1、 Certain topics are taboo in some cultures.E.g.,asking an older Latina/Hispanic unmarried woman about sex behavior can be considered offensive.You may want to tell the patient that you realize that some things are not normally discussed,but that it is necessary so that the best care can be planned L
2、atino/Hispanic alternative and complementary healing systems or techniques include:Curanderismo,Espiritismo,and Santeria.Healers include:Curanderos(general practitioners of Mexican folk healing)Espiritistas(Puerto Rican faith healers)Santeros(Cuban faith healers)Yerbistas(herbalists)Sobadores(massag
3、e therapists)Folk healers often treat children for conditions such as:Colico(colic)Empacho(locked bowels)Susto(fright)Mal de ojo(evil eye)Caida de la mollera(fallen fontanel)Healers also perform spiritual cleansing(barridas or limpias).Insufficient data exists regarding the extent to which alternati
4、ve and complementary healers and systems are used by Hispanics Villa,M.L.,Cuellar,J.,Gamel,N.,&Yeo,G.(1993).Aging and Health:Hispanic American Elders(2nd edition),SGEC Working Paper Series,Number 5,Ethnogeriatric Reviews,Stanford Geriatric Education Center.Compared with non Latino whites,Latinos are
5、 three times as likely to be uninsured.Many have no regular source of primary care,receive fewer check-ups,cancer screenings and other preventive services.They rely heavily on sporadic and emergency room care.As a result of late diagnosis,breast cancer is the leading cause of cancer death among Lati
6、nas.National Cancer Institute,Cancer Net,Breast Cancer Facts,1999 Doty and Ives have extensively documented Latinos“Double burden”1)Limited English proficiency(LEP)2)Lack of health insurance Together,the“double burden”can be a death sentence Doty,M.and Ives,B.“Quality of Health Care for Hispanic Pop
7、ulations:Findings from the Commonwealth Fund 2001 Health Care Quality Survey.”Commonwealth Fund(March 2002),Pub#526.In the US,providers tend to be monolingual-English only.And/or have insufficient knowledge of Spanish and lack awareness of medically relevant aspects of culture Latino patient and Ang
8、lo provider have communication gap,and different worldviews Providers should evaluate whether questions or instructions given to LEP patients have been understood To be polite,some Hispanic/Latino patients will nod“yes”but not really comprehend.Much of communication between people is nonverbal.One m
9、ust learn it to be able to truly communicate However,Nonverbal Communication is rarely a part of Foreign Language training in the higher education systemNonverbal communication is the sum of non-linguistic messages that are encoded and decoded through Gestures Facial expressions Eye contact Tone of
10、voice Pauses,silences Cultural,linguistic,and nonlinguistic gaps can lead to miscommunication and mistrust.Health care personnel must be trained in cross cultural assessment and in both the verbal and nonverbal aspects of communication To prevent poor health outcomes for Hispanic/Latinos and to ligh
11、ten their“double burden”Efforts to improve the quality of Anglo-Latino communication in health care settings are ethical imperatives.Health messages and patient education documents should be not only linguistically translated but also culturally adapted.Straight translation into Spanish has many lim
12、itations.Cultural adaptation is a more effective method to achieve health promotion.In translation,conceptual equivalence is more important than linguistic equivalence Health behavior modification approaches must be culturally appropriate to be effective Uninsured Latinos in Columbus report job-rela
13、ted injuries,trauma,diabetes,hypertension,allergies,need for birth control,skin rash and other conditions Often they can not afford to take time away from work to go to a doctor during the day Source:State of La Clinica Latina:A First Year Report”Raquel Diaz-Sprague,PharmD MS MLHR,January 29,2002 As
14、 Latinos are the least paid workers,and the least insured,they can not afford the cost of a primary care medical consultation or to buy the prescriptions they need to control chronic diseases or conditions such as allergies,asthma,diabetes,and hypertension Traumatic injuries sometimes are left unatt
15、ended resulting in irreparable losses.E.g.,Marcos,a 48 year old Mexican construction worker was opening a door by hammering on a concrete wall on a Tuesday afternoon A piece of concrete flew into his right eye.He felt like he was bleeding but no blood was coming from the eye.The pain was acute.His f
16、oreman“examined”him,told him“its nothing”gave him Tylenol and told him to keep working or hell be fired Marcos kept taking Tylenol and kept working with eye pain for 5 days.The foreman finally took him to an emergency room on Sunday evening He had an emergency operation to remove a metal piece from
17、the eye.The operation cost$2000.He gave the hospital all he had,$400.The foreman refused to help pay.The hospital refused to do follow up care.He needs an operation to correct the eye muscles.He cant be scheduled for lack of resources for payment.He has lost 95%vision in that eye.Some Latinos are pu
18、tting off going to a doctor because of fear they will be asked to show“papers.”They may or may not have legal papers.They may be using someone elses papers with a different name and a different date of birth.In 2000 HHS published guidelines Cultural and Linguistically Appropriate Services(CLAS)urgin
19、g providers to:Provide qualified interpreters.Provide written materials in the patients language Nearly 45 million Americans 15.6%of the U.S.population did not have health insurance during a typical month in 2003.This represents an increase of 5 million people and more than 1 percent of the populati
20、on since 1990 Source:Protecting the Protecting the Uninsured”Kenneth E.Thorpe,Ph.D.New England Journal of Medicine October 6,2004 Volume 351 October 7,2004 Number 15 http:/content.nejm.org/Lack of access to care for the working poor and the 45 million uninsured in the US-the richest nation on earth-
21、is an ethical issue requiring action response.Lack of access to health care puts people at risk for severe conditions that could have been effectively managed when diagnosed and treated at an early stage.Many new Hispanic/Latino immigrants have unmet primary health care needs.Most are uninsured,have
22、 little financial resources and rely on episodic or emergency care.From 1999-2002,I led a group of volunteers as Chair of Latino Health Alliance and Founding Director of La Clinica Latina.The clinic currently operates for about 3 hours 2 or 3 nights a month.It is funded by the OSU Medical Center.The
23、 staff is all volunteer.Mission of La Clinica Latina To educate Latinos in Columbus on health care issues and provide free primary care in a bilingual and bicultural atmosphere.The clinic opened on December 19,2000.An 8-month old boy presenting a leg burn was the first patient.The burn was caused by
24、 a chemical gel leaking from a cheap diaper.He was treated and recovered quickly.We fell in love with him.His parents were so very grateful.La Clinica provided 727 patient visits to 320 patients in 2001.Source:State of La Clinica Latina:A First Year Report”Raquel Diaz-Sprague,PharmD MS MLHR,January
25、29,2002 AMP 641 evolved from a minimodule in the Medical Humanities Program for MEDI and MEDII.Course offered Spring Quarter open to students in any college.AMP 641 is included in the Latino/a Studies curriculum of the College of Humanities,Division of Comparative Ethnic Studies.The course provides
26、instruction on medical terminology,cultural adaptation in translation,medically relevant aspects of Hispanic/Latino culture,service learning Permission of Instructor is required.Instructor:Raquel Diaz-Sprague,PharmD Contact diaz-sprague.1osu.edu Almost one in 6 people in the US lacks health insuranc
27、e.The number of uninsured is growing as costs escalate.The nation must end this health injustice.Creative solutions to provide access to health care for all are needed.It is an ethical imperative.Charitable“free clinics”while providing a wonderful and noble service can do little to alleviate the US
28、health care access crisis.Expanding a network of free or low-cost clinics,is at best a“bandage”over a deep,festering wound.Universal coverage is needed The inhumanity of slavery in the US could not have been ended by expanding emancipation,but by abolishing the institution of slavery!So must this na
29、tion abolish,for all time to come,the inhumanity of“lack of health care coverage”built in the US healthcare system.Will we join the civilized world?Source:“Intercultural Understanding and Communication Can Help Bridge Health Gaps for Latinos”Presentation by Raquel Diaz-Sprague,American Association f
30、or Practical and Professional Ethics,13th Annual Meeting.,February 27,20040C4F7JaMdPhSkVnZq$u*x-A2D5G8KbNfQiTlXo#r%v(y0B3E6I9LcOgRjVmYp!t&w)z1C4G7JaMePhSo#r%u(y+B3E6H9LcOfRjUmYp!s&w)z0C4F7JaMdPhSkVnZq$u*x-A2D5G8KbNfQiTlXo#r%v(y0B3E6I9LcOgRjVmYp!t&w)z1C4G7JaMePhSkWnZq$u*x+A2D5H8KbNfQiUlXo#s%v(y0B3F6I
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