Take it or leave it

“At one point I thought: take it or leave it,” said Marijke, a case manager for dementia in the City of Eindhoven. Marijke was one of the fifteen participants in my cultural awareness training. Marijke’s frustration was shared by her peers. “Migrant families do not always recognize or acknowledge dementia in a family member,” Marijke continued. “Those families are often unwilling to accept our help that is available to them.”

Ellen, from Rotterdam, portrayed one of her cases. “A Vietnamese family was assigned to me last year. The father had been diagnosed with Alzheimer’s and the one of the daughters had finally contacted us for support. Had she only called us earlier!” Ellen sighed, “Not only was the father in an advanced stage of dementia, but the eldest daughter was under a lot of strain. Her younger sister was the one who had called us. She had clearly gone against the wishes of her family to go outside for help. The family had slowly become isolated.”

Anneke, who is based in The Hague, said: “Well at least they had decided themselves that an outside agency was the best way to go.”

“The one daughter, yes,” responded Ellen. “But I agree: we are often facing reluctance and sometimes outright distrust.”

Dementia in migrant communities is an increasing problem in the Netherlands and worldwide. The number of patients diagnosed with dementia increases at a rate more than double of that of native Dutch. There are a number of reasons for this increase. Until recently, the mean age for migrants was well below 65.The original migrants are getting older now and these older, first generation, members of these communities are often more susceptible to the health risks associated with poor diet, lack of exercise and smoking and, consequently, to the risk of vascular dementia through conditions such as heart disease and diabetes. Individual cases become complex because of delayed consultation for diagnosis, fear of discrimination and cultural stigma.

Ellen, Anneke, Marijke and the others discussed different families with a migrant background – mostly families from South East Asia, Turkey, Eastern Europe, North Africa and the Caribbean – in their practice. They agreed that there were certain common tendencies amongst these families: lack of trust, concealing the dementia and keeping it within the family were only a few of the aspects mentioned.

I asked the group to discuss a few Dutch family cases in their practice and list the differences they observed from the migrant families. All agreed that the differences were profound and that this challenged them as caretakers: rather than using the ‘Dutch approach’, they had to now navigate carefully through the cultural nuances that were often “rough seas” for the families concerned. “Dutch families actively seek external help even if this is not yet assigned to them,” Ellen said. “There is immediate trust in the relief we can offer. That is in contrast with many of the migrant families.” The others agreed. There is no immediate trust.

“Would I trust external care takers as easily if I would be an expat?” It was Willem from Amsterdam posing this rhetorical question. The group was unanimous in their response.

“Yes, I think my initial reaction to the offer of external care would be to grant trust, as long as the organization involved is certified, of course.” Marijke voiced the sentiment of the group.

“Or is there more to it than just trust?” I asked. The group pondered my question. Trust for sure, but most had also sensed shame, a tendency ‘to keep it within the family’. And was it shame because of the stigma of dementia or the shame of being seen as letting the family down if one would not provide the care?

“In the Netherlands we might feel guilty of sending a parent off to a nursing home or have outside support services attend to the need of the elderly. But we do not feel shame. It is accepted that we have our own lives. Children, jobs, many activities. It is how our parents raised us; to lead our own lives,” said Julie.

“And we do not have a moral obligation to be the sole caretaker – this strong sense of needing to fulfill a duty, a deeply rooted obligation towards the elderly,” added Ellen. “The elder daughter of the Vietnamese family, a mom of three with a part-time job, was compelled, at her own expense, to go through great length in caring for her father. She once told me that she did this to gain his blessings.”

The group realized that in other cultures there is a precarious balance between shame, inner pride and duty. If a family member suffers from Alzheimer’s, this balance is put to the test. Perhaps, because of the stigma of dementia, to save face in the community but also because of fear of condemnation? The group summarized: “Trying to keep it within the family,” said one. “Conflict between shame and inner pride,” said another. The result is often a long stage of denial and concealment, and finally isolation.

“The Korean way of thinking, I was once told by a third-generation teenager with roots in Korea,” said Marijke, “is that caring for the elderly is a responsibility and fulfilling this obligation is associated with a deep feeling of ‘saving face’”.

The group of dedicated case managers recognized the deeply rooted cultural differences that emerge when family members become seriously ill, exacerbated in cases of dementia. By sharing their experiences and understanding the deeper values in these communities the Dutch care takers learned to accept that the relationship between individuals is developed differently in the Netherlands than in many other cultures. The Dutch society is built on individuality, many others on collectivism.

During the training the care takers’ frustration of not being accepted, let alone involved, in an early stage was transformed to understanding and accepting cross-cultural issues such as trust, saving face and obligation. ‘Take or leave it’ is not an option. The option is to accept and address these issues and provide enough opportunity to build trust, avoid loss of face and allow younger generations to fulfill their duties. Caring for these sentiments is caring for the person suffering from dementia as well as for the family doing their best to cope with difficult times and trying to be a local on foreign soil.

De Macht van Tijd

In 2006 was Hua Wei een van de belangrijkste kandidaten om de apparatuur te leveren voor een landelijk crisiscentrum in Sri Lanka. De communicatie verliep moeizaam en de haastig ingevlogen Australiër die het systeem alsnog aan de man moest brengen kwam te laat. Voor de technologie hadden we het niet hoeven laten, maar de communicatie tussen de vele internationale betrokkenen zou veel te wensen over hebben gelaten. Toch begrepen we toen al: Hua Wei, een bedrijf om in de gaten te houden.

In 2006 zagen we al dat China langzaam maar zeker de Europeanen en Amerikanen uit de markt aan het drukken waren. China kreeg steeds meer grip op de infrastructuur in het strategisch gelegen Sri Lanka. Later, toen China de vlag hees voor de nieuwe zijderoute, het OBOR project, beseften velen in het Westen pas hoe China de kaas van het brood had gegeten.

Maar al die tijd werkten de Chinezen aan iets veel groters, iets dat hen nog veel meer macht zou verschaffen: een virtuele zijderoute. Een route die loopt via onze mainframes, routers en mobiele telefoons. De virtuele vlag is in China allang gehesen en wij wrijven het slaapzand uit onze ogen.

Eigenlijk is er niets nieuws gebeurd. Bedrijven als Cisco, Microsoft en Apple zaten al onder onze huid. Alleen: de Chinezen hebben de tijd. Veel tijd. Geen kwartaalcijfers en verkiezingen. En dat is hun grootste troef.

House Pimping

It was early November. The leaves had turned yellow and were, with their last strength, still hanging onto their branches. The day was another record-breaking one, with temperatures soaring to a wonderful 15 degrees centigrade. The sun had just crawled above the buildings along the Prinsengracht and played a final trick with me. I cherished the moment, smartphone tucked away, sipping a cortado, and sitting back.

Tourists from all the countries I ever visited were passing by.  Lees verder

To your health!

Published in the Xpat Journal.

In most cultures, people have their own way of making a toast. People raise their glass and say things like na zradavi, egészségére, salud, santé, zum Wohl or ganbei. And proost! here in the Netherlands. These are all local expressions for wishing you good health.

“Luckily, there are destinations where good relationships are sealed by juices or tea”

In some cultures, you look your well-wisher in the eyes, in others, you take the spirit without a flinch and in a single gulp, and in yet others, you stand straight and pronounce a speech. And everywhere, the drink is to your health with an immediate breach of the pledge by having you take a glass of an often-fiery local substance that will normally not improve your health. During my many business travels, I have raised hundreds of glasses with colleagues, customers and suppliers. Small glasses in China, huge ones in Germany, sophisticated ones in France and cheap ones back home. I must be the healthiest person on earth with so many people wishing me all this well-being.

Going Dutch

In many cultures, the most important consideration is to ‘give face’ to your hosts. It is a good idea to deflect compliments while offering many to others; humility being a virtue. Being Dutch, however, it takes time to become aware of all the intercultural sensitivities surrounding a toast. If we are not careful, a few shots of alcohol might just be enough to awaken the Dutch bluntness in us, to the point where we feel free to point out a flaw or mistake, offending others at the table in the act. Expats in the Netherlands may have experienced this already. As we travel, however, it is we who need to be sensitive to other cultures. Let me share a few of my experiences from around the world – you will see how different they are! Lees verder

Nothing to Brag About


Cultural differences have an influence, in multiple ways, on the relationship between teachers and students, teachers and parents and between students. The ultimate learning outcome, short or long-term, may not be what parents, teachers or students expect if cultural differences are not recognized and reconciled. In this article, I will refer to three social dilemmas that have a significant impact on education: how people deal with authority, how people relate to each other and how people are motivated. Lees verder

Do We All Agree?

Dutch Politicians can appear wimpy. During negotiations this may play out well………

Consensus has always been in the DNA of the Dutch. It is the basis of what the Dutch call ‘effective decision-making’. The expat is often fascinated and frustrated by this culture of consultation and tolerance. Fascinated, because there always seems a way out of the most complex social controversies. Frustrated, because being part of a work environment that is built on the premise of consensus might be maddening for those from more hierarchical or decisive cultures.

Protest Movemement of the 60s

‘Consensus-thinking’ allows for relatively relaxed changes in society, according to Historian James C. Kennedy. He studied the Dutch culture of give and take and compared the protest movements of the 60s in Amsterdam, Paris and the USA. Kennedy concluded that, in comparison with for instance the USA, social changes occurred comparatively swiftly in the Netherlands. While many holding power in the USA and France resisted the developments in the 60s, the Dutch leaders did little to maintain the status quo. Not so much because of their progressive nature, but because of their conviction that changes were inevitable. Moving along with the times seemed to be the only sensible option. The Dutch political elite never really excluded, but instead embraced, deviations of thought and the minorities representing these views. The counter-culture therefore was facilitated by the ability of the dominant culture to self-criticise, and was eventually ushered into the social mainstream. Lees verder

Op reis (2)

Macondo is niet zozeer een plaats, maar een gemoedstoestand.

Het is tegenwoordig bijna niet mogelijk om onbevangen op reis te gaan. Er is zoveel informatie beschikbaar, we laten ons niet makkelijk meer verassen. Reisgidsen tonen mooie plaatjes en leiden de reiziger over denkbeeldig platgetreden paden. TripAdvisor vertelt ons waar we het best kunnen eten. Booking.com weet al waar we willen slapen voordat we zijn ingelogd. En dan al die selfies van vrienden of minder bekenden die ons met duckface en al de weg wijzen naar wat wel het allerleukst van het land moet zijn.Maar er zijn ook vooroordelen die worden verspreid door populisten of reizigers met slechte ervaringen, mensen die feiten en fictie door elkaar halen. ‘Alle ellende in de wereld wordt veroorzaakt doordat mensen niet gewoon thuis kunnen blijven,’ zei de Franse filosoof Blaise Pascal ooit. We volgen de journaals en krijgen heel korte, vaak negatieve, indrukken van de landen, waar we vervolgens liever niet meer naartoe gaan. Ik hoor reizigers over dezelfde landen en culturen heel verschillende dingen zeggen. De een vindt Russen nors, lomp en aan alcohol verslaafd, de ander vindt hen warm, gastvrij en vrienden voor het leven. Indiërs stinken of ze zijn kleurrijk, Amerikanen zijn dom of ras-optimisten. Colombia kampt al tientallen jaren met zo’n negatief imago. Er circuleren honderden video’s, gemaakt door willekeurige Colombianen, die de wereld laten zien wat voor prachtig land het wel niet is, hoe gastvrij, vrolijk en ontwikkeld de Colombianen zijn. Zelf stuit ik regelmatig op onbegrip als ik mensen vertel dat ik Colombia een van de mooiste landen vind die ik ken, en de Colombianen een geweldig volk. Dat vind ik ondanks alles wat ik daar meemaakte. Ja, want incidenten, ook al worden ze breed uitgemeten, zijn niet meer dan dat: incidenten. Er is nog zoveel meer. Maar het valt niet altijd mee. Ook ik moest weleens denken aan de woorden van Friedrich Nietzsche: ‘En degenen die men zag dansen werden voor gek verklaard door diegenen die de muziek niet konden horen.’ Het loont de moeite de muziek te ontdekken. Lees verder

Op reis (2)

Over de persoonlijke hygiëne van anderen kunnen wij ons vaak verbazen. Ook op reis zullen we regelmatig naar de toilet moeten en als we getroffen worden in de buik zelfs heel vaak. We worden soms danig op de proef gesteld. In Nederland krijgen vrouwen evenveel toiletruimte als mannen, ook al zijn ze vaak in de minderheid. De ruimtes zijn zeer klein en voorzien van het hoognodige. Als het wc-papier op is, wordt de gebruiker verwacht een nieuwe rol bij de receptie te gaan halen om er vervolgens door de gang mee naar het toilet te lopen. Collega’s wensen je nog net geen succes. In België en Luxemburg is dat wel anders: ruime toiletten, haakjes voor het colbert, een spray voor de wc-bril en duidelijke gedragsregels op een bordje – en vaak nog een echte toiletjuffrouw. In Duitsland en Zwitserland is het allemaal even beschaafd en netjes, terwijl Japan doorslaat met hightech toiletten waar je je zonder gebruiksaanwijzing niet even rustig kunt terugtrekken. Fransen hebben niet voor niets het parfum uitgevonden, want de toiletgeuren zijn er niet uit te roeien. Overigens zijn die geuren nog van enig nut, want anders zouden de weinige toiletten helemaal niet te vinden zijn. Lees verder

Making a pitch for a treatment

Visiting a doctor in a foreign country can be pretty stressful, and cultural differences become more pronounced when people are upset. As an expat and frequent traveler, I have had many such experiences, including suspected malaria in India, an operation in Guatemala and a dentist visit in Colombia.

From the side-lines, I have been a pre-hospital emergencies consultant in many other countries and the brother of a GP based in Spain. Far from making me an expert, these real life episodes have given me an objective and tongue-in-cheek view on the health care system at home, in the Netherlands.

The first port of call in the Dutch medical care system is the office of the General Practitioner (GP), the huisarts. This person is the strict gatekeeper for all of your medical needs that are not immediately life-threatening. Some, who think they need a specialist, see the GP as a roadblock, whereas others see him or – increasingly – her as a trusted family friend. Either way, a GP must not be underestimated; even though he may not be wearing a white coat, he/she is a specialist in general matters. Read more….

Geduldig Geld

Op de OBOR Top in Beijing vorige week licht China een tipje van de sluier op van zijn lange termijn beleid om via ontwikkelingsinvesteringen de globalisering naar zijn hand te zetten. De One Belt, One Road (OBOR) is de nieuwe zijde route die China verdere welvaart en stabiliteit moet brengen. De Chinezen werken al decennia aan het ontwikkelen van deze handelsroutes en zorgen er voor dat de honderdtal landen die op de routes liggen tot hun vriendenkring gaan behoren. ‘Wie zich wilt ontwikkelen moet andere helpen ontwikkelen’ zei Confucius en het buitenlands/economisch beleid van China is doordrenkt van dat gedachtegoed.

Sri Lanka ligt op de belt en is daarmee onderdeel van de road. Hambatota was ooit een stoffig plaatsje in het zuid-oosten van het eiland. Het is de plaats waar de voormalig president Mahinda Rajapaksa vandaan komt. Tijdens diens bewind transformeerden de Chinezen Hambatota in een moderne havenstad met een internationale luchthaven. Daarmee kregen de Chinezen, in de achtertuin van India, een prachtige pleisterplaats op de route van grondstofrijke Afrika naar China. De rol van China is steeds groter geworden in Sri Lanka en daarmee de rol van de traditionele handelspartners kleiner. Met name het Verenigd Koninkrijk, Duitsland en ook Nederland kregen te maken met een assertief Sri Lanka dat zich, gesterkt door hun nieuwe Chinese vrienden, ging afzetten tegen koloniale machten die hun de les lazen over de effectieve strijd die zij voerden tegen de Tamil terroristen. Opdrachten die eerder aan Europese bedrijven gegund werden gingen naar Chinese bedrijven. Niet in de laatste plaats vanwege zeer lange betaaltermijnen. Chinees geld blijkt geduldig te zijn.

Het is slechts een van de vele voorbeelden van Chinese diplomatie en onverzettelijkheid. ‘China first and China great again!’ President Xi Jinping zal het ongetwijfeld denken, maar nimmer uitspreken. Hij weet dat op de lange termijn China vrienden nodig heeft en vrienden deel je in je welvaart, ook al is het uit eigen belang. De relatie met vrienden is onverdeelbaar. Die is goed of niet-bestaand; er zit niets tussenin. En daar is Geduldig Geld voor nodig. Geld, veel geld, dat langer dan tien jaar uitgezet wordt. Eerst bij de vrienden zelf en nu ook bij multi laterale instellingen zoals de nieuwe Asian Infrastructure Investment Bank (AIIB). OBOR, lange tijd in aanleg en versluierd is al vergevorderd. Ongetwijfeld is de volgende Zijde Route een virtuele. Bedrijven als Hua Wei (129 op de Fortune Global 500 lijst) staan al aan de basis van menig complex en essentieel communicatienetwerk, ook in Nederland.

Geduldig Geld. Jammer dat wij er zo weinig van hebben.

Fragmenten uit Do we have a deal? Onderhandelen in andere culturen.

Meer: janvincentmeertens.com