I recently had the opportunity to visit a Chinese medical school and spend some time with both faculty and students. The leadership of the school was interested in pursuing North American accreditation. I was part of a team invited to advise about the state of compliance with those standards, and to help prepare the faculty and curricular leadership for the review process.
The visit was organized in the style of a typical accreditation visit, structured as a series of interviews with groups of faculty, curricular leaders, students and administrative staff. Each meeting was typically focused on a subset of standards.
One such meeting, which I’d been dreading, involved the accreditation standards dealing with the issue of Diversity. I was not at all sure how the North American sensibility regarding diversity would translate to such a different cultural and political setting, and was concerned about inadvertently causing some offense to our hosts, who had been nothing but gracious.
The meeting involved about ten faculty and administrative staff. They were chosen, in part, because of facility in English, but their understanding and ability to express responses varied considerably. As a result, questions were often followed by spontaneous conversations in Mandarin where those with better understanding would translate to others and, presumably, responses were considered and formulated. These “huddles” sometimes got quite animated and the tone and gestures themselves seemed very revealing.
The preliminary questions for this particular session were quite straightforward, generally confirmation of factual information. All was going along quite smoothly with a generally light and friendly atmosphere in the room. Then, and in the interest of simulating a true accreditation visit, I probed further. “And how do your admission practices and curriculum recognize the diversity of your population?”
The previously relaxed and animated group went quiet, all eyes on me. After what seemed like a very long pause, the faculty member who’d been the lead discussant for the group asked me to clarify what I meant by “diversity”.
I tried to explain that North American medical school standards required a commitment to social accountability, a component of which was the recognition of cultural, gender and ethnic differences in the students and society they would eventually serve.
My explanation was translated to the group, followed by the most animated and prolonged exchange they’d had to date. The other panel members and I sat back taking all this in. The expressions and tone suggested confusion, perhaps mild offense and considerable concern about how to respond.
After what seemed like quite a long and somewhat uncomfortable time, the lead faculty member turned to me and said simply, “We’re all Chinese”.
With more than a little trepidation, I decided to press on. “But I’ve read recently that there are over 50 different ethnic and cultural groups within China. Diversity also extends to issues of gender and sexual orientation. How is that diversity accounted for in your admissions and faculty appointment processes, for example?”
After another translation, an even longer and more animated Mandarin huddle ensued. Finally, the response:
“But, we’re all Chinese”.
In the interests of maintaining good relations and ensuring the review team got home safely, I decided to leave it at that.
In the ensuing months, my thoughts have often returned to that particular exchange. Of all the conversations during that visit, that was the one that brought home most clearly the differences in our societies. Fundamentally, the Chinese political structure and the values that it espouses prioritize the state over the individual. It’s not that myriad cultural, racial, religious and language differences don’t exist or are unimportant to their 1.5 billion citizens, it’s simply that those differences are considered secondary to their common, unifying allegiance to the state. They’re all Chinese first. Other characteristics, choices or preferences come second, or not at all. They have, as a society, essentially chosen to suppress or ignore their diversity.
All this is in rather stark contrast to our culture in Canada where diversity is celebrated and even legislated, permeating even our educational programs. We are free, as Canadians, to identify in (almost) any way and with (almost) any group we chose, the exceptions being organizations that are known to advocate violence or hatred in the pursuit of their particular perceptions of diversity.
I came away from all this with a deeper appreciation of the incredible privilege our society provides. The freedom to choose how one wishes to be identified is precious. It’s also easily taken for granted, largely because most of us have never had to struggle to achieve it, and have never lived without it.
What my brief and admittedly superficial encounter with Chinese culture brought home to me is that we all have the freedom to choose how we wish to engage each other, and how we collectively wish to engage the world. For any two people, indeed for any two peoples, both common and differentiating issues can be easily identified. In any encounter, from simple to profound, the parties involved face a choice. Their encounter and their ongoing relationship can be defined by points of mutual interest, or by those characteristics that divide them.
All this brings to mind the words of President John F. Kennedy who, in a commencement address at American University in 1963, at the height of the Cold War, nuclear proliferation and the constant threat of accidental or intentional Armageddon, reached out to both his own people and his global adversaries with these words:
“So let us not be blind to our differences, but let us also direct attention to our common interests and the means by which those differences can be resolved. And if we cannot end now our differences, at least we can help make the world safe for diversity. For in the final analysis, our most basic common link, is that we all inhabit this small planet, we all breathe the same air, we all cherish our children’s futures, and we are all mortal.”
How will we, as Canadians, chose to use the freedom of choice that we have inherited? From time to time, might our chosen approach to our various diversity challenges be “We’re all Canadian”?
Hi Tony -great blog. Canada is a wonderful country but I am concerned that the rise of a belief that intersectional differences trump the reality of the commonalities we share threatens to Balkanize our society and turn each of us into an “n=1”. We share our humanity, our 36,000 genes and more. We live in a privileged country and we will likely be happier and better able to improve the world if we can agree that we are all Canadians and work to perfect our confederation, ensuring an equitable place within Canada for all people.
Thanks for this thoughtful comment Steve. Couldn’t agree more.
I think one of the biggest differences between the Chinese and Canadian populations is that Canada is founded upon colonialism and we who live here today are all immigrants. In Canada and really, most of the entire world, there is white privilege that gives folks of Caucasian backgrounds tangible and intangible benefits. The Han population in China is the equivalent but that history is quite different.
Yes China is a collectivistic society but I think the biggest similarity with Canada is that it has a dominant group holding much of the power in the country. In China, 92% of people are Han Chinese – this is much more than the Caucasian population in Canada. The power is incredibly skewed and for 92% of the population there is no personal incentive to change the status quo. Han Chinese have barely even begun to acknowledge diversity not to mention welcome it in medical schools. In Canada, it has been an uphill battle of folks of marginalized communities have fought hard to be acknowledged and accepted. Not just the hate crimes, but also the daily microaggressions. By erasing these experiences, we don’t acknowledge the oppression of those groups (because it may not be personally relevant to some of us).
This is very much an ongoing issue, and that’s why it’s too early to go back to saying “We’re all Canadian.”
Hello Jennifer, and thanks for your response. I think it’s very important that we have more open discussion about the very perspectives you raise and so I’m grateful for your willingness to bring them forward. I would offer a different perspective on a couple of your points. I think characterizing Canada, or any country, as a nation of immigrants is both inaccurate and unfair to those who made an active choice to seek out opportunity and a better life for themselves and their families. In many cases, it was to escape the “privilege” that existed in their birth countries. I would also point out that diversity relates to much more than cultural/racial background. We are all different in a variety of ways. There are certainly those among us who will focus primarily on those differences and express them in inappropriate ways, intentionally or unintentionally. The issue, for each of us, is whether we choose to focus on what separates us, or what we share as human beings. The issue is relevant for us all, but particularly for those in medicine who have chosen to overcome barriers and serve all our fellow citizens. In any case, let’s keep the dialogue open on this important topic, and thanks again for your willingness to discuss.