Transcript Hmong Patients

Native American Patients
Essentials of Cultural Competence in Pharmacy
Practice: Chapter 7 Notes
Chapter Author: Dr. Stephen Saiz
Learning Objectives
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Articulate ways assimilation and acculturation have
impacted the identity of Native Americans.
Identify key ceremonies and practices that may have
interactions with medication.
Discuss the unique identity development of Native
Americans.
Identify ways medicine and wellness are defined within
the Native culture.
Native Americans in the U.S.
 Census numbers for people who identify their ethnicity as Native American.
 Census numbers for people who identify themselves as Native American in
combination with one or more other ethnicities.
 Percentage in the total population.
History of Native Americans in U.S.
 1820’s Supreme Court Justice John Marshall tries to protect tribal
interests from claims of individual states.
 1830: President Andrew Jackson defies Marshall’s ruling and gets
the Indian Removal Act passed.
 Removal policy resulted in what is now called the Trail of Tears,
4000-5000 Cherokee died during the extradition.
 When land could no longer be secured through physical removal
or war, Congress passed the 1887 Dawes Act.
 1950s: BIA undertook an Employment Assistance Program.
Forcibly moved thousands of people off reservations for
education, job training and housing.
Health and Wellness
 Cree term Miyowichehtowin = “having good relations”
 Iriquois term Shen-nen Kowa = “maintaining peace between
parties”
 Lakota term Mitakuye Oyasin = “all my relatives”
 Navajo term Hozho = “walking in beauty”
 Each expression describes a life of balance and harmony in all
living things.
Traditional Healers
 May be sought when things are out of balance.
 The patient will talk, pray and make a tobacco offering to the
healer.
 If the healer decides he/she can be of help, the healer will take the
tobacco.
 Healer will draw from his/her knowledge of the power and
qualities of plants, minerals and animal life and prescribe an herbal
tea or ingestion of minerals or participation in a healing ceremony.
 The intent of the medicine is to heal the spirit, to bring that
person back into harmony with Nature where all his/her relatives
reside.
Ceremonies
 Much of traditional Native American healing is done through
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ceremonies
Inipi = sweatlodge (water (pejuta) is medicine). Water is taken in
2 ways during sweat: 1. poured on heated rocks for steam. 2.
passed between each round of steaming to cool and refresh
participants.
Hanbelaycha=Fasting Ceremony (vision quest). To give thanks,
pray for the wellbeing of the community, or receive
guidance/direction for future actions. Go alone to wilderness and
pray without access to food or water for up to 4 days and nights.
Sundance = Wiwang. During the hottest part of the summer,
individuals pray for the welfare of their community. Sundancers
sacrifice in hope their pain and effort will alleviate pain and
suffering in their community.
Notable concerns for sunlight, heat and psychotrophic
medications.
Views of Health/Health Care
 Patient and healer are seen as equal.
 Relationship between patient and healer is a source of
healing.
 Distinction between curing and healing: Native medicine
takes care of the spirit, the life force that all things share.
Western medicine addresses cures (tumors shrink, bone is
set, heart valve repaired).
What Constitutes Medicine?
 Western: drugs
 Native: simple as ingesting water, breathing deeply, or
making an herbal tea.
 VA and American Indian health programs have begun to
reimburse Native healers for providing traditional health care
to native peoples.
Wellness/Red Road
 “The path to wellness in indigenous communities is often
referred to as the Red Road: a journey and a way to well-being
that First Nations people must travel in order to be truly
healthy human beings.”
 Red Road=the proper way to live in harmony among the
distractions of surrounding cultures.
Health Issues
 Lower life expectancy (2.4 years less than the U.S. all races
population; 74.5 vs. 76.9)
 Lacking safe and adequate water supply and waste disposal
for 12% (1% of general population)
 Younger population, more rural than general U.S. population
Health Disparities Among Native
Americans in the U.S.
Alcohol induced death
Breast Cancer
Cerebrovascular
Cervical Cancer
Diabetes
Heart Disease
42.1
16.5
59.9
4.5
73.2
236.2
6.9
6.9
57.9
1.4
25.3
247.8
More Health Disparities…
o
NA
US Population
HIV Infection
2.9
5.0
Homicide (assault)
11.4
7.1
Infant Deaths
8.5
6.8
Maternal Deaths
12.5
9.9
MV Crashes
50.4
15.3
Pneumonia/Flue
31.0
22.0
Things to Remember
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Each Native American participates differently in their
culture. A model of acculturation is important to consider
when providing services to Native peoples
Native people may be wary of health care professionals.
Often a relationship needs to be established if you are to get
a comprehensive picture of the person you are serving.
Policies of assimilation and the introduction of foreign
illnesses have resulted in the presence of P.T.S.D. like
symptoms in many Native people (historical grief/trauma).
Native belief systems value balance and harmony with
nature.
Participating in traditional ceremonies may require great
personal sacrifice and deprivation. The practice of these
ceremonies may complicate the effectiveness of Western
medicines.
More Things to Remember…
 Medicine to Native people is usually a compound found in
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nature (water, plant or mineral) and is administered to bring
the patient back to harmony and balance with the life force
that all of Nature shares.
Studies have established that as many as 70% of Native people
have used traditional medicine.
Most dominant culture images of Native people are derived
from inaccurate, costumed charades of real Native people.
Native Americans do not possess a large enough number of
assimilated individuals to effectively challenge the veracity of
racist caricatures. Understanding authentic Native ways
requires effort and respectful curiosity.
The protective role the government plays in the life of Native
persons has fostered paternalism towards Native people. It can
result in behaviors that make Native peoples less than full
partners in their health care decisions.
Movie…
Culturally Competent Patient Navigation on
Reservations in SD (50 mins)
http://videos.med.wisc.edu/videoInfo.php?videoid=
203
Reflection Questions
1. What strategies will you use to treat patients who
supplement contemporary medical treatment with
traditional Native American healing rituals?
2. How will you use your understanding of the spiritual
background of Native Americans in your pharmacy practice?
3. In what ways did the information presented in this chapter
affect your view of Native Americans?