Health Promotion Plan for Substance Abuse for the Trinidadian Culture 1

Health Promotion Plan for Substance Abuse for the Trinidadian Culture

Nadzeya Lazarev

New York City College of Technology

NUR 3010 Section 8515

Prof. Okumakpeyi

October 24, 2011

Health Promotion Plan for Substance Abuse for the Trinidadian Culture 2

Practices

There are 186,000 Trinidadian Americans living in the United States. The largest

distribution of the population is concentrated in the north-east region. (U.S. Census

Bureau, 2007) Trinidadians are mostly of African descent and Indian descent. Some

Trinidadians have European, Middle-Eastern, Chinese, and Pilipino ancestry.

Trinidadians can write and speak standard English. They also speak nonstandard

English, a mixture of British English, Spanish, French, and Hindi. Their national slogan

“Together we aspire, together we achieve” symbolizes multiculturalism, unity in

diversity, and tolerance (Yelvington, n.d.).

Maharajh and Ali carried out the research to discover such cultural behaviors of

the Trinidadian culture as obsessional lateness, liming, tabanca, carnival mentality, and

playboy personality (2002). Trinidadians’ obsessional lateness is expressed by being

late for any event for 15-45 minutes. Liming is a major cultural event when Trinidadians

gather together to hang out. “It is an activity geared towards relaxation, stress relief

through the means of talking, eating and drinking or just doing nothing” (Maharajh & Ali,

2002). Trinidadians can experience tabanca, a state of depression with withdrawal

symptoms, if a loved one rejects them. They worry about unrequited love so much that

they refuse to eat and sleep. Carnival mentality is described as a non-stop party where

Trinidadians can be involved in consuming a lot of alcohol, taking part in immoral and

vulgar activities without any consequences. Playboy personality refers to a man has

many girlfriends and is only interested in sexual gratification from them. His dress is

elegant, his car is expensive, and his purse has lots of money. This man believes he is

“God’s gift to women, a real charmer” (Maharajh & Ali, 2002).

Health Promotion Plan for Substance Abuse for the Trinidadian Culture 3

Beliefs

Trinidadians are known for their religious diversity. There are various groups of

Christianity (Roman Catholics, Anglicans, Presbyterians, etc.), Hinduism, and Islam.

Many Trinidadians believe in spiritual travel. While praying, a spirit can travel out of the

body that gives an opportunity to be closer to God (Maharajh & Ali, 2002).

Trinidadians also believe in a phenomenon called the evil eye when strangers or

enemies of a mother can cause such misfortunes as illness or death to a baby. The

child who has fever, change of skin color, inability to void, loss of appetite or weight is

considered to be a victim of the evil eye. Therefore, to protect a child from the evil eye,

the child wears a bracelet of blue beads (Allen, 1998).

Values

For Trinidadians, social status is recognized by material possessions such as

cars, houses, high technology electronics, and dress. The important symbols of middle-

class status are also education and use of standard English. The parents do their

utmost to give higher education to their children. Moreover, Trinidadians place a high

value on sociability and publicity (Yelvington, n.d.).

Trinidadians raise their children in strict discipline. Children are not allowed to

argue with their caretakers; they must respect adults. If a child is disobedient, it will be

shame to his/her family. While boys are raised to be aggressive, girls are inspired to

underline their physical beauty (Yelvington, n.d.).

Customs

The most important event in Trinidadians’ life is Carnival. Trinidadians allow the

evil spirits to be released for a couple of days. The event is full of colorful costumes,

Health Promotion Plan for Substance Abuse for the Trinidadian Culture 4

calypso music, stick fighting and limbo dance. Trinidadians work hard to prepare for

Carnival and take part in different competitions. As Trinidadians associate ceremonial

events with food, they generously give food to everybody during Carnival. Their food is

a mixture of African and Indian cuisine with some elements of French, Chinese,

Spanish, and English traditions (Yelvington, n.d.).

Another significant festival is Diwali, the festival of lights, celebrated in Hindus

families. The families gather together in their homes to celebrate the victory of

goodness over evil.

Cultural Meaning of Health and Illness

The health beliefs of Trinidadians are influenced by a spiritual belief system

which declares a holism between mind, body and spirit. They believe that supernatural

powers or gods create different misfortunes such as financial loss, accident, or illness.

Trinidadians contact a priest who is in close contact with the powers. The priest will

decide what treatment is appropriate for misfortune, whether it includes herbal remedies

or pharmacological drugs, prayer, or sacrifice to a god. The priest can not only

determine the treatment, but he/she can advise about the prevention of misfortune by

changing the diet, drinking a magic substance, making sacrifices or carrying protective

charms (Allen, 1998).

The priest sometimes advises Trinidadians to visit a medical doctor. However,

many Trinidadians think “prevention and cure of disease depends primarily on one’s

relationship with God; …doctors are technicians, altering the physics or chemistry of the

body but with no insight into the spiritual roots of disease” (Allen, 1998, p. 86).

Health Promotion Plan for Substance Abuse for the Trinidadian Culture 5

These beliefs and practices of health and illness continue to be as resistant

alternatives to the modern medicine. “Biomedicine can coexist with spiritual belief

systems which include illness as only one dimension of the vagaries of life” (Allen, 1998,

p. 87). For example, Trinidadians can take dietary supplements and pharmacological

drugs and at the same time obey the advice of their priest and carry charms.

Leading Health Objective: Substance Abuse (Alcohol)

Alcohol is an intoxicating substance that affects every organ in the body. Alcohol

consumption is one of the major risks for developing over 60 health problems such as

cirrhosis of the liver, cancers of mouth and oropharynx, cardiovascular diseases, and

neuropsychiatric diseases. Alcohol can lead to falls, intentional and non intentional

injuries, accidental poisonings, and road traffic accidents. Alcohol drinking can also

cause social and public problems: domestic violence, child abuse, marital problems,

financial problems, unemployment, crime, homicide, or suicide. Moreover, alcohol

consumption is connected with high-risk behaviors such as unsafe sexual practices and

use of drugs that can lead to HIV/AIDS and other sexually transmitted diseases,

teenage pregnancy, and drug dependence (Monteiro, 2007).

“In 2005, an estimated 22 million Americans struggle with a drug or alcohol

problem. Almost 95 percent of people with substance use problems are considered

unaware of their problem. Of those who recognize their problem, 273,000 have made

an unsuccessful effort to obtain treatment” (Healthy People 2020, 2011).

According to U.S. Preventive Services Task Force, alcohol misuse can be

applied to risky and harmful drinking and alcohol dependence (2004). Risky drinking

refers to “more than 7 drinks per week or more than 3 drinks per occasion for women,

Health Promotion Plan for Substance Abuse for the Trinidadian Culture 6

and more than 14 drinks per week or more than 4 drinks per occasion for men”. Harmful

drinking has been applied to people who are “currently experiencing physical, social, or

psychological harm from alcohol use but do not meet criteria for dependence”. Alcohol

dependence refers to “repeated negative physical, psychological, and social effects

from alcohol”.

Alcohol is the substance used more regularly among Trinidadians than any other

substance (tobacco, marijuana, or cocaine). In 2007, Rollocks and Dass conducted the

research and find out that Indo-Trinidadians and Mixed descents had a higher level of

alcohol consumption than Afro-Trinidadians. Furthermore, Indo-Trinidadians start

drinking alcohol at an earlier age than others.

Regardless of the prevalence of alcohol problems among Trinidadians, there is

lack of clinical and community interventions and consumer resources. Protecting the

health and safety of Trinidadians, preventable measures to reduce alcohol

consumption, alcohol-related problems and alcohol-related diseases should be taken

into account.

Culturally Specific Considerations for the Interview

While interviewing and taking a heath history of Trinidadians’ patients, a nurse

should be aware of some specific cultural considerations. During the greeting,

Trinidadians can make a simple nod of the head or shake hands disregard of gender.

Males and females are considered equal in the culture. However, some women,

especially Indo-Trinidadians, may prefer a woman heath provider. During the

conversation, Trinidadians are direct and to the point; therefore, direct questioning to

obtain information about a patient can be used. They maintain personal space of about

Health Promotion Plan for Substance Abuse for the Trinidadian Culture 7

two feet and do not tend to touch people. Moreover, Trinidadians maintain direct eye

contact during the interaction. Maintaining eye contact indicates high levels of

knowledge and confidence, and looking upward signals thinking (McCarthy & Lee,

2006). Hence, the nurse may arrange the room in the way that the nurse and the patient

maintain eye contact (e.g., position a chair in front of the patient).

Trinidadians’ patients should be taught about a high level of alcohol consumption

among their individuals and what harm is caused by alcohol use. Regular screening and

behavior counseling about alcohol drinking should be done to reduce alcohol misuse

among Trinidadians. To elicit information about alcohol use, CAGE screening

questionnaire may be used in a non-judgmental way.

CAGE questions:

Have you felt you ought to cut down on your drinking?

Have people annoyed you by criticizing your drinking?

Have you felt bad or guilty about your drinking?

Have you ever had a drink first thing in the morning to steady your nerves or get

rid of a hangover? (Smeltzer, Bare, Hinkle & Cheever, 2008)

To provide culturally competent care, a nurse must be aware of a patient cultural

background. However, it is important not to stereotype Trinidadians and draw the

inference that all individuals from the Trinidadian culture will adhere to the same

practices, beliefs, values, and customs. The nurse should see each patient as unique

and learn the patient’s cultural preference.

Health Promotion Plan for Substance Abuse for the Trinidadian Culture 8

Community Health Clinic “Together we aspire, together we achieve”

The national slogan of Trinidadians “Together we aspire, together we achieve” is

incorporated into the name of the community health clinic. It will attract Trinidadians and

encourage them to join together to stand against a common problem of alcohol to

protect their community, their families, and their children.

One of the most important components of a health promotion plan is education.

Trinidadians should be aware of alcohol prevalence in their community. Trinidadians

must receive information about what is considered risky and harmful drinking and

alcohol dependence and what effects of alcohol consumption have on their health and

their community. It is important to start education as earlier as possible due to the

underage drinking. Teaching can be provided through combination of actions:

Post alcohol warnings in the settings where alcohol is sold;

Broadcast information through media: newspapers, TV, radio, internet;

Create a page on Facebook, Twitter and other social sites and encourage

Trinidadians, especially adolescents, to join discussions;

Distribute informative pamphlets through medical offices, clinics,

pharmacies, and schools;

Provide individual counseling by professional health care providers;

Arrange group education classes in community health clinics, community

centers, schools, and other available places;

Conduct a publicity campaign (i.e., alcohol advertising promotes underage

use of alcohol beverages; therefore, alcohol should be forbidden in places

where children are present).

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Because Trinidadians place a high value on sociability and gregariousness,

health promotion plan for Trinidadians will work most effectively at a group level.

Trinidadians prefer gather together and be involved in the planning and implementing of

programs. They like to inquire their knowledge through group discussions. Because

Trinidadians are generous with food, free food will be offered during educational classes

or meetings. It will promote the impression of something pleasant among Trinidadians.

Another component of the health promotion plan is directed toward healthy

behavior. Since Trinidadians enjoy liming or spending time by doing nothing, so the

strategies are focused on the involvement in community organizations. Trinidadians’

youth will be encouraged to participate in different active organizations (e.g., Scouts)

and clubs (e.g., dance or sport clubs). They should be motivated to learning and

enhancing their abilities by participating in various competitions, creating projects, and

receiving rewards. In addition, by making youth feel more responsible, they can be

assigned to be mentors in their peer group. The mentors will meet regularly with adults

and discuss any concerns or problems. In this case, not only youth benefit from

trustworthiness and accountability, but also adults who will have the latest reliable

information about what is going on with youth.

Free professional educational classes are arranged for Trinidadians’ adults to

find a good job and make them busy. Recreational healthy activities are also provided

for the adults to avoid social isolation and boredom. Moreover, during any community

organizations, alcohol products are not served. Trinidadians’ adults, first of all, need to

start working on their behavior modification and stop the association of any event with

drinking alcohol. By this way, the adults provide role modeling for their young

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generation. Trinidadians, who have already developed alcohol problems, will be

monitored individually by a healthcare professional, in addition to activities discussed

above.

There is no doubt that public participation, community support and cooperation

among Trinidadians will lead to a successful health promotion plan.

Cultural Competency in Nursing Practice

While working on the health promotion plan for Trinidadians, I have learned a lot

of specific information about their culture and become aware of their unique practices,

beliefs, values, and customs. In order to prepare a successful plan, first of all, I

acknowledged my own cultural perspective. I explored that my cultural beliefs are

different from Trinidadians’ ones. I understood that the conflict between our beliefs

should not be a barrier in building relationships, gaining trust and providing care. We are

all diverse and unique. Only then, I integrated the knowledge of the Trinidadian culture

into my work. It helped me to avoid any biases, stereotypes, and assumptions, and

make planning care culturally competent.

Health Promotion Plan for Substance Abuse for the Trinidadian Culture 11

References

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Maharajh, H.D. and Ali, A. (2002). Recognition of Cultural Behaviors In Trinidad and

Tobago. Internet Journal of Third World Medicine, 1(2). Retrieved September 20,

2011, from the Academic Search Complete database.

McCarthy, A. and Lee, K. (2006). Cultural Display Rules Drive Eye Gaze during

Thinking. Cross Cultural Psychology, 37(6), 717-722.

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10.1080/00952990601091192

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nical

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