ABSTRACT
Cultural competence was introduced in order to help clinicians bridge cultural divides between themselves and the communities they serve, but these models have also promoted the idea that culture is innate, unchanging, and uniform across any given community. This chapter picks up where the best intentions of cultural competence training began, recognizing that strong cultural norms really do matter for clinical care. The chapter then complicates the idea of cultural norms, revealing the often multiple and contradictory ways that culture appears from within any given group. To explore how norms are tied up in larger institutional forms of power and knowledge, the chapter turns to the concept of biopower. These concepts are explored through the story of a Navajo trans woman named Lola, one of the authors of this chapter. The chapter traces the way that her encounters with the healthcare system are embedded in larger stories—historical, religious, and social. Her story shows that norms are internalized, often subconsciously, and that they are enforced, sometimes cruelly or violently. They are also reinforced through the practices and bureaucratic infrastructures of medicine, sometimes inadvertently, and they can both benefit and damage individuals and communities.
