Why be Culturally Competent?Why be Culturally Competent?

Project Goals

ResourcesResources

•Verify the existence, availability, and relevance of Verify the existence, availability, and relevance of every listed resource listed in the CVAHEC Cultural every listed resource listed in the CVAHEC Cultural Competency ManualCompetency Manual

•Add each source to EndNoteAdd each source to EndNote® ® to standardize to standardize citation format and ensure future availability and citation format and ensure future availability and reference easereference ease

Structure Structure

•Develop a standardized template for each chapter Develop a standardized template for each chapter to convey population-specific information in a to convey population-specific information in a uniform, streamlined, and easily searchable manner uniform, streamlined, and easily searchable manner

•Edit existing content for impartiality and consistent Edit existing content for impartiality and consistent voice voice

•Identify key points to be highlighted in “pop-out Identify key points to be highlighted in “pop-out boxes” boxes”

Introduction RewriteIntroduction Rewrite

• Emphasize the importance of Cultural Competency Emphasize the importance of Cultural Competency in the context of health disparities in the context of health disparities

•Address barriers care providers face in treating Address barriers care providers face in treating refugee/immigrant/or minority populationsrefugee/immigrant/or minority populations

New Chapters New Chapters

• Add chapters on Burmese Refugees and Chinese Add chapters on Burmese Refugees and Chinese Immigrants to reflect Vermont’s changing population Immigrants to reflect Vermont’s changing population

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METHODSMETHODS

This program is funded by U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA)

Cultural Competency for Health Care Providers Chelsea Harris MS-II, Charlotte Reback MD, University of Vermont College of Medicine, Burlington VT2011 SEARCH Scholars Project

ResourcesSource material was evaluated and subsequently coded on the following scheme: a. Relevant and current: likely to be used as a primary source when reformatting the documentb. Relevant for additional reading: worthy of inclusion as a hyperlink or pop-out box within the main document c. Helpful source to be cited in appendix but not highlighted in the main text d. Less relevant and/or out of date e. Non-existent, not useful, not relevant A summary of each source, based on abstract, introduction and discussion was also included

When you learn something from people, or from a culture, you accept it as a gift, and it is your lifelong commitment to preserve it and build on it ~Yo-Yo Ma

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StructureStructure: : We took a tiered approach in determining the new We took a tiered approach in determining the new organization of the manual. We started with the questionorganization of the manual. We started with the question “why is cultural competence important?” “why is cultural competence important?” thenthen narrowed to address narrowed to address “what are the barriers?” “what are the barriers?” and and finally included finally included chapters on individual populationschapters on individual populations. . We designed the chapter template to begin with an We designed the chapter template to begin with an almanac/demographic portion followed by a more almanac/demographic portion followed by a more detailed cultural profile detailed cultural profile

Information for chapters on new Information for chapters on new populations was obtained via a literature populations was obtained via a literature search and communication with search and communication with community members and invested community members and invested parties parties

Challenges: As a small state, there is not a lot of Vermont –specific data available

Because of limited time frame, structural changes need be appropriate to scope so that the manual remains useable between updates

Diverse populations and experiences make generalizations difficult

Structural barriers to Care Structural barriers to Care

Spotlight on Burmese Refugees

Spotlight on Chinese Immigrants

“Respect for one’s parents is

the highest duty of civil

life”

History: Asian Americans are the fastest growing demographic in the US, but Chinese immigration has a long history, that impacts cultural norms today Culture: built around the central pillars of honor and respect for family, “saving face” is a major motivator

Family: model for all relationships in Chinese SocietyEducation: highly valued among all socioeconomic levelsHealth: approached in a holistic manner, focused on harmony Infectious Disease: Hepatitis B, TBLife Style: Cancer, increased chronic illness with acculturation Family Planning: still taboo, but changing norms Mental Health: highly stigmatized, holistic approachTraditional practices: highly developed though most immigrants use both Western and traditional medicine

• Inadequate understanding of patients’ previous health care experience

• Practitioner biases • Lack of diversity in health care • Underdeveloped clinic infrastructure • Poor communication

“Cultural competence is not a panacea that will single-handedly improve health outcomes and eliminate disparities, but a necessary set of skills for physicians who wish to deliver high-quality care to all patients.”

The literature is increasingly supporting the idea that, besides The literature is increasingly supporting the idea that, besides being a worthy goal in and of itself, cultural competency is being a worthy goal in and of itself, cultural competency is improving health outcomes, and may increasingly have a role in improving health outcomes, and may increasingly have a role in cost saving as well. It is an integral part of any substantial effort cost saving as well. It is an integral part of any substantial effort to address health care disparities. to address health care disparities.

History: Burma is home to one of the world’s longest running civil wars , and consequently a major refugee crisis Culture: Burma is one of the most ethnically diverse countries in the world; however most refugees in Vermont and the US are Karen Religion: Buddhism, Animism Christianity, Islam: along ethnic lines Diet: rice based, augmented with vegetables and fish paste, “hot” and “cold” foods play a role in health Family: prominent social force; tradition of communal child rearingEducation: strong tradition stemming from Buddhist monasteries Health: varies based on individual refugee experience Infectious Disease: Intestinal parasites, Hepatitis B, TBLife Style: Betel Nut, Cigarettes and Alcohol, lead poisoning Family Planning: low education, acceptable as “child spacing”Mental Health: frequent history of trauma, stigmatized Traditional practices: strong history, food plays an integral role

Religion: Buddhism, Taoism, Confucianism, ChristianityDiet: rice and noodle based, supplemented with fish and vegetables. All foods have yin or yang properties depending on their energies