Stanford School of Medicine
Stanford Center for
Biomedical Ethics–

Worlds Apart

A documentary film and medical education project to improve multicultural health.

Produced by Maren Grainger-Monsen, M.D. and Julia Haslett.

View and download a copy of the Worlds Apart Facilitator's Guide (pdf).

Justine C. was born with a hole in her heart. Her doctors want to do surgery to repair her heart. But her mother and grandmother, both refugees from Laos, worry that the scar left by the surgery will stay with her into her next reincarnation. They want to seek advice and treatment from the monks at the local Buddhist temple. Will Justine's heart be repaired?

Mohammad K. has stomach cancer. After surgery, his doctors recommended chemotherapy but he turned it down. Six months later Mohammad's eldest daughter Noorzia, alarmed at her father's deteriorating condition, wants to know why he isn't getting treated. Could it be that the kind of chemotherapy offered made it impossible for her father, a devout Muslim from Afghanistan, to observe daily prayer? Why wasn't he given other options, Noorzia wonders. Would a professional translator have helped avoid this misunderstanding? Does her father still have a chance?

Robert P. needs a kidney. Two years ago when his kidneys failed he had to fight to get placed on the transplant list. Since then he's sought care with a new nephrologist who he hopes will be more sensitive to his needs and concerns, and most importantly, be someone he can trust. As a health policy analyst, Robert, who is African-American, knows he's going to wait twice as long as a white patient for a transplant. He's determined to find out why.

Alicia M.
Alicia M. has missed several appointments with her new doctor. Her diabetes, hypertension, asthma and depression have been aggravated by her recent eviction from her apartment of 18 years. She believes her mother's death was caused by taking too much medication, and worries that she may be taking too much prescription medication herself. Alicia feels that by using home remedies together with prescriptions she can do better than with either alone. Her doctor is finding her to be a challenging patient due to poor diabetes control and the missed appointments-but what her doctor doesn't realize is how Alicia's life has been turned upside down by being forced out of her home, causing her to lose the will to keep up with her health care.

Directed by award-winning physician/filmmaker Maren Grainger-Monsen and filmmaker Julia Haslett, the films follow patients and families faced with critical medical decisions as they navigate their way through the health care system. Shot in patients' homes, neighborhoods, and places of worship, hospital wards and community clinics, Worlds Apart provides a balanced yet penetrating look at both the patient's culture and the culture of medicine.

Accompanying the four videos is a study guide designed by cross-cultural medicine educators Drs. Alexander Green and Joseph Betancourt. With the support of the Association of American Medical Colleges, Worlds Apart will be used to teach medical students and health care professionals about cross-cultural communication and cultural sensitivity.

Dr. Grainger-Monsen is currently producing a full-length documentary film for broadcast that will be released in the fall of 2004. The film will explore in greater detail the interactions between culturally diverse patients and their healthcare providers in the United States. In examining the effect of sociocultural barriers on communication and health outcomes, the film will reveal a great deal about both problems and opportunities in cross-cultural healthcare.

These projects are funded in part by the generous support of The California Endowment, the Commonwealth Fund, the Greenwall Foundation, and the Arthur Vining Davis Foundations.

> Order copy of the film "Worlds Apart"

> Download NPR interview with Dr. Grainger-Monsen about Worlds Apart

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