Cultural Competence in Prenatal Care, Childbirth and Beyond. Jennifer K. Phillips MD 6/22/2011

Transcription

1 Cultural Competence in Prenatal Care, Childbirth and Beyond Jennifer K. Phillips MD 6/22/2011

2 Cultural Competence an ability to interact effectively with people of different cultures. Cultural competence comprises four components: (a) Awareness of one's own cultural worldview, (b) Attitude towards cultural differences, (c) Knowledge of different cultural practices and worldviews, and (d) cross-cultural skills. In other words: possessing knowledge, awareness, and respect for other cultures.

3 Why do we care? Developing cultural competence results in an ability to understand, communicate with, and effectively interact with and care for people across cultures. We want to decrease racial and ethnic health disparities that exist in the United States.

4 Stereotype vs Generalization It is important to distinguish between stereotyping (the wrong assumption that everyone in a given culture is alike) and generalizations (awareness of cultural norms). Generalizations can be helpful. We must factor in individual characteristics such as education, nationality, faith, and acculturation. Every individual is unique.

5 Cultural Competence - necessity in healthcare It is not surprising that the healthcare profession was the first to promote cultural competence. A poor diagnosis due to lack of cultural understanding, for example, can have fatal consequences. (1)

6 Consider the Culture Nonverbal or Verbal? Is identity more group oriented or individual? Is there an internal or external locus of control? Does respect mean being on time or giving more time? Is Conflict resolved with emotions or words?

7 Important issues to explore in Prenatal Care Reasons for Pregnancy (planned/unplanned) Prenatal care before A patient s prior birth experience and expectations History of unrepaired 3 rd and 4 th degree tears History of female genital mutilation (FGM is predominantly practiced innortheast and Central Africa and parts of the Near East and Southeast Asia, although it has also been reported to occur in individual tribes in South America and Australia.)(5)

8 Female Genital Mutilation Female circumcision (also termed female genital mutilation), a tradition of some cultures that may have severe health consequences. Female circumcision is illegal in the United States. This procedure is performed on preadolescent girls. It includes the milder sunna forms, in which a part of the clitoris is removed- usually the clitoral prepuce; and the much more extreme infibulation forms, in which the clitoris and labia are excised and most of the vaginal opening is sewn together.

9 Domestic Violence and Abuse Common in many cultures Get patient alone to ask if she feels safe at home It may take time to build the trust that it takes for a woman to disclose abuse Consider PTSD and trauma history; including rape

10 Example Questions What was your last birth like? Who was there with you? Did you receive prenatal care? What was it like? What did you like about your prenatal care and birth experience? What did you dislike? What scares you about birth? What scares you about the hospital? What have you heard about prenatal care and birth here? What do you hope for your prenatal care and birth experience here? Who would you like to help you make decisions? Who would you like to support you in labor?

11 Family Planning and Birth Control Ask about desired family size Understand cultural aspects of menstruation- a blessing or a curse? Offer birth control and explain how they work- don t assume they know

12 Did you know? Frio de la matriz ( frozen womb ) What is it? Pelvic congestion and decreased libido believed to be caused by insufficient rest after childbirth Treatment: Damiana tea (Turnera); rest (4)

13 Did you know? Mal de ojo ( evil eye ) What is it? A hex cast on children, sometimes unconsciously, that is believed to be caused by the admiring gaze of someone more powerful The hex can be broken if the person responsible for the hex touches the child or if a healer passes an egg over the child s body. Children may wear charms for protection.(4)

14 Hot vs cold paradigm Pregnancy is seen as a hot condition in some Latino belief paradigms. Asian, Middle Eastern and Latino cultures all have beliefs about hot and cold imbalance. Hot or cold food is usually seen as treatment as well as certain herbs and cupping or coining. Usually if one has a hot malady- they are treated with something cold and vice versa.

15 Vietnamese Culture emphasis on accommodation rather than confrontation Tend not to display emotions, positive or negative Reserved Difficult saying no to requests and yes to offers May be afraid to ask questions

16 Somalian Culture Children are always blessings, more is always better. Contraception is more acceptable if it is for the health of the woman; anemia, exhaustion, etc May not feel safe delivering at hospital Due date is a foreign concept; babies come when they are ready Breastfeed for long periods- usually 2 years

17 CROSS-CULTURAL MEDICINE Western notions of body, health, and illness are often different from those of other cultures, as are perceived roles of patients, physicians, and medications(2). Familiarizing oneself with some general principles of a certain culture can be useful, but care must be taken not to stereotype persons within any group. An alternative and possibly more feasible approach may be to adopt and practice cultural humility, exploring similarities and differences between oneself and each patient encountered, rather than learning the details of each culture(3).

18 References (1) Mercedes Martin & Billy E. Vaughn (2007). Strategic Diversity & Inclusion Management magazine, pp DTUI Publications Division: San Francisco, CA. (2) Primary Care for Refugees ; B ECKSTEIN, MD Am Fam Physician Feb 15;83(4): (3) Tervalon M, Murray-García J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998;9(2): Cross-Cultural Medicine (4) Cross Cultural Medicine. GREGORY JUCKETT, M.D., M.P.H., West Virginia University School of Medicine, Morgantown, West Virginia; Am Fam Physician Dec 1;72(11): (5) Alexia Lewnes, ed (2005)"Changing a harmful social convention: female genital cutting/mutilation". Innocenti Digest (Florence, Italy: Giuntina): 1 2. ISBN