CULTURAL C

OMPETE

NCY

AND AW

ARENESS

PRESENTE

D BY

MAZALO LO

OKY, F

ALL 2

014. MPH

WHAT IS CULTURAL COMPETENCY?

Culture is often described as the combination of a body of

knowledge, a body of belief and a body of behavior. It involves a

number of elements, including personal identification, language,

thoughts, communications, actions, customs, beliefs, values, and

institutions that are often specific to ethnic, racial, religious,

geographic, or social groups.

For the provider of health information or health care, these

elements influence beliefs and belief systems surrounding

health, healing, wellness, illness, disease, and delivery of

health services. The concept of cultural competency has a

positive effect on patient care delivery by enabling providers

to deliver services that are respectful of and responsive to

the health beliefs, practices and cultural and linguistic needs

of diverse patients (CDC, 2014).

Why is cultural competency important?

Cultural competency is critical to reducing health disparities and improving access to

high- quality health care, health care that is respectful of and responsive to the needs of diverse

patients. When developed and implemented as a framework, cultural comp etence enables

systems, agencies, and groups of professionals to function effectively to understand the needs of

groups accessing health information and health care or participating in research -in an inclusive

partnership where the provider and the user of the in formation meet on common ground

(CDC, 2014).

CULTURAL AWARENESS: TOGO, WEST AFRICA:

http://www.state.gov/p/af/ci/to/

Togolese usually have two or three meals per day, each

consisting largely of a starch product, such as cassava,

maize, rice, yams, or plantains. A hot, spicy sauce is

served with midday or evening meals, consisting of a

protein, fish, goat, beans, or beef and often rich in palm

(red) oil or peanut paste. Fruits and vegetables, though

readily available, are eaten more by the bourgeoisie.

Traditional French staples, including baguettes, are mainstream in the cities. A

Togolese funeral is a most important event. Wildly extravagant (by Western

standards), funeral celebrations are a daily occurrence. Marching bands,

choirs, football tournaments, banquets, and stately services are as

fundamental as an expensively decorated coffin. Funerals often take

place over a month or more, and families frequently sell or mortgage

land or homes to pay for the funeral of a beloved and elderly relative.

If the person dies in an accident, however, or some other sudden tragedy (AIDS,

for example), this is considered a "hot death," and the funeral services are

concluded more quickly, with little circumstance.

HAITIANS: FOOD BELIEFS AND RITUALS

http://wtrys/namerica/caribb/ht.htm

Haitians believe that exposing the body to an imbalance of “hot” (cho) and “cold” (fret)

factors cause illness. Haitians also assess food in terms of heavy or light qualities; one should eat

heavy foods, such as cornmeal mush, broiled plantain, or Potato, during the day to provide

energy for work. One should eat light foods, such as hot chocolate milk, bread or soup, for

dinner because they are easily digested.

Method of preparation also important: Boiled green plantains are heavy, but fried yellow/ripe

plantains are light.

Food taboos and prescriptions

Food prohibitions are related to particular diseases and life stages.

For example, to avoid acne, teenagers should not drink citrus juices, such as orange or

lemon.

After strenuous activity or any activity that makes the body hot, one should not eat cold food

because that will cause an imbalance (chofret). When ill, Haitians like pumpkin soup, bouillon,

or a special soup of green vegetable, meat, plantain, dumplings and yam, all kinds of porridge,

oatmeal, and akasan, a cornmeal cream prepared with milk, sugar, cinnamon, vanilla flavoring,

and a pinch of salt.

Hospitality: Haitians are very hospitable. Welcome guests to their home with food, refusal of

which is impolite. May offer child’s bed if guest stays overnight. Family offers most

comfortable space to guest.

Pain (doule)

Haitians can use numerical scales for symptoms if the scales are explained.

Have very low pain threshold. Whole demeanor changes.

Very verbal about what hurts. Sometimes moan.

Usually very vague about location of pain, believing that whole body is affected; because

disease travels, location of pain not important.

Prefer injections. In lieu of injections, order of preference is elixir, tablets, and capsules.

Accept alternative pain treatments.

Haitian can present him or herself in the clinical area and says,

“I am suffocating” (Map toufe) or “I cannot breathe” (Mwen-pa

ka respire). As a care provider, offer oxygen only when

absolutely necessary, as Haitians associate it with serious

disease.Having a son a first born is extremely important because it means he will carry on the family name. Father does not participate in child bearing; he believes that birth is a private event that

is best handled by women. Do not encourage male circumcision, believing that

it reduces sexual satisfaction. Females are not circumcised. Haitians have

inappropriate and undesirable attitudes about birth control. They are very

sensitive and suspicious when topic of discussion is about STIs and HIV because,

in 1982, Haiti was the first developing country blamed for the origin of AIDS.

They still endure stigma of “Haitians are AIDS carriers.” They do not recognize

male partner’s responsibility in preventing conception. Males resent condom

use, believing that condoms reduce sexual pleasure.

Dyspnea

A primary respiratory ailment is oppression.

Haitians use this term to describe asthma, a state of anxiety and

hyperventilation.

Consider oppression (like many respiratory conditions) a “cold” state.

Patient says, “I am suffocating” (Map toufe) or “I cannot breathe”

(Mwen-pa ka respire).

Offer oxygen only when absolutely necessary, as Haitians associate it

with serious disease.

Middle east Indians women

Middle Eastern

Considering the Middle Eastern culture, communication can be a challenge between Middle

Eastern patients and Western health care professionals. Middle Easterners approach life

differently in significant ways from Westerners in terms of time control, power distance,

male or female roles, personal space, and privacy. Ways of handling bad news should be

consider. The degree of exposure to Western or American culture greatly affects an

individual’s attitudes and behaviors. Religious affiliations are also extremely influential.

While it is useful to apply.

generalizations when learning about patterns of communication, it is also important to

avoid applying hard and fast rules in any cross-cultural interaction.

Time Control

Punctuality is less important in the Middle East than in the United States. A patient

might be late for an appointment, or not come at all, because another matter immediately at

hand was seen as more important than the previously scheduled appointment. The matter taking

precedence often involves meeting the needs of someone a person feels obligated to in a

reciprocal relationship. For example, a family member or close friend. Americans, being task-

oriented, plan their days around getting things accomplished and are annoyed by a nonchalant

approach to time. Americans who are left waiting for more than a few minutes may feel

they are being disrespected; the late arriver should offer a good explanation for not

showing up on time. Middle Easterners on the other hand may be offended by the

Americans attention to getting things done rather than taking the time to establish a

relationship.

Middle Easterners touch more frequently, just like Togolese do. This difference in

personal conversing space can make Westerns feel very uncomfortable. The collapsing of

personal space may feel invasive or even somewhat aggressive.

Privacy

Middle East individual may tend to resist disclosing detailed personal information to

strangers, including healthcare professionals. Data for health histories may not be willingly

given and request for information may be viewed with some suspicion until it is clear why the

questions are being asked. Once trust with a caregiver is established, personal information is

given more freely.

Middle Easterners desire to please or to appear good, and less dominant persons must at

all costs placate stronger ones. Healthcare providers should be aware that Middle Easterner is not

likely to ask questions or give information that would contradict or show disrespect. Depending

on the degree of acculturation in the U.S, in religious views, a Middle Eastern person,

especially a male, may feel uncomfortable interacting with a female doctor as a person of

real authority.

Health and Illness Behavior

Middle Easterners have respect for Western medicine. However, in working with any immigrant population, healthcare practitioners should be aware of common folk beliefs and practices. Much like Latino people, Middle Easterners may believe in illness causation such as the Evil Eye. In this belief, anything that provokes jealousy in another gives the envious person the power to cause illness or misfortune for the lucky person or family. Often the object of envy is a beautiful baby or child. Much like Latino and Asian people, Middle Easterners believe in the importance of balancing “hot” and “cold” foods – qualities that do not necessarily have to do with actual food temperature. Healthcare practitioners have frequently observed among Middle Easterners a fatalistic acceptance of disease or death: it’s all in Allah’s hands.

Preventive care is not practiced as commonly in the Middle East as it is in the United States. Middle Eastern patients may expect to receive a prescription because medication is heavily used. Middle Easterners often fear hospital admission because hospitals are considered places of misfortune where people go to die. Moslems are concerned that a family cannot be sure that the body of one of its members will be treated correctly according to religious customs, should a patient die in hospital. Family members do not plan for death and never give up hope until a patient has actually died; grief is not permitted to be shown in the presence of a dying person.

Once death has occurred, mourning may be loud and obvious. A person who is not

overcome with emotion is not admired. It takes more time to consult with a Middle Eastern

family, and that scheduling should be arranged accordingly when possible.

Mexicans:

Because family is very important to Mexicans, it may be helpful to speak with both the

patient and family members. However, to protect confidentiality, seek a patient’s permission

first. Do not assume that nonverbal cues, such as nodding “yes,” mean that a patient is agreeing

to take medications as prescribed (CDC, 2014).

ERITREA

The largest religions in Eritrea are Sunni Muslim (approximately 50%), Orthodox Christian (approximately 40%), Eastern Rite and Roman Catholic (approximately 5%), and the Evangelical Church of Eritrea (approximately 2%). Other minority groups include Seventh-Day Adventists, Jehovah's Witnesses, Baha'is, Buddhists, and Hindus. Islam predominates in the eastern and western lowlands while Christianity is dominant in the highlands. Along ethnic lines, members of the Tigrinya group are primarily Orthodox Christian. Most of the Tigre, Nara, Afar, Saho, Beja, Rashaida, and Blen are Muslim.

Over 50% of the Kunama are Roman Catholic.

Traditionally, the girls are taught to perform household tasks,

but with family roles changing due to immigration, the boys in

the family also help out with housecleaning and dishwashing. As

both spouses begin to work more outside the home, household

duties are more frequently shared

Infant Feeding, Care

Eritreans highly value breastfeeding and as a result, most Eritrean women breastfeed their babies. Women generally breastfeed for up to a year and may stay home for the first 3 to 6 months of their infants’ lives in order to accommodate breastfeeding.

There is often a push to introduce solid foods to infants at 4 months, which is a few months earlier than recommended by American pediatricians.

Eritreans believe in the healing powers of different

plants, although they generally see a medical practitioner

first. If Western medicine does not work, Eritreans may

return home as a last resort to utilize natural native

remedies. Eritreans may not realize that large quantities of

some plants may interact with pharmaceutical drugs and

therefore it should be explained that although herbs may

not seem like medication to the patient, doctors should

be informed if the patient is using them.

Female circumcision is practiced in Eritrea and traditionally

performed by lay healers. The type of female circumcision varies

from region to region. Eritreans wish to have all males circumcised.

Most Eritreans used hospitals in much the same way as here in the

United States (Cooper, 2010).

In the United States

Eritreans generally try Western medicine first for treatment and

believe that doctors in this country are able to help them. They may

be concerned that too much blood is drawn for testing and would

prefer to avoid this unless absolutely necessary.

They may be resistant to blood transfusions but also understand

that if absolutely necessary they will comply. If blood is being

drawn, providers should explain exactly what the purpose is and

what tests are being done on the blood. It should also be

explained that blood tests do not necessarily provide a total

medical overview and sometimes blood tests are looking for one

specific variable.

Gender concordance between the health care provider and the

patient is considered important by many Eritreans. Eritrean men

would prefer to be cared for by male health care providers.

Eritrean women strongly wish to be cared for by female providers

and if an interpreter is needed, a female is preferred (Cooper,

2010).

If an Eritrean is diagnosed with a life-threatening illness, they first

follow the Western medical plan. Eritreans strongly wish that the

family be informed first of a serious illness or poor prognosis

rather than the patient, this way the family can inform the

patient.

If the patient is expected to die, it should be explained to the

family that organs will not be harvested without consent. This

information is especially important if an autopsy is to be

performed (Cooper, 2010).

Vietnamese Cultural Profile

To avoid confrontation or disrespect, many will not vocalize disagreement.

Praising someone profusely is often regarded as flattery, and sometimes even mockery. Most people are very modest and deflect praise.

Insults to elders or ancestors are very serious and often lead to severed social ties.

General EtiquetteMany will smile easily and often, regardless of the underlying emotion, so a smile cannot automatically be interpreted as happiness or agreement.

Vietnamese often laugh in situations that other cultures may find inappropriate. This laughter is not intended as ridicule.

Breaking a promise can be a serious violation of social expectation. It is very difficult to re-establish a lost confidence.

When inviting a friend on an outing, the person who offers the invitation usually offers to pay to the bill.

During social gatherings, Vietnamese will often arrive late so as not to appear overly enthusiastic. However, they are punctual to appointments in professional settings.

Infant Feeding, Care

Most Vietnamese women breastfeed their infants for the first 6-12 months (both in the U.S. and in

Vietnam). In the Country of Origin, Western medicine in Vietnam consisted of many things, mostly

antibiotics, Vitamin B12 shots for "feeling bad," and IV fluids. Attitudes towards suffering: Many see

suffering and illness as an unavoidable part of life. Some also feel (the Hmong in particular) that the length

of one's life is predetermined, and life prolonging or lifesaving care is futile. Also within the community,

stoicism, a masculine trait among mostly older gentlemen, is a highly respected personal trait which can

prevent people from seeking care. Poor physician-patient communication: Southeast Asian cultures value

politeness, respect for authority, and avoidance of shame. Because of this, many will not ask questions, will

not voice disagreement or concern, and will not reveal intentions or actions that seem in contrast to the

physician’s wishes. If patients disagree or do not understand, they may simply listen and answer yes in

respect, then not return for further care or comply with recommendations (Doan and Gruen, 2010).

 

Establishing trust with our patients is the key for success in

caring for different individuals in our communities.

References

Carteret, M. (2011). Health Care for Middle Eastern Patients & Families.

Retrieved from

http:/ /www.dimensionsofculture.com/2010/10/health-care-for-middle-

eastern-patients-families/

Centers for disease control and prevention. (2014). Chapter 2. Overview of

Mexican Culture. Retrieved from

Colin, J , M. (n.d.). Cultural and Clinical Care for Haitians. Retrieved from

http:/ /www.in.gov/ isdh/files/Haiti_Cultural_and_Clinical_Care_Present

ation_Read-Only.pdf

Cooper, D. (2010). Eritrean Cultural Profile. Retrieved from

https:/ /ethnomed.org/culture/eritrean/eritrean-cultural-profile

References cont’

Doan, O and Gruen, S. (2010). Vietnamese Cultural Profile. Retrieved

October 20, 2014, from

https://ethnomed.org/culture/vietnamese/vietnamese-cultural-profile

Everyculture.com. (2014). Culture of Togo. Retrieved October 15, 2014,

from http://www.everyculture.com/To-Z/Togo.html

http://www.worldatlas.com/webimage/countrys/namerica/caribb/ht.htm

http://www.worldatlas.com/webimage/countrys/namerica/caribb/ht.htm