1. History Project Goals and Methods Cultural Competency for Health Care Providers: Bhutanese Refugees Lauren Kreiger MS-II, Nicole Fossiano MSW Candidate, Charles Maclean MD, University of Vermont College of Medicine, Burlington VT 2012 SEARCH Scholar Project Social Etiquette May be practiced, supplementing western medicine. Includes the using oils and herbs, for example, as a cure for a sore throat. Some Nepali-speaking Bhutanese may believe that certain foods should be avoided when ill or pregnant. Inclusion in Curriculum Recommendations for Medical School curriculum: Include a culture specific reading from the Cultural Competency for Healthcare Providers manual during the PCR session on medical translation. Learn more about our diverse patient population; become aware of this valuable resource (available at www.cvahec.org). Hold a practice session with the standardized patients using a medical interpreter to practice in a learning environment. High rates of PTSD, anxiety and depression from forced displacement, physical and sexual trauma Suicides among resettled Bhutanese are high There is stigma against mental health so many refugees are unwilling to discuss mental health issues until they become severe Connecting Cultures at UVM Behavioral Therapy and Psychotherapy Center provides individual and group counseling for refugees The Champlain Valley Area Health Education Center has created a Cultural Competency for Healthcare Providers manual. This manual provides an overview into what cultural competency is and why it is an important focus for healthcare. This manual also gives insight into the special populations of Chittenden county, including information on resettled refugees. A new population of resettled refugees began arriving in 2005 from Bhutan. In 2012 the Nepali-speaking Bhutanese population is the third largest refugee group in Chittenden county. Our project was to include a new chapter in the manual on this population. Learn about the history and culture of Nepali-speaking Bhutanese refugees Learn about medical and mental health challenges unique to Bhutanese Meet with Bhutanese community leaders, and community agencies that provide resources to the refugees Shadow a health care provider while providing care to a Bhutanese patient Write a chapter in the AHEC Cultural Competency Manual Background Bhutan Land of the Thunder Dragon Images from The World Fact book Geography of Bhutan Specific Healthcare Concerns Background and Culture Education Mental Health Traditional Medicine Late 19 th Century people of Nepali origin moved to Southern Bhutan for work. However in the 1980’s they were seen as a threat to political order, and the King of Bhutan forced the Nepali- speaking Bhutanese out of the country. Nepal was unwilling to accept them as citizens, and over 100,000 people became refugees. The US has agreed to resettle 60,000 refugees and in the summer of 2012, 40,000 have been resettled. There are currently 1,000 Nepali speaking Bhutanese refugees in Vermont. Religion is variable: Hindus (60%), Buddhists (30%) and Christians (10%) Many Hindus will not eat pork or beef Staples of diet include rice and lentils Although there is a caste system in Hinduism, that may not be followed strictly by the younger generations Although not common, polygamy and arranged marriages may still occur Traditionally parents would be cared for by the youngest son Younger generations have had access to public education up to grade 10. Some have finished high school (grade 12) and attended college in India. Many refugees speak Nepali, Bhutanese and English as schools were taught in English. Challenges include having limited exposure to technology, difficulties with spoken English and feeling isolated at school. Major health care challenges include malnutrition from life in the refugee camps. There are high rates of Vitamin A and B12 deficiencies leading to night blindness and anemia. In addition, dental care was limited and some refugees may not be aware of proper dental hygiene. There is also an unexplained high rate of deafness. Another challenge is that the concepts of consent to care, confidentiality and being an active participant in health care decisions may be new to many Bhutanese refugees. Health care has traditionally been acute, and the importance of preventative care may not be valued. Additional counseling may be needed to explain these cultural differences. “ Culture is too sensitive, if you take it too seriously; you need to take it from the heart.” ~Jeetan Khadka “Cultural and tradition are hard to separate.” ~Anonymous Hello and goodbye: Namaste “Head wiggle” means yes or maybe Especially for elders, handshaking and eye contact may make them uncomfortable at first. Not maintaining eye contact is a sign of respect When first offered food/drink it is polite to say no, will accept on second offer if they truly want it Permission is needed before entering a Nepali speaking Bhutanese home Hugging is only done between romantic couples Keep in mind that every Nepali-speaking Bhutanese person is unique and one should ask rather than make broad generalizations. “If we work together as a government and community we will be successful.” ~Anonymous