Cultural Diversity in Health Care

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Cultural Diversity in Health Care
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Culture

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

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Ethnicity

• Classification of people based on national origin
  or culture
• Examples African American, Asian American,
  European American, Hispanic American, Middle
  Eastern/Arabic American, Native American

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Race

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

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Cultural Diversity

• Differences based on cultural, ethnic, and racial
  factors
• Melting Pot or Salad Bowl approach
• Must be considered when providing health care
• Healthcare providers must recognize and
  appreciate the characteristics of all patients

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Holistic Care

• Must be developed to include cultural diversity
  of America
• Addresses 3 aspects of well-being
  mental/emotional, physical, and social

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Areas of Cultural Diversity

• Family organization
• Language
• Personal space
• Touching
• Eye contact

• Gestures
• Health care beliefs
• Spirituality
• Religion

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Cultural Diversity Impacts Beliefs

• Birth
• Death
• Health
• Illness
• Health Care

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Health

• Varies Based on Cultural Background

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World Health Organization

• A state of complete physical, mental, and social
  well-being, not merely the absence of disease

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South African

• Harmony with nature
• Harmony of mind, body, and spirit

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Asian

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

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European

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

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Hispanic

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

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Middle Eastern/Arabic

• Spiritual Causes
• Cleanliness

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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.)

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• 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)

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Illness

• Abnormal functioning of a bodys system or
  systems
• Causes vary based on cultural/ethnic background

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South African

• Spirits/demons
• Conflicts in life
• Gods punishment

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Asian

• Imbalance of yin and yang
• Supernatural forces
• Unhealthy environment

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European

• Sin
• Outside sources microorganisms, toxins

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Hispanic

• Sins
• Fright
• Evil Eye
• Envy
• Imbalance between hot and cold

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Middle Eastern/Arab

• Sins
• Evil Eye
• Spiritual causes

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Native American

• Supernatural forces
• Violation of a taboo
• Imbalance between man and nature

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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

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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

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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

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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

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Preventions Irish

• Never go to bed with wet hair
• Dont look in the mirror at night close closet
  doors (prevents evil spirits)
• Eat lots of oily food
• Take Father Johns Medicine every so often

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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

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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

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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

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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

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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

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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

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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

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Home Treatments Islam

• Sore throat gargle with vinegar and water
• Indigestion baking soda and water
• Sore muscles alcohol and water
• Rashes apply corn starch

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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

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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

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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

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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

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Home Treatments Italian

• Acne apply babys 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

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Healthcare Providers Culture

• Cultural Diversity in Health and Illness, Second
  Edition, p.70

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Beliefs

• Standardized definitions of health and illness
• The omnipotence of technology

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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

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Habits

• Charting
• The constant use of jargon
• Use of a systematic approach and
  problem-solving methodology

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Likes

• Promptness
• Neatness and organization
• Compliance

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Dislikes

• Tardiness
• Disorderliness and disorganization

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Customs

• Professional deference and adherence to the
  pecking order found in autocratic and
  bureaucratic systems

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Customs

• Handwashing

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Customs

• Employment of certain procedures attending birth
  and death

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Rituals

• The physical examination
• The surgical procedure
• Limiting visitors and visiting hours

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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

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Examples of Cultural Clashes

• Mr. Smith in room 222 is the ideal patient. He
  never has a single complaint.

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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.

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Examples of Cultural Clashes

• Mr. Chen in room 225 says nothing. I often
  wonder what he is feeling.

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Healthcare Providers

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

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Religion and Healing

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

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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

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Traditional Methods of Prevention
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Protective Objects

• Amulets
• Bangles
• Talismans

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Protective Substances

• Garlic
• Onions
• Chachayotel
• 1000 year old eggs
• Kosher foods

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Protective Religious Practices

• Social, moral, dietary practices
• Burning candles
• Rituals of redemption
• Prayer

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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

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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

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Forms of Spiritual Healing

• Spiritual healing
• Inner healing
• Physical healing
• Deliverance or exorcism
• Auric healing
• Pilgrimages

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Healthcare Providers Must Be Aware of the
Multitude of Sources Outside of Mainstream
Medicine!

• Embrace Diversity in Medicine. Teach Tolerance to
  Healthcare Providers!