Cultural Considerations when Collaborating with Families

Transcription

1 Cultural Considerations when Collaborating with Families Cheryl J.E. Doyle, MD FAAP, FCCP, ABIHM

2 Objectives 1. Define Integrative Holistic Medicine 2. Ethnic Therapies in the context of cultural competence 3. The Impact of Unspoken Legacies

3 Integrative Holistic Medicine Combines conventional & complimentary treatment modalities in order to achieve optimal health Healing addresses the whole person: Body Mind Spirit

4 Integrative Holistic Medicine Holistic refers to how we approach our patients The patient is individualized Concept of a LIFE SYSTEM impacting on health As healers WE are part of that system

5 Ethnic/ Cultural Therapies Traditional Chinese Medicine Ayurveda Hispanic African/Caribbean The World is Flat Medicine

6 Hispanic Therapies 13.3% US population Diverse Populations: Mexican Central American South American Puerto Rican Cuban

7 Hispanic Therapies Religion, faith, spiritual healing integral part of health & well being Santeria, Curanderismo reflect African influence in the Caribbean & Brazil

8 Hispanic Therapies Health = balance of body s 4 humors: Blood Phlegm Yellow Bile Black Bile Physical Properties: Hot/cold Moist/dry

9 Hispanic Therapies Common use of traditional therapies for asthma Asthma is a cold disease: Remedies with HOT qualities used to restore humoral balance Ortiz,B, et al Ann Pharmacotherapy 2007:

10 Hispanic Therapies Siete Jarabes / Seven Syrups 1. Honey syrup 2. Sweet Almond Oil 3. Castor Oil 4. Wild Cherry 5. Licorice 6. Honey 7. Cocillana

11 Traditional Chinese Medicine Wellness = state of balance between Yin & Yang Five Elements: Fire Bitter Water Salt Wood Sour Earth Sweet Metal Acrid

12 TCM Asthma Therapies Ma Huang Magnolia Minor Blue Dragon Scutellaria Ginkgo Biloba Cinnamon Licorice

13 Ma Huang Ephedrine: adrenergic agonist Alpha & beta receptor activity L- ephedrine - agonist relaxes bronchial smooth muscle

14 African/Caribbean Therapies Onion (Allium cepa) Quercitin Diphenylthiosulfate Isothiocyanate Cepaenes Asthma, chest colds, persistent cough therapy in Trinidad

15 African/ Caribbean Therapies Cepaenes active compounds in onion extracts Cepaenes & thiosulfinates Dose dependent inhibition of 5-LO activity Wagner H, et al Prostaglandins Leutkotrienes EFAs 1990: 59-62

16 Beware of Being Unaware Lack of awareness of patient s unconventional therapies: Risk of drug or disease interactions Unnecessary changes in therapy Unnecessary diagnostic tests Risk of therapeutic failure

17 Challenges Lower Expectations Reactivity vs. Proactivity Concept of preventive care/ Avoidance Fear Factor Mistrust

18 Surgical Experimentation James Marion Sims, MD Purchased female slaves for experiments Devised speculum Surgical creation of vesico-vaginal fistulapracticed correction/ NO Anesthesia Procurement of cadavers from burial grounds for anatomical dissection in medical schools

19 Tuskegee Experiment Syphilis Study Documentation of the natural course of Syphilis Denial of treatment/penicillin Forced autopsies

20 Disparate Radiation Radiation Experimentation /Plutonium Ralph Nader-revealed a nationwide practice of giving African Americans 25-50% stronger x-ray doses Skin is darker Bones are harder and denser 1963 edition of X-Ray Technology by Jacobi recommended higher doses for Negro pts

21 Fenfluramine Columbia University & NYSPI ( ) Study & Prevention of childhood disruptive behaviors Conducted studies to establish genetic predilection to violence N=126 black males age 6-10 yrs Treated with Fenfluramine / precursor of serotonin component of Fen-Phen

22 Sooo. Mindful Cultural Collaboration Convey respect and tolerance toward unconventional therapies Incorporate inquiry re: CAM into historytaking LEARN to INTEGRATE complimentary & conventional when not contraindicated BE SENSITIVE to legacy of mistrust

23 The truly competent physician is the one who sits down, senses the mystery of another human being, and offers with an open hand the simple gifts of personal interest and understanding. Imhotep The Morning After Harold Jenkins,M.D. JAMA 2002, 161-2