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Anita, a Swiss occupational therapist, is going for a first-time home visit to one of her patients who has immigrated from Nepal.

She met Mrs Maiya at the rehabilitation hospital where she was treated after a stroke. Part of the therapy involved making tea in the occupational therapy kitchen as this is a meaningful task for Mrs Maiya. It took much longer for Anita to establish a good therapist-client relationship than usual.

Anita does a home visit at Mrs Maiya’s house. Mrs Maiya invites Anita to sit in the kitchen while Mrs Maiya prepares the tea. Anita is surprised to see that the tea is prepared very differently to the one they made in the hospital and learns that the traditional Nepali tea is a salted milky version. She remembers seeing a documentary about it and that refusing it would cause great offence.

Anita knows that drinking the salty tea would make her nauseous immediately. She worries that declining the tea would have a negative impact on her relationship with Mrs Maiya.

What should Anita do?

Please select the alternative(s) which are the best action(s):

1.Anita politely declines to drink the tea on the basis that she does not like it.

2.Anita politely declines the tea by saying that she is allergic to milk products, which is a white lie.

3.Anita drinks the tea and feels nauseous.

4.Anita takes a sip and remarks that this is a very new taste for her. She can then ask Mrs Maiya if she had a similar experience with Swiss food when she came.

Analysis

1.This is one of the solutions but not the best one. Anita’s answer is an example of a low context communication in which the message is stated explicitly, vested in words of precise and unambiguous meanings (Hall, 1976). This contrasts to «high-context» communication in which most of the information is inarticulate, involves shared knowledge, experiences and assumptions and is conveyed even through non-verbal communications. The communication of many Nepalese tends to be high-context oriented, which appreciates a roundabout message if unpleasantness has to be conveyed. As such, it is not sensible for Anita to decline to drink the tea, as there are better strategies for Anita to cope with this undesirable social situation. Such one-sided behaviour is likely to stress the relationship building process. Please select again.

2.A white lie is a possible answer. Some people may feel uncomfortable using a white lie. In a professional context, a white lie may not be ideal for everyone. On the other hand, if you’re building a relationship with a patient, a white lie can be used to give face to the tea maker by not explicitly confronting her. Maybe there is an even better answer – look for it.

3.This is probably not the best solution, although some people may do it and suffer. Anita needs to be fit to carry out the home visit assessment.

4.This is the best solution for both Mrs Maiya and Anita. By drinking a sip of the tea, Anita reinforces Mrs Maiya’s ability to carry out her task in tea making. This boosts Mrs Maiya’s confidence and fosters their relationship. Anita knows that a good patient-therapist relationship is crucial for the recovery of the patient. As personal relationships are often very important in Nepal, much time is spent on building the relationship, in this situation, over a cup of chai (this is common in high-context and/or particularistic cultures). Popular conversation topics to help building the relationship include family, work, life experience etc. According to Kim et al. (2012), changing the topic of conversation can disinvite further attention to the undesirable situation. One other option could be for Mrs Maiya to offer a choice in drinks.