Cultural Diversity in Health Care

Cultural Diversity Objectives Essential Questions Identify the major ethnic groups in the United States Examine the interrelationships of culture, religion, and ethnicity relative to health and illness beliefs and practices. Identify, define, and discuss terms and factors relating to human relations Develop personal strategies for building good relationships Explain the importance of human relations in an organizational setting Compare complementary medicine and alternative medicine How does one’s culture influence health care decisions? How does one's family influence heath care decisions? Why do I have to be courteous to others of another culture? What is Alternative and Complementary Medicine and why do we need to learn about it?

Culture Set of values, beliefs, attitudes, languages, symbols, rituals, behaviors, customs of a group of people Learned and shared Dynamic and changing

Ethnicity Classification of people based on national origin or culture Members of an ethnic group share heritage, national origin, social customs, and language Examples: African American, Asian American, European American, Hispanic American, Middle Eastern/Arabic American, Native American

Race Classification of people based on physical or biological characteristics Involves multiple cultures and ethnic groups

Cultural Diversity Differences based on cultural, ethnic, and racial factors Culture is the way an ethnic group views the world Traditions are passed on from one generation to the next Healthcare providers must recognize and appreciate the characteristics of all patients

Cultural Diversity Impacts Beliefs Birth Death Health Illness Health Care

Areas of Cultural Diversity Family organization Language Personal space Touching Eye contact Gestures Health care beliefs Spirituality Religion

Areas of Cultural Diversity Families form the basis of cultural social groups Families organization determines who will make health care decisions

Areas of Cultural Diversity Religious practices and spirituality Give people a sense of wholeness and are influenced by cultural beliefs Rituals are practiced by some religions, some involve objects that have religious significance We must respect these rituals and treat religious objects with care

Guidelines for Developing Cultural Sensitivity Review your own belief system Consider how culture affects your own behavior Look at all patients as individuals Recognize that patients are a combination of heritage, culture, and community Recognize that culture influences the way people behave and interact with others

Guidelines for Developing Cultural Sensitivity Handle religious articles with respect Provide privacy when a spiritual advisor is visiting or when the patient is practicing a devotional act Learn about cultural beliefs and practices of the cultural groups in your community Politely ask patients about unfamiliar practices Attend staff development classes that promote cultural sensitivity http://www.youtube.com/watch?v=PdLPe7XjdKc

South African Harmony with nature Harmony of mind, body, and spirit

Asian Physical and spiritual harmony with nature Balance of yin and yang

European Personal responsibility with diet, rest, exercise, and prevention

Hispanic Good luck Reward from God Balance between hot and cold forces

Middle Eastern/Arabic Spiritual Causes Cleanliness

Healthful Hints from Long Ago “A sassafras root carried in the pocket guards against illness.” (superstition of Old Saint Simons) “Asafetida worn on a string around the neck protects a child from many diseases, and a buckeye carried in the pocket protects against rheumatism.” (Blue Ridge and Great Smokey Mts.)

“ A single, pierced nutmeg, worn around the neck on a string, will protect you from boils, croup, body lice, and various lung diseases.” (New England) “A well-ventilated bedroom will prevent morning headaches and lassitude.” (1914 Almanac)

Illness Abnormal functioning of a body’s system or systems Causes vary based on cultural/ethnic background

South African Spirits/demons Conflicts in life God’s punishment

Asian Imbalance of yin and yang Supernatural forces Unhealthy environment

European Sin Outside sources: microorganisms, toxins

Hispanic Sins Fright Evil Eye Envy Imbalance between hot and cold

Middle Eastern/Arab Sins Evil Eye Spiritual causes

Native American Supernatural forces Violation of a taboo Imbalance between man and nature

Folk Remedies Beliefs and practices ethnically similar Religion plays a role in perception of, interpretation of, and behavior in health and illness Women are usually the prime caregivers Can create delay in seeking professional help

Preventions Jewish: camphor around the neck in winter in a small cloth bag to prevent measles and scarlet fever Black and Native Americans: blackstrap molasses Black Africans (Ethiopia): eat hot & sour foods i.e. lemons, fresh garlic, pepper

Preventions Germans: no sweets at meals, drink glass of water at meals, cod-liver oil, plenty of milk, spring tonic (sulfured molasses) Islam: dress properly for the season & weather, keep feet from getting wet in the rain

Preventions: Irish Clean out bowels with senna for 8 days Spring tonic of sulfured molasses Onions under the bed to keep nasal passages clear Bag of camphor around the neck during flu season

Preventions: Irish Never go to bed with wet hair Don’t look in the mirror at night & close closet doors (prevents evil spirits) Eat lots of oily food Take Father John’s Medicine every so often

Preventions: Italian Garlic cloves strung on a piece of string around neck of infants and children to prevent colds and “evil” stares Red ribbon around neck of infant does the same thing Never wash or bathe during period

Preventions: Italian Never wash hair before going outdoors or at night Keep a pair of open scissors under mattress of crib to prevent “evil” in newborn Wrap a bandage around the baby from the waist to the feet for 1st 6 months to prevent bowlegs

Home Treatments: Jewish Sore throat: find salted herring, wrap it in a towel, put it around the neck, let it stay there overnight, gargle with salt water Boils: fry chopped onions, make a compress and apply to the infections

Home Treatments: Blacks/Native Americans Bloody nose: place keys on chain around neck Sore throat: suck yolks out of egg shell, honey and lemon, baking soda, salt , warm water, onions around the neck

Home Treatments: Black African Evil Eye: put some kind of plant root on fire and make the man who has the evil eye smile and the man talks about his illness

Home Treatments: Germans Coughs: honey & vinegar; boiled onion water, honey, & lemon; hot water & Vicks Swollen glands/mumps: put pepper on salt pork and tie around the neck Earache: few drops of warm milk in the ear, laxatives when needed

Home Treatments: Germans Sty: cold tea-leaf compresses Fever: mix whiskey, water, & lemon juice to drink before bed (causes person to sweat and break fever) Constipation: Ivory soap suppositories

Home Treatments: Islam Sore throat: gargle with vinegar and water Indigestion: baking soda and water Sore muscles: alcohol and water Rashes: apply corn starch

Home Treatments: Irish See doctor only in an emergency Earache: heat salt, put in stocking behind ear Fever: spirits of niter on a dry sugar cube Colds: hot lemonade and a tablespoon of whiskey; egg whites; ipecac

Home Treatments: Irish Coughs: linseed poultice on chest; flaxseed poultice on back; red flannel cloth soaked in hot water and placed on chest all night Menstrual cramps: hot milk sprinkled with ginger, glass of warm wine, hot-water bottle on stomach

Home Treatments: Irish Nausea: castor oil, hot ginger ale, cup of hot boiled water Sore throat: paint throat with iodine, honey and lemon, Karo syrup; paint with kerosene oil with rag then tie sock around the neck; paint with iodine or Mercurochrome and gargle with salt water, honey melted Vicks

Home Treatments: Italian Chicken soup for everything Boils: cooked oatmeal wrapped in a cloth (steaming hot) and applied to drain pus Headache: kerchief with ice in it wrapped around the head Cramps: crème de menthe

Home Treatments: Italian Acne: apply baby’s urine To build up blood: eggnog with brandy; Marsala wine and milk Backache: place a silver dollar on the sore area and light a match to it, while the match is burning put a glass over the silver dollar and slightly lift the glass, this causes suction which lifts the pain out

Healthcare Providers’ Culture Cultural Diversity in Health and Illness, Second Edition, p.70

Beliefs “Standardized definitions of health and illness “The omnipotence of technology”

Practices “The maintenance of health and the prevention of disease through such mechanisms as the avoidance of stress and the use of immunizations” “Annual physical examinations and diagnostic procedures such as Pap smears”

Habits “Charting” “The constant use of jargon” “ Use of a systematic approach and problem-solving methodology”

Likes “Promptness” “Neatness and organization” “Compliance”

Dislikes “Tardiness” “Disorderliness and disorganization”

Customs “Professional deference and adherence to the ‘pecking order’ found in autocratic and bureaucratic systems”

Customs “Handwashing”

Customs “Employment of certain procedures attending birth and death”

Rituals “The physical examination” “The surgical procedure” “Limiting visitors and visiting hours”

Cultural Beliefs Concerning Epidemiology and Pain Medical culture is in direct opposition sometimes Bacteria/viruses/carcinogens/pollutants versus “soul loss”/”spirit possession”/voodoo/witchcraft Free, open expression of feelings versus never revealing true feelings

Examples of Cultural Clashes “Mr. Smith in room 222 is the ideal patient. He never has a single complaint.” Are you sure he has no complaints or is it his cultural influence not to be a bother?

Examples of Cultural Clashes “Mrs. Cohen in room 223 is a real complainer. She is constantly asking for pain medication and putting on her light.” Is she really in pain or is it her cultural programming concerning dealing with pain?

Examples of Cultural Clashes “Mr. Chen in room 225 says nothing. I often wonder what he is feeling.” What is really happening with Mr. Chen?

Healthcare Providers Must change to accommodate other cultural beliefs and behaviors towards health and illness

Religion and Healing Vital role in perception of health and illness Rites surrounding birth and death Diet

Traditional Etiology: Evil Eye Power of eye strikes victim Injury, illness, misfortune is sudden Person with evil eye may not know it Victim may not know source of evil Prevented or cured by rituals/symbols, removal of spell or evil agent Explains sickness and misfortune

Traditional Methods of Prevention

Protective Objects Amulets Bangles Talismans

Protective Substances Garlic Onions Chachayotel 1000 year old eggs Kosher foods

Protective Religious Practices Social, moral, dietary practices Burning candles Rituals of redemption Prayer

Examples of Saints for Protection Blessing of the Throats on St. Blaise Day Virgin of Guadalupe St. Anthony of Padua: barren women St. Odilla: blindness Our Lady of Lourdes: bodily ills

Beliefs Affecting Therapy Use of healers with divine powers Natural products: herbs, berries Purgatives Blood-letting Removal of person with evil eye Avoidance of provocation of envy

Forms of Spiritual Healing Inner healing Physical healing Deliverance or exorcism Auric healing Pilgrimages

Healthcare Providers Must Be Aware of the Multitude of Sources Outside of Mainstream Medicine! Embrace Diversity in Medicine. Teach Tolerance to Healthcare Providers!