Study Guide: Multiculturalism

Bellevue Hospital, the oldest public hospital in the United States, is not only the home of the Bellevue Literary Review but a model for practicing healthcare in a multicultural setting. Bellevue Hospital takes care of patients from numerous different countries around the world. With the rapidly changing demographic of the United States, issues of multiculturalism play a distinct and important role in health care today. Health care professionals often interact with patients from countries whose cultural beliefs and values influence their healthcare choices. These issues are often sensitive and difficult to talk about. With this thought in mind, we have selected from the Bellevue Literary Review fiction, non-fiction and poetry that include multiculturalism as a theme to facilitate the discussion of health and medicine through a cross-cultural lens.

These readings provide a framework for considering the illness experience from a multicultural perspective. The study guide is useful for teachers of literature, ethics, medical/nursing students, social workers, as well as for health care professionals, adult continuing education courses, and general reading groups that want to discuss the issue of multiculturalism as relating to health and illness.

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Written by: Devyani Kothari and Alexandra Ritter




"Eggs" by Susi Wyss (Vol. 7, No. 2)

1. Discuss the relationship between Grace and her new friend Solange.
2. What is the significance of the motif of eggs in the story?
3. How does Grace feel about losing her mother and father? How does the loss affect her behavior?
4. In what ways is Grace a child? a young woman? a mature adult?
5. How does Grace’s desire and perception of being an adult change from the beginning to the end of the story?
6. What is Grace’s reaction when she is given a condom by her friend Solange before they enter Bar Etoile?
7. How does the setting of the story (in Bangui, the capital of the Central African Republic) and the references to specific African items (cassava, kangoya, pagne cloth, mishwi stand) add to the depth of the piece?
8. Is Grace a ngangou wali (strong woman)?
9. From the description and setting of the story, what is the disease Grace’s mother most likely passed away from?
10. Why is Alexi so angry when Grace gives him the condom?
11. Discuss the relationship between Alexi and Grace. In what ways are they similar? In what ways are they different?
12. How does the description of Grace’s first sexual experience with Alexi make the reader feel?

Taking care of a sick/dying parent
Loss of a parent/parents
Loss of family unit
Parental separation
Coming of age/Becoming an adult
Women’s health
Birth control

"The Road from Cubabi" by E. Dianne Bechtel (Vol. 8, No. 1)

1. How does Gabriela’s disability (limp) affect her daily life?
2. What is the significance of God and religion in this story.
3. Discuss the author’s descriptions of Gabriela’s pain (word choice, imagery).
4. How did the four men in the Chevy Bel Air treat Gabriela?
5. Characterize the relationship between Gabriela and her husband, Daniel.
6. How does Daniel’s job and consequently, lifestyle affect their marriage?
7. Discuss Gabriela’s view on abortion and how it is influenced by her religious and cultural views.
8. Contrast the grandfather/grandson in the horse and wagon with the four men in the Chevy Bel Air.
9. Why does Gabriela have a miscarriage at the end of the story?
10. The story is set in Cubabi, Mexico, a town close to the US border. How does the setting of the story affect its dramatic arc?
11. Which “cultural” details enrich the story?
12. Discuss Diana’s role in the story and the similarities between mother and daughter when Gabriela was her age.

Single Mother
Childhood deformity
Pain (physical and emotional)
Sexual Harassment

"Baba" by Kalindi Akolekar Handler (Vol. 9, No. 1)

1. How does Nirmila feel about taking care of her elderly grandfather?
2. Nirmila is caught in the middle between her parents and grandfather. What stress does that place on her?
3. What stress does Baba (an elderly family member with vascular dementia) place on his family?
4. How does Baba’s vascular dementia affect his relationship with his son, daughter-in-law and granddaughter?
5. What is Baba’s opinion of his mental illness?
6. This story highlights the concept of “generation gap”. Discuss the differences in thinking between the three generations (Baba, Nirmila’s parents and Nirmila).
7. Discuss Baba’s character: his way of thinking and life story, in particular. In what ways is it antiquated (“old system”); in what ways is it modern (“new system”)?
8. In South Asian culture, respecting elders is an important value. What does “filial obligation” mean? How does it play out in this story?
9. Discuss Nirmila’s character. What is she expected to do? What does she want to do? Do you think the responsibilities her parents placed on her are reasonable?
10. What is Baba’s opinion of his son and his family? Why does he constantly say negative things about them?
11. Describe Nirmila’s childhood. To what extent is it shaped by her South Asian culture?
12. Discuss the significance of the Bollywood movie, KKKG, in this story.

Family Relationships
Taking care of a parent/grandparent
Family Hierarchy
Cultural Divide
First vs. Second generation immigrants
Generation gap
Impact of mental illness (vascular dementia) on family
New system vs. Old system

"Before the Jacaranda Trees Bloom" by Sequoia Nagamatsu (Vol. 9, No. 2)

1. How would you characterize the relationship between Atsuko and Hallie?
2. What brings Atsuko and Hallie to South Africa for the summer?
3. What do Atsuko’s parents think of her relationship with Hallie? How do they react?
4. What do the mochi symbolize?
5. Discuss the impact of HIV/AIDs in South Africa as illustrated in the story.
6. How are Zimbabweans looked upon and treated in South Africa? Describe Effie’s situation.
7. Describe the family (Nohle, Zenzele and Thabiso) that Atsuko and Hallie are assigned to. What makes their family situation difficult?
8. How does Atsuko view HIV and AIDS? How is her viewpoint different from Hallie?
9. Describe the relationship between Zenzele and Atsuko/Hallie.
10. What does being a “grown-up” mean to Atsuko?
11. In what ways is Zenzele a child? An adult?
12. How does Atsuko feel about leaving South Africa and Zenzele at the end of the story?

Lesbian relationship
HIV/AIDS in adults and children
Parental approval/disapproval
Homosexuality in East Asian cultures
Dysfunctional family
Coming of age/Becoming an adult
Loss of a parent

"Cocido" by Larry Hill (Vol. 10, No. 1)

1. What is the significance of the dish, cocido, in the story?
2. How does the meth affect Tensia?
3. Why was Alex “hiding” from his family after coming back from the war in Iraq?
4. What influences Alex to come back home?
5. How does Alex feel about coming back home?
6. Do you think Alex has post-traumatic stress disorder (PTSD)? Why or why not?
7. Describe Alex’s relationship with his mother.
8. How would you characterize Alex’s relationship with his sister, Tensia?
9. At the end of the story, Alex contemplates taking his life. What makes him change his mind?
10. What does the family restaurant, Villarreal’s, signify?
11. Why did Alex decide to leave his family and go fight in Iraq?
12. What leads to Tensia’s death?

Post-traumatic stress disorder (PTSD)
Dysfunctional family
War injuries
Iraqi war veteran

"Katie Ireland" by Hunter Liguore (Vol. 10, No. 2)

1. Discuss the theme of sinning throughout the piece, especially in the beginning and end.
2. Describe how the Irish potato famine sets the background for the piece and adds to the depth and complexity of the story.
3. How does Katie meet “the man”?
4. How does Katie feel about taking care of her three younger siblings?
5. What happened to Katie’s parents?
6. How does Katie feel about exchanging sex for food to feed herself and her siblings?
7. Do you think Katie develops a liking to the lawyer?
8. How does Katie feel about getting pregnant with the lawyer’s baby?
9. Describe the circumstances of the lawyer’s death.
10. What is Katie’s ultimate fate?
11. Do you think Katie is “an innocent or a sinner”?

Irish potato famine
Loss of parents
Coming of age/Becoming an adult

"Condensed Milk" by Danielle Eigner (Vol. 11, No. 1)

1. Describe the setting of the story—where and when does it take place?
2. What specific details does the author use to paint life in Port-au-Prince, Haiti, after the earthquake?
3. How does the background of the World Cup add to the richness of the story?
4. Describe Maralah’s character.
5. What is a tap-tap?
6. What does it mean to drink bleach? Why did Maralah drink bleach? Why did her niece, Clementine, drink bleach?
7. What is condensed milk used for? How do you think it works?
8. How does the author portray the health care system in Haiti after the earthquake in relation to seeking care for Clementine’s son?
9. How does healthcare in Haiti differ from healthcare in the United States?
10. Describe the last scene in the story. What is its significance?

Haiti earthquake
Loss of a child
Husband leaving
Healthcare in a third-world country
Home remedy
Abandoned baby

"Two Countries" by Elisa Fernandez-Arias (Vol. 11, No. 2)

1. Why is Jack so reluctant to have anything to do with the “real world”?
2. How has his father’s death affected Jack?
3. Why is Jack so concerned with keeping his life in the US separate from his life in Uruguay?
4. Discuss the significance of the cat in the story.
5. Why does Jack stop Estela in the middle of their near sexual experience?
6. What is the significance of Jack changing his name from Joaquín to Jack?
7. Why does Jack finally choose to go home?
8. What kind of person do you think Jack is? Is his transgression forgivable because of his emotional turmoil over his father’s death? Why or why not?
9. How does Jack’s character change from the beginning to the end of the piece?
10. What is the difference between Jack’s “old self” and the self he creates in Uruguay? Do you think he returns to his “old self” by the end?

Loss of a parent
Personal responsibility
Family relationships
Cultural identity


"Third Wife" by Shavonne Wei-Ming Clarke (Vol. 11, No. 2)

1. What feeling does the description of the setting in the first paragraph elicit? How does this set up the tone for the rest of the story?
2. Why does Reumah continue to bind her feet even after the ban against binding is put into effect?
3. How do Reumah’s bound feet affect her day-to-day life as she gets older, and how does this influence her view of life?
4. What is the significance of Tong Sen changing Reumah’s name?
5. How has Reumah’s view of herself changed from her adolescence to the present?
6. Discuss the symbolic use of smells in the story and how each smell reflects the character it is describing.
7. What is the tone of Reumah’s description of hers and the other wives’ sexual encounters with Tong Sen? What does this say about their relationship to their husband?
8. What is the significance of the broken pipe?
9. How does Reumah’s relationship with Zahrin compare to her relationship with Tong Sen?
10. Why does Reumah say she will “never call [Zahrin] a boy again” near the end of the story? Why does she call him a boy in the beginning?
11. Why does Reumah choose to “float away” at the end of the story?
12. What is the significance of Reumah calling herself “the old wife”?

Foot binding
Pain (physical/emotional)
Family relationships
Self worth
Coming of age
Assisted suicide



"Bones of Jade, Soul of Ice" by Sarah Liu (Vol. 7, No. 1)

1. Discuss Sarah’s definitions of each of the words in Part I.
2. What is the significance of the title, “Bones of Jade, Soul of Ice”?
3. How does Sarah deal with her leukemia?
4. In what ways is Sarah “Chinese?” In what ways is she more American?
5. How would you describe Baba’s views on Chinese culture?
6. How does Sarah feel about taking care of her dying father at home? What stress and strain does it place on her?
7. How does Sarah feel when she finds a half-empty bottle of whiskey in her father’s drawers?
8. Discuss the process of dying. How is it for the loved ones?
9. What is hospice? Discuss the differences between dying at home vs. in the hospital.
10. What is the significant of the vignette at the end of the piece?

Esophageal Cancer
Cultural Divide
Domestic Violence
Child Abuse
Growing up
Caring for a dying parent
Loss of a parent

"Okahandja Lessons" by Emily Rapp (Vol. 8, No. 1)

1. Where is Namibia? What are its surrounding countries? Where is Okahandja and Windhoek in Namibia?
2. What are the “Okahandja Lessons” that Emily learns on her ten day trip?
3. Discuss the circumstances surrounding Emily’s leg prosthesis.
4. How does her leg prosthesis affect her body image?
5. How does Emily feel when she sees the two amputee beggars while having coffee in Okahandja?
6. Discuss the similarities and differences of being an amputee from a war injury (like a land mine, or dismemberment) vs. a congenital defect.
7. What does Emily have to do to take care of her prosthesis? In what ways is it more difficult in Namibia vs. the US?
8. How does Emily feel when she takes her road test to get her drivers license at the Cheyenne, Wyoming DMV?
9. Describe Emily’s living quarters in Okahandja.
10. Discuss Emily’s feelings on seeing extreme poverty in the rural villages outside of Windhoek.
11. How does Emily react when her prosthesis is revealed in the van on the way to the church?
12. Why does Emily paint her toenails and fingernails after coming back from church?
13. Discuss the significance of the “dark” that Emily describes in Namibia.
14. What is Emily’s revelation at the end of the story?

Body Image

"The Codeine of Jordan" by J.S. Brown (Vol. 11, No. 2)

1. How does the first paragraph set up the tone for the rest of the story?
2. Why has the author taken up with Mateo while abroad?
3. How are the author and Mateo “misplaced”?
4. Why does the doctor ask about the author’s marital status? Why does he assume she is a virgin?
5. How does the author feel when she is being examined and treated by the doctor?
6. In what ways is it easier for the author to get her prescription in Jordan? In what ways is it more difficult?
7. What does the author’s experience in Jordan say about the status of women in Jordan?

Women’s health
Urinary tract infection
Personal responsibility
Healthcare in Middle Eastern countries
Sexual health
Women’s status in Middle Eastern countries



"Brazil, 1968" by Claudia Cortese (Vol. 9, No. 2)

1. What feelings does the poem inspire in the reader?
2. “We’re going to cure you.” What do you think the military regime was trying to cure?
3. What political events were occurring in Brazil in 1968?
4. Discuss the stanzas that describe the surgery of “torture” and the surgery to reverse it.