Caring for the Southeast Asian Patient. Who Are they?

Transcription

1 Caring for the Southeast Asian Patient Lynne H. Nguyen, M.P.H. Board VP, Asian American Health Coalition Director, Minority & Women Clinical Trials Recruitment, M. D. Anderson Cancer Center Who Are they? 1

2 Identification of Southeast Asians Classification complicated due to diversity Most common languages in Houston: Vietnamese, Hindi/Gujarati/Urdu, Chinese (Cantonese/Mandarin), Korean Religion: Christianity, Buddhism, Hinduism, Islam Culture Asian data is often presented in the aggregate, applied to the group as a whole. This may mask important differences among different subgroups Establishing a Foundation for Understanding Culture is best used to understand behavior, rather than to predict it, since variation within a culture is usually greater than that between cultures G. Galanti 2

3 Your Responsibility Cultural competence requires individual providers at a minimum to Acknowledge cultural differences Understand your own culture Engage in self-assessment Acquire cultural knowledge & skills View behavior within a cultural context Cross et al, 1989 Stereotype vs. Generalization Yuko grew up in Japan. She must know karate. Yuko grew up in Japan. Yuko, did you ever study karate? 3

4 Important Values Patient-Focused Care: Key Components of World View Mental/Physical Disabilities Ethnic Heritage Family Background Educational Experiences Group Membership Relationship Status Nationality Economic Status/Class Political Affiliations ME Culture Social Class Religious Tradition Gender Language Sexual Orientation Regional Background Age Occupation Travel Experiences Race Chaplain David F. Berg, MA, MDiv & Doretta E. Stark, MA, LICSW A Profile 90% of Asian adults in Harris County are first-generation (from Vietnam, Cambodia, Laos, China, India, Pakistan, the Philippines, Korea, or other API nations) 67% grew up in their native lands, and came to the U.S. as adults 47% came to Houston directly from abroad, without having lived anywhere else in America Steven Klineberg,

5 A Closer Look Vietnamese are significantly more likely to not have graduated from high school Filipinos are most likely to have college degrees S. Asians and Filipinos are most likely to have post graduate degrees 28% of Vietnamese work in production or day labor jobs SE Asians are more likely to not have insurance and to report problems getting groceries for their families. Steven Klineberg, 2002 The Model Minority 59% have college degrees 24% have done post graduate work beyond college Stable families, lower divorce rates, polite, well-behaved children Steven Klineberg,

6 Conditions/Diseases to Note Cancers Breast Lung Colon Prostate Liver Stomach Cervical Thyroid Cardiovascular diseases Stroke Heart attack Other risks Diabetes Mental health Tobacco use Tuberculosis Hepatitis B Thalassemia Asian and Pacific Islander American Health Forum ( Non-Verbal Communication Note: Eye contact Personal space Touch Hand gestures Nodding Smiling, shrugging Stoicism (pain, mental health) Time orientation Approaches: Avoid hand gestures. Use both hands to give something Observe spatial needs Explain procedures before physical Assess pain/discomfort, offer solutions Calm, unhurried demeanor Emphasize time focus, explain, remind 6

7 Verbal Communication Note: Approaches: Yes Avoid jargon Saving face Focus on the highest priorities: He said, she said informed consent, self-care skills, Tone of voice how to recognize problems and know how to respond, and Indirect style answering questions. Translations Be explicit on next steps. Assess understanding through demonstration or explanation Ask open-ended ended questions Clarify Establish trust before discussing personal issues Formal approach, address elders first, use titles Allow longer response time Beware of family translators Desire for Information & Decision-Making Note: Patriarchal view of medicine Family may prefer patients not receive bad news Respect for age Respect for education and wisdom Respect for harmony Fear of technology Approaches: Provide options, but also recommendations Ask who should be included in medical decisions Formal and warm style Appropriate dress Share information/ resources 7

8 Health Beliefs & Practices Note: Hot and Cold Traditional medicines Causes of illness Body image Home remedies Efficacy of western medicines Prevention and prophylactics Respect for propriety & harmony Fear of technology. Hospital/hospice seen as last resort Your number s s up Approaches: Suggest balanced diet Ask about herbal medicine use. Check for drug interactions. Tamp down emotions. Ask, clarify Check medication regime, get relatives observations, repeat instructions, explain Have same gender person present during physical exams Explain procedures before and during Accommodate patient s s preference when possible Working with Interpreters Remember that a translated conversation takes twice as long Look at your client, not the translator. Don t t say, Tell her that.. Speak directly to the client DO NOT use family members - especially children - as interpreters unless client specifically requests that Translators and interpreters are highly trained professionals 8

9 Undocumented Immigrants, Refugees, Asylees Utmost sensitivity is required. They may have experienced treatment ent at the hands of official institutions that one could hardly imagine, such as torture and trauma, execution or kidnapping of family members, forced separations, harrassments,, etc... Giving out any identifying information, including names or co- residents and location of relatives, can be threatening You may be perceived as an authority figure and therefore not to be trusted. Questionnaires, forms, informed consents... Can be anxiety- provoking Emotional and mental illness, often covert, are especially prevalent among refugees and asylees.. Often the symptoms, if expressed at all, are expressed physically. Many will deny a problem Certain health problems such as TB and parasites can be prevalent Carrie Cameron, Ph.D. Working with Other Cultures: Skills Summary Think about acculturation level Develop the ability to tolerate and SES your emotions and reactions Remember, culture is often without acting on them behind well-meaning clashes Don t t put too much pressure over ethical & unethical, on yourself to be correct. professional & unprofessional, Learn as you go etc. Always be on the lookout for Identify and use culture the missing piece of the brokers puzzle. There is usually a Use the strengths of the culture you ve learned about to reason why people act and feel the way they do build a bridge - BUT you don t Always strive for a creative have to change your behavior third solution for each type of client 9

10 LEARN to Become Culturally Competent Listen with sympathy and understanding to the patient's perception of the problem Explain your perceptions of the problem and your strategy for treatment. Acknowledge and discuss the differences and similarities between these perceptions. Recommend treatment while remembering the patient's cultural parameters. Negotiate agreement. It is important to understand the patient's explanatory model so that medical treatment fits in their cultural framework. Berlin & Fowkes 8 Questions to Ask 1. What do you call the problem? 2. What do you think caused this problem? 3. Why do you think it started when it did? 4. What do you think the sickness does? How does it work? 5. How severe is the sickness? Will it have a short or long course? 6. What kind of treatment do you think the patient should receive? What are the most important results you hope she receives from this treatment? 7. What are the chief problems the sickness has caused? 8. What do you fear most about the sickness? Arthur Kleinman et al,

11 When Communications Go Awry When Communications Go Awry 11

12 The New Golden Rule Treat others as THEY would like to be treated 12