Fahema Begum, aged 19, arrived in London from the rural district of Sylhet, three months after her arranged marriage. She asked for a repeat prescription of the desogestrel that had been prescribed in Bangladesh. She was rapidly learning English and, although a little shy, her manner was cheerful and open, and she took as much part as she could in the three-way consultation with her husband and the doctor. Her attitude contrasted strongly with that of her husband’s family who had been with the practice for seven years. Her mother-in-law’s contraceptive history started after her ninth pregnancy: an IUCD was fitted after a termination of a pregnancy that neither she nor her husband could support, given the eight other children, a two-bedroomed flat, and her own severe asthma. Fahema’s father-in-law at that time had acknowledged that their religion did not permit abortion, but sought the support of the doctor to help them decide whether or not they could put their individual needs before their cultural doctrines.
Catalogues of cultural norms not only go out of date quickly but tend to encourage rigid and even racist attitudes because of their generality. They formulate a view of the doctor in relationship with a homogeneous group rather than with individuals with a shared culture. It is difficult, unless the book is on the desk top (which would be ridiculous), to memorize information that is presented in such a format, and even harder to accurately identify the exact cultural identity of the patients as they present, just from their name and appearance.
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