Transcript About my life and work

Respectful Communication
• 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
Alternative & Complementary
Healing Systems/Techniques
• Latino/Hispanic alternative and
complementary healing systems or
techniques include: Curanderismo,
Espiritismo, and Santeria.
• Healers include:
• Curanderos (general practitioners of
Mexican folk healing)
Alternative & Complementary
Healing Systems/Techniques
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Espiritistas (Puerto Rican faith healers)
Santeros (Cuban faith healers)
Yerbistas (herbalists)
Sobadores (massage therapists)
Folk healers often treat children for
conditions such as:
Alternative & Complementary
Healing Systems/Techniques
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Colico (colic)
Empacho (locked bowels)
Susto (fright)
Mal de ojo (evil eye)
Caida de la mollera (fallen fontanel)
Alternative & Complementary
Healing Systems/Techniques
• Healers also perform spiritual cleansing
(barridas or limpias).
• Insufficient data exists regarding the
extent to which alternative 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.
Latino Health Care Gaps
• Compared with non Latino whites, Latinos are 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 Latinas.
• National Cancer Institute, Cancer Net, Breast Cancer Facts,
1999
Hispanic/Latinos “Double burden”
• 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 Populations: Findings from the
Commonwealth Fund 2001 Health Care Quality
Survey.”Commonwealth Fund (March 2002), Pub #
526.
English-only Healthcare Providers
• 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 Anglo provider have
communication gap, and different
worldviews
Evaluating Effective
Communication
• 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.
Nonverbal Communication
• Much of communication between people is
nonverbal. One must learn it to be able to
truly communicate
• However, Nonverbal Communication is
rarely a part of Foreign Language training
in the higher education system
Nonverbal communication
– Nonverbal communication is the sum of
non-linguistic messages that are
encoded and decoded through
– Gestures
– Facial expressions
– Eye contact
– Tone of voice
– Pauses, silences
Communication gaps
• 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
Two-way communication: ethical
imperative
• To prevent poor health outcomes for
Hispanic/Latinos and to lighten their
“double burden”
• Efforts to improve the quality of AngloLatino communication in health care
settings are ethical imperatives.
Translation vs. Cultural Adaptation
• Health messages and patient education
documents should be not only linguistically
translated but also culturally adapted.
• Straight translation into Spanish has many
limitations.
• Cultural adaptation is a more effective
method to achieve health promotion.
Conceptual equivalence
• In translation, conceptual
equivalence is more important
than linguistic equivalence
• Health behavior modification
approaches must be culturally
appropriate to be effective
Latinos in Columbus: Health gaps
• Uninsured Latinos in Columbus report jobrelated 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
Latinos in Columbus: Health
Care Gaps
• As 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
Latinos in Columbus: Health gaps
• Traumatic injuries sometimes are left
unattended 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
Latinos in Columbus: Health gaps
• 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 foreman
“examined” him, told him “it’s nothing”
gave him Tylenol and told him to keep
working or he’ll be fired
Latinos in Columbus: Health gaps
• 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 the eye.
Latinos in Columbus: Health gaps
• 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 can’t be scheduled
for lack of resources for payment.
• He has lost 95% vision in that eye.
Mistaken Identities & Fear Factor
• Some Latinos are putting 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 else’s
papers with a different name and a
different date of birth.
Bridging the Gaps
• In 2000 HHS published guidelines
Cultural and Linguistically Appropriate
Services (CLAS) urging providers to:
• Provide qualified interpreters.
• Provide written materials in the
patient’s language
Nearly 45 Million Uninsured
• 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 population 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/
Health care -- a human right
• Lack of access to care for the working
poor and the 45 million uninsured in the
US - the richest nation on earth - 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.
Helping Latinos in Columbus
• Many new Hispanic/Latino immigrants have
unmet primary health care needs. Most are
uninsured, have 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 staff is all volunteer.
La Clinica Latina
• 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.
La Clinica Latina (cont.)
• The clinic opened on December 19, 2000. An 8month old boy presenting a leg burn was the first
patient. The burn was caused by 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 29, 2002
La Clinica Latina: Reception Area
(snapshot taken in 2002)
Educating Health Providers: Medical
Communication with Latinos (AMP
641)
• 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.
Medical Communication with
Latinos (AMP 641)
• The course provides 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 [email protected]
Thoughts and Reflection
• Almost one in 6 people in the US lacks
health insurance. 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.
Thoughts and Reflection
• Charitable “free clinics” while providing a
wonderful and noble service can do little to
alleviate the US 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
Final Thought and Reflection
• 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 nation 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 for Practical and
Professional Ethics, 13th Annual Meeting., February 27, 2004