Dr Beatriz CardonaUWS Office of Engagement University of Western Sydney

What we need to consider◦ Demographics (refugees and low socio

economic migrants in western sydney)◦ Disparities in Health Status◦ Health Practices and Beliefs◦ Barriers to Health Care

◦ Culture informs our identity◦ Culture affects the roles played within a family,

ethnic group and community◦ Culture defines family relationships, family

structure, attitudes, beliefs, practices and styles of communication

◦ It also impact on our health practices and choices: for example: use of complementary medicine, attitudes towards vaccinations, dress and food preferences, attitudes toward women, etc

◦ However Culture is not he only or the most important determinant of health: think of the 3 factors: demographics, environment and culture

It reflects the ability to acquire and use knowledge of health care related beliefs, attitudes, practices and communication patterns of clients and their families to improve services, strengthen programs, increase community participation and close the gaps in health status among diverse population groups.

Cultural competency is not static – you don’t really become but constantly becoming

Fluid Culture as constantly being negotiated Multiple cultural identities No single formula but emphasis on

processes and skills we use to negotiate interactions

Cultures in negotiation _ cultural self-awareness

Cultural Competence is a set of values, behaviors, attitudes and practices within a system, organization, or among individuals that enables them to work effectively across cultures.

cultural competence focuses on the capacity of the health worker to improve health status by integrating culture into the clinical context.

the point of cultural competence is to maximise gains from a health intervention where the parties are from different cultures

Multicultural policy in NSW is administered by the Community Relations Commission (CRC) for a multicultural NSW and is based on 4 principles of multiculturalism.

Principles of Multiculturalism require that

each public authority respect and accommodate the culture, language and

religion of all individuals. Cultural diversity is defined as : people from

a range of cultural, ethnic, linguistic and religious background

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• “The healthy migrant effect”: Initial migrant healthadvantage often deteriorates over time as diet andexercise patterns change• Limited research into immigrant health in Australia invisibility can undermine equity in healthcare provision• Immigrants face additional language and/or culturalbarriers not experienced by Australian-born patients• Poor engagement of older migrants to health systemundermines self-management of chronic conditions:effective communication is crucial to effective care

• Humanitarian immigrants (refugees) are known to have poorer health than other immigrants (Khoo 2010) • Vitamin D deficiency common in newly arrived refugee children- consider rickets (Sheikh et al,

2011) • Afghanis may need written information in Dari and Pashtu, as well as interpreters (Omeri et al,

2006) • Ask Horn of Africa refugees about prior use of qaat (e.g. addictive - illegal in Aust.) (Bruce-Chwatt

(2010)

• inadequate vaccinations, nutritional deficiencies (vitamin D and iron) and dental disease

• infectious diseases (gastrointestinal infections,schistosomiasis, and latent tuberculosis)

• musculoskeletal, social and psychological problems e.g. PTSD, anxiety, depression

“I do not understand the health care system in Australia. I have to rely on family and friends …”

“It is difficult to find a service that provides an interpreter …”

“Because of my religion, I prefer to see afemale doctor … especially for reproductive

issues” (Omeri et al, 2006)

Can you give any examples?

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Interpreters Bilingual health workers Culturally appropriate food Non denominational quiet rooms Translated health information Cultural competence training Signage

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Understand the importance of culture

Recognise the dynamics of cultural differences

Build cultural knowledge

Adapt services to meet cultural needs

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• Language Differences• Culture• Non verbal communication• Stereotyping• Discrimination

• Stress• Organisational constraints• The human factor• Resistance to change

http://www.youtube.com/watch?v=OwmhZNd9uQE&feature=BFa&list=PL3113DC6B0561C3C6&index=2

The Culture of Western Medicine◦ Meliorism – make it better◦ Dominance over nature – take control◦ Activism – do something◦ Timeliness – sooner than later◦ Therapeutic aggressiveness – stronger=better◦ Future orientation – plan, newer=better◦ Standardization – treat similar the same

“Ours”◦ Make it Better◦ Control Over Nature◦ Do Something◦ Intervene Now◦ Strong Measures◦ Plan Ahead – Recent

is Best◦ Standardize – Treat

Everyone the Same

“Others”◦ Accept With Grace◦ Balance/Harmony with

Nature◦ Wait and See◦ Cautious Deliberation◦ Gentle Approach◦ Take Life As It Comes –

“Time Honored”◦ Individualize – Recognize

Differences

The Cultural Competence Continuum

◦ Where Am I Now?◦ Where Could I Be?

Cultural Competence Definitions◦ Cultural Destructiveness: forced assimilation,

subjugation, rights and privileges for dominant groups only

◦ Cultural Incapacity: racism, maintain stereotypes, unfair hiring practices

◦ Cultural Blindness: differences ignored, “treat everyone the same”, only meet needs of dominant groups

Cultural Competence DefinitionsCultural Pre-competence: explore cultural issues,

are committed, assess needs of organization and individuals

Cultural Competence: recognize individual and cultural differences, seek advice from diverse groups, hire culturally unbiased staff

Cultural proficiency: implement changes to improve services based upon cultural needs, do research and teach

Acquiring Cultural Competence

◦ Starts with Awareness◦ Grows with Knowledge◦ Enhanced with Specific Skills◦ Polished through Cross-Cultural Encounters

Culturally sensitive approach to asking inquiring about a health problem

◦ What do you call your problem?◦ What do you think caused your problem?◦ Why do you think it started when it did?◦ What does your sickness do to you? How does

it work?◦ How severe is it? How long do you think you

will have it?(continued next page)

Culturally sensitive approach to asking about a health problem

◦ What do you fear most about your illness?◦ What are the chief problems your sickness has

caused you?◦ Anyone else with the same problem?◦ What have you done so far to treat your illness:

What treatments do you think you should receive? What important results do you hope to receive from the treatment?

◦ Who else can help you?

Listen to the patient’s perception of the problem

Explain your perception of the problemAcknowledge and discuss

differences/similaritiesRecommend treatmentNegotiate treatment

Pre interview sessionPre interview session Brief the interpreter about the session Obtain cultural background information from the interpreter Establish mode of interpretingDuring the interviewDuring the interview Introduce everyone and establish roles Establish ground rules – speaking THROUGH the interpreter

TO the client Maintain eye contact with the client, if culturally appropriate Speak slowly and clearly Summarize your discussion periodically throughout the

interview With consecutive interpreting, use short sentencesPost interview sessionPost interview session De-brief the interpreter

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Use simple, plain English Avoid jargon Don’t use slang or verbal jokes Speak slowly, but do not shout or raise

your voice Be concise and clear Give instructions in a clear, logical

sequence Ensure you have been understood Reinforce what you say Reduce the stress Be aware of your language all the time

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Australian Bureau of Statistics, Census data 2006 ECC NSW, COPS NSW & DADHC (2006) Cultural

Competency & Case Management Training Package Multicultural skills for health staff, Cultural diversity

training unit, University of Sydney, 1998 Cross cultural workshop, Macarthur health service Centre for culture, ethnicity & health www.ceh.org.au Multicultural awareness, Corporate orientation

program, SSWAHS Cultural competence, Facility orientation program,

Fairfield Hospital Sockalingum adapted from Hayes, Cultural

Competence Continuum, 1993 and Terry Cross Cultural Competency Continuum

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