American Indian Population

Transcription

1 American Indian Cultural Differences in the Expression of Physical Pain Elder s Quote: We are not understood, that is why so many of us walk around in pain Suzanne L. Cross, PhD, ACSW, LMSW Saginaw Chippewa Indian Tribe of Michigan Associate Professor Emeritus Michigan State University-School of Social Work Angelique G. Day, PhD, MSW Assistant Professor Wayne State University School of Social Work American Indian Population 566 U.S. Federally Recognized Tribes 245 Non Federally Recognized Tribes State Recognized Tribes (each State) Population- U.S. 5.2 Million (CDC, 2010) West 40.7% Midwest 16.8% South 32.8% Northeast 9.7% 1492 Arrival of Columbus 1790 Forced Inland 1830 Indian Country 1860 Immigration Stampede 1890 Vanquished 2090 Indian Country? Indian = Reservation Lands the Expression of Physical Pain 1

2 Emilys map Michigan Tribes American Indian Population 22% On Reservations & Indian Settlements 78% Off Reservation Median Age 29 yrs. (U.S yrs.) Median Income $37,353 and (U.S. $56,566) the Expression of Physical Pain 2

3 American Indian Health (IHS) What makes the American Indian Population different from all other racial ethnic groups in the U.S. is the unique government to government relationship. Treaties between the United States Government and Indian Tribal Nations frequently call for the provision education and health care support. Indian Health Services The IHS: Agency within the Department of Health and Human Services that is charged with serving the health needs of the population, more than half (78%) of AI/ANs do not permanently reside on a reservation, and therefore have limited or no access to IHS. Health Care Reform (Patient Protection and Affordable Care Act) Reauthorizes the Indian Health Care Improvement Act 566 federally recognized American Indian and Alaska Native Tribes and their descendants are eligible for services provided by Indian Health Services Indian Health Services Goals 1. Assists Tribes in developing their health programs through activities such as health management training, technical assistance, and human resource development. 2. Assists Tribes in coordinating health planning, in obtaining and using health resources available through Federal, State, and local programs, and in operating comprehensive health care services and health programs. 3. Provides comprehensive health care services, including rehabilitative services, and development of community sanitation facilities. the Expression of Physical Pain 3

4 Health Care Status of American Indian & Alaska Natives This is generalized, depends on each Tribal Nation for Ex: Lakota 52 Females and 48 Males. American Indians and Alaska Natives die at higher rates than other Americans from respiratory disease, chronic liver & cirrhosis, diabetes, unintentional injuries, and suicide. American Indians and Alaska Natives born today have a life expectancy average that is 6.5 years less than the U.S. all races population (72.3 years to 78.8 years, respectively). Ten Leading Causes of Death AI/AN s as Compared to the Nation AI/AN 1. Heart disease 2. Cancer 3. Unintentional injuries 4. Diabetes 5. Chronic liver disease & Cirrhosis 6. Chronic lower respiratory diseases 7. Stroke 8. Suicide 9. Influenza and Pneumonia 10. Nephritis, Nephritic Syndrome U.S. 1. Heart disease 2. Cancer 3. Chronic lower respiratory diseases 4. Stroke 5. Unintentional injuries 6. Alzheimer s Disease 7. Diabetes 8. Nephritis, Nephritic Syndrome 9. Influenza and Pneumonia 10. Suicide Source: Health, United States, Disproportionate Disease Burden Why? Historical Traumas, Inadequate Education, Disproportionate Poverty, Discrimination in the Delivery of Health Services, and Lack of Cultural Competencies. the Expression of Physical Pain 4

5 Historical Trauma=Distrust Many of the Policies Resulted in Broken Treaties which caused Death, Harm, Loss of Children, Imprisonment, Loss of Languages & Cultures. Examples: Child Removal Health & Education Promises Religious Freedom Act 1978 Research Misconduct Sterilization of Indian Women Tylenol Tested on Population Carlisle Indian School 1885, Carlisle, PA. Degree of Acculturation Assimilated Bi-cultural Traditional 15% 60% 25% Factors: Religion/Spiritual Beliefs, Child Rearing, Medicine, Ceremonies, Extended Family, Cultural & Social Activities, and Employment Dr. John Red Horse University of Wisconsin the Expression of Physical Pain 5

6 Illness Causation Violation against nature & spiritual laws causing an imbalance of Mind, Body, Spirit Bio-physiological Basis for Greater Pain Tolerance Studies Indicate Stoicism is common and perhaps there is Biological and/or Physiological Reason Significance of the Research Medical literature exists that purports that AI s have higher pain tolerance (Talit, Kerry, Kuhn, et al., 2013) Studies are needed to determine best practice for health care professionals to assist AI s with pain management which includes cultural competance the Expression of Physical Pain 6

7 Research Questions What are the physical ailments that cause pain for American Indians? Are there gender and age differences in the expression of pain, help seeking and pain management? What are recommendations American Indians have for medical health care professionals? Table 1: Sample Description (N=75) Characteristics Total N % Age Below and older Gender Male Female Reservation Status On Off Beliefs Bicultural Assimilated Traditional 8 11 Findings Table 2: Physical ailments experienced by participants* (N=75) N % Joint Pain Arthritis Headache 4 5 GERD 3 4 Diabetes 2 3 Each of these diseases represent 1 subject: 1 1 gout, hernia, eczema, heal spur, menstrual cramps, cancer, COPD, heart disease, eye, auto immune disease, lung disease Disease unspecified 5 5 No Disease (N/A) Total responses *Results add up to greater than 100% because some subjects had multiple morbidities the Expression of Physical Pain 7

8 Universal Pain Assessment Tool How would you rate your pain on a daily basis? M= 3.54 (SD 2.44) Gender (X 2 (15)= 16.55, P<.35) Age (X 2 (15) = 23.34, P <.07) Findings: Theme 1 Table 3: Treatments Sought in Response to Pain (N=41) N % Over the Counter Drugs Prescription Drugs Use of relaxation techniques (massage, aroma therapy) Tough it out /Do nothing Exercise PT/OT/Chiropractor 8 11 Applying heat/ice 7 9 Home remedies 6 8 Traditional medicines/healer 4 5 Prayer ( Creator, spirituality ) 4 5 Total responses *Results add up to greater than 100% because some subjects identified multiple treatments to manage their pain Findings: Theme 2 Table 4: Who Did Respondents Seek Help From? Who did respondents seek help from? N % Western biomedical health Care Physician Self Traditional Native healer Massage therapist Family 9 12 Tribal clinic 5 6 Total responses *Results add up to greater than 100% because some subjects identified multiple treatments to manage their pain the Expression of Physical Pain 8

9 Findings: Theme 3 Table 5: Recommendations for Health Care Professionals Communication ; use simple language ; listen to me ; look at me and not your clock N % if I go to the Dr., it MUST be bad Don t want strong drugs, worry about to many meds, fear addition 6 8 Be respectful of traditional methods 4 5 Total responses Case Studies How to Heal Oneself Self-talk & Visualization Smudging Self with Herbs Tobacco Offering Hot and Cold Baths Getting Away Affirmation of Self (I will be Strong, Healthy, Happy, & Protected) the Expression of Physical Pain 9

10 Cultural & Behavioral Difference in the Expression of Symptomatology May use vague terms for pain Stories and Symbols Environment (lightening, drum, trees, deep spreading roots, spider web, etc.) Moderate to Severe Pain described with the same terminology Potential Barriers to Mainstream Health Care Delivery Language Barriers Eye Contact Medical Terminology Personal Space Coping Behaviors Exclusion of Family Ignore Symptoms Lack of Ceremonies Accept Disabilities Traditional Medicines Stereotypes-Stoicism (frequently not mentioned) Use of Silence Cont. Potential Barriers to Mainstream Health Care Delivery Questions Too Personal Disagree with Provider Attitude Too Upbeat Share Their Experiences/Medications Stress of Living Bi-Culturally More Focus on Good Person then Credentials the Expression of Physical Pain 10

11 Lack of Cultural Competency Results in Assumptions Noncompliant Resistant Uncooperative Impairment of Thought or Hearing Paranoia Malingerer or Substance Seeker Traditional Healers Rely Strongly on Prayer Healing is a Gift from the Creator Assistants Learn from Mentors Practices not written down because maybe exploited by those who don t fully understand. Traditional Healers Long process (strength, sacrifice & patience) Male or Female Depends on Tribal Nation belief system Use of Traditional Healing or Mainstream Medicine Combination Four levels-talk, Prayer, Hands on, Medicines Oral/Topical the Expression of Physical Pain 11

12 Ceremonies to Support Healing Ghost Supper Honor Song Ceremony in One Year Adopt a Behavior of the Person who walked on Illness and Death Illness A case of being Unwell or Out of Balance Body/Mind/Spirit Death Walked On On His or Her Journey All Tribal Nations have Ceremonies Some Never Mention the Person s Name Again Culturally Safe Health Services Environment Void of Stereotypes Void of Negative Comments Culturally Competent Include in Treatment Plan Translate Terminology Aware of and Collaborate with Tribal Nations Services the Expression of Physical Pain 12

13 Miigwetch - Thank you for sharing your time Questions?? Dr. Cross suzanne.cross@ssc.msu.edu Dr. Day ew6080@wayne.edu the Expression of Physical Pain 13