Latin-American normative values around healthcare. Vannina Gwilliam MSRS, RT (R), BA CMI Hem/Onc/BMT - Primary Children s Hospital

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1 Latin-American normative values around healthcare Vannina Gwilliam MSRS, RT (R), BA CMI Hem/Onc/BMT - Primary Children s Hospital

2 Demographics Hispanic/Latino Population in the US: 17.6% Hispanic/Latino population in Utah: 13.7% Hispanics may be of any race, so also are included in applicable race categories. United State Census Bureau (July 2015) Hispanics are the biggest and fastest growing ethnic group in Utah (Utah Hispanic Chamber of Commerce)

3 Latino-American Culture and Patient relationship with medical providers

4 Simpatía(politeness) Value placed on politeness and pleasantness in the face of stress. Avoidance of hostile confrontation Patients will expect the physician to be polite and pleasant, however the relative neutral attitude of some US physicians may be viewed as negative among Latinos. This may cause: patients to withhold clinical details, non adherence to therapy and poor follow-up, and decreased satisfaction with care. Example/Recommendations Patient may trust someone in the facility that speaks Spanish. This may be why many patients may provide more info to the interpreter after the physician lives the room.

5 Personalismo (Formal friendliness) Latinos place a great emphasis in personal relationships. Failure to connect personally with the Latino patient can mean a loss of trust, non-compliance, and the patient may seek a different provider. Example/Recommendations If provider seems hurried, detached and aloof, the patient may experience resentment and be dissatisfied with care. Start a conversation with a polite conversation: asking about their family and follow with a personal detail. Physician's handshake or placing the hand on the shoulder helps communicate warmth. Share your own experience on a topic that may create a personal connection.

6 Respeto (respect) Examples Respeto: Expect status differences among member of the society. Each person is expected to defer to those who are in position of authority according to age, gender, social position, title, economic status. Doctors and healthcare providers are viewed as authority figures: patient may not ask questions or inform the doctor that he/she may not agree with the recommendations, mainly because does not want to disrespect the physicians authority. May nod to demonstrate carefully listening even though the patient may not agree with the plan of care.

7 Confianza (trust) Confianza implies a trust based largely in personal relationships. Sometimes is more important the idea that a person knows us or is one of us (this outweighs the person s credentials or professional accomplishments Example/Recommendations Talk to your patients about their family and show genuine interest. You will have to build a relationship of trust when asking for participation in a research study. Some patients may feel that if they are not treated with confianza they may be experiencing discrimination.

Familismo (family)/ Fatalismo (fatalism) Familismo: Important decisions are made by the extended family not the individual. Fatalismo: it s the belief that the individual can do little to alter fate.

8 Familismo (family)/ Fatalismo (fatalism) Familismo: Important decisions are made by the extended family not the individual. Fatalismo: it s the belief that the individual can do little to alter fate. Adverse health consequences: less preventative screening and avoidance of effective therapy Examples The Family makes a decision on serious medical conditions. Patient may trust more the information provided by a family member. Clinical care can be affected: signing consents, end-of-life decisions, treatment. Fatalismo: Cancer = Death Losing the hair (clarification of chemotherapy side effects) Providers: can use emphasis in asking the patient to take care of their health so they can take care of their family. Family members may not want to share with their love one that they have cancer (specially with young adults)

Health Care Beliefs Folk Illnesses Traditional healers: Empacho (indigestion) Ataque de Nervios ( nervous attack ) Caída de la mollera ( fallen fontanel ) Curanderismo in Mexico and much of Latin

9 Health Care Beliefs Folk Illnesses Traditional healers: Empacho (indigestion) Ataque de Nervios ( nervous attack ) Caída de la mollera ( fallen fontanel ) Curanderismo in Mexico and much of Latin America Santería in Brazil and Cuba Espiritismo en Puerto Rico Mal de aire ( bad air ) Mal de ojos ( evil eye ) Susto ( soul loss ) Healing specialties: yerberas (herbalists), hueseros (bone setters), parteras (midwives), and sobadores (similar to PT). Fatiga (shortness of breath, fatigue) Bilis (anger) Remedios caseros (Home care remedies) Pasmo ( frozen face ) Mal puesto ( sorcery )

10 Tips: An interpreter is not only there to interpret words, he is the best resource to help understand the Latino culture. Interpreters are also Cultural brokers. Discharge instructions/ Plan of care: provide information according to the patient s educational level. Sometimes color coding meds is helpful if patient can t read. Ensure they have a thermometer at home, if you need to check for fevers.

11 Questions?

12 References Culture and the patient-physician relationship: Achieving cultural competence in health care. The journal of Pediatrics. Glenn Flores, MD. Division of General Pediatrics, Boston Medical Center, Boston, MA. January 2000 Volume 136, Issue 1, Pages Images: PCH Oncology Google images

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