensions and attitude towards service learning and with working

with another culture?

I wasnt opposed to working with another culture, I choose to work with the homeless

community because I thought that if any culture group out there, the homeless community would

need assistance.

What did you learn about the culture that you were serving?

Most of what I learned I thought I had already knew because of my own experience with being

homeless for over a year. I learned a lot more about what it means to be homeless and or needy

with a medical problem. A lot of people who are homeless and have a medical need dont have

access to medical facilities or a primary care physician. Its places like Fourth Street Clinic that

really help.

Did your apprehension and attitude change throughout the project?

My apprehension and attitude changed throughout the project many a time. There were some

people whom I interacted with that I wish I could have done more for. I also had a hard time with

some of the patients I was working with, I wasnt used to seeing so many neglected medical

issues that had far gone past a resolve. I was pretty uncomfortable being around the smell of the

clinic for the beginning two hours each day too. The more I was there the more ways I found to

meditate these issues and change my perception.

Did the application of theory help you understand your experience?

I think when I applied my theory of proxemics to my experience it helped me understand a lot of

the use of space. When I understood how you approach a patient with a homeless background is

much different of that of someone coming from the middle-class it made my interactions with

patients from that background feel much safer and at ease.

How do you feel about the contribution that you made to your community through your

participation in the service learning project?

I feel great about how I contributed to my community. I feel like I really made a difference for

some people. I hope people will be able to seek out more help for their medical problems sooner

rather than later because they feel safe and not ashamed.

How can you incorporate what you learned in your service learning project in future

classes, your career and in your life?

I can incorporate the theory of proxemics in my daily life by being aware of others unique

personal space. Giving more space to those who require it and being aware of other cultures

when they use their space differently than my own. Paying attention to people's body language

and using the theory will give me an advantage to general communication and relationships.
References

Goodman, Lisa A. "No Safe Place: Sexual Assault in the Lives of Homeless

Women."VAWnet. N.p., 01 Sept. 2016. Web. 02 Dec. 2017.

Vox, Voxdotcom. "Proxemics: The Study of Personal Space." YouTube. YouTube, 05

July 2016. Web. 01 Dec. 2017.

Studies, Comm. "Proxemics." Communication Studies. N.p., 29 Jan. 2013. Web. 02 Dec.

2017