Vari Hall, Santa Clara University500 El Camino RealSanta Clara, CA 95053408-554-5319, Ethical Considerations for COVID-19 Vaccination, Hackworth Fellowships Project Showcase 2021, The Ethics of Going Back to School in a Pandemic, Systemic Racism, Police Brutality, and the Killing of George Floyd, COVID-19: Ethics, Health and Moving Forward, The Ethical Implications of Mass Shootings, Political Speech in the Age of Social Media, Point/Counterpoint: Democratic Legitimacy, Brett Kavanaugh and the Ethics of the Supreme Court Confirmation Process, https://depts.washington.edu/pfes/PDFs/LatinoCultureClue.pdf, Culturally Competent Care for Latino Patients. Notably, studies that disaggregate Hispanics by their ancestral origin may provide greater insight into the sources of ethnic disparities. Genetics, environment, and life experiences can all have an impact on . While this has been a challenge across patient populations, it has been especially pronounced among the U.S. Latino population, which shows a rate of non-adherence almost 40% higher than the rate seen in the U.S. Caucasian population. Bilingual posters and medical literature are an important starting point. Hayes-Bautista relayed that one important theme presented in the collaborative workshops is how . In addition, diet and exercise do not have a prominent place in the daily activities of the Hispanic family. By comparison, only 35% of Hispanics 50 and older say the same - a 30-percentage-point gap. Get to know your fellow coach managers and direct reports. Respeto implies attentive concern for the patient and respect of his or her personhood and age, especially if the patient is older. 10Mead et. PDF Hispanic Culture and Healthcare in the United States Additionally, when a woman gets married, her husband's name may be appended to her father's name. To provide an updated understanding of folk and traditional medicine (FTM) among Hispanic parents in the United States, we surveyed 200 caregivers identifying their child as Hispanic in a pediatric primary care clinic about their cultural health beliefs and practices. The Bracero program, a guest worker program started in 1942, was designed to bring experienced agricultural laborers to the U.S. from Mexico and led to a huge influx of Mexican immigrants. The material in this section is part of a larger project by the Markkula Center for Applied Ethics on culturally competent care; that is, health care that is sensitive to the differing values and needs of cultural subgroups within our pluralistic society. In a 2002 report from the Institute of Medicine, more than 175 studies were cited to document this disparity.6 In an attempt to address this problem, the National Standards for Culturally and Linguistically Appropriate Services (CLAS) were released in 2001 by the Office of Minority Health of the U.S. Department of Health and Human Services.7 Fourteen guidelines were published, which were organized around three main themes: culturally competent care, language access services, and organizational supports. An intention-to-treat approach using a last-observation-carried-forward method was used to analyze outcome data whereby the last available measurement for all participants was then used for all time points through the 12-month final follow-up. During Maria's next visit, you arrange for a telephone interpreter, which enables you to take a brief social history. The cultural value of familism has important implications for the successful treatment of a child with AD/HD. This is especially (though far from uniquely) true in the agricultural sector of the U.S. economy. Cold water with lemon for high blood pressure. As with any circumscribed ethnic group, there is, of course, enormous cultural heterogeneity among Latino patients-to the point where it seems almost ludicrous to try to identify broad cultural tendencies across such diversity. Yet the call for cultural competence can-at its best-urge practitioners to adopt instead a stance of cultural "humility": one which encourages an open mind, and a recognition that each one of us sees the world through our own very distinctive cultural lenses. Web-based resources are available to assist physicians in understanding Latino health beliefs (Table 4). From the upstairs hallway of our home, I watched my great-aunt prepare for the cleansing. . Case 1: Delinquency or a Mental Health Problem: The Case of Pablo Sanchez, Case 3: From Chronic to Critical: End-of-Life Decisions. Fluegelman, Andrew, ed. Animal-based medicines are also used, including snake oil, which is obtained from the fat of snake skins, and bufo toad medicine, which contains a powerful psychedelic. al., "Racial and Ethnic Disparities in U.S. Health Care: A Chartbook" (The Commonwealth Fund, March 2008), Charts 6-25 and 6-26; and Joseph R. Betancourt, Alexander R. Green, and J. Emilio Carrillo, "The Challenges of Cross-Cultural Healthcare-Diversity, Ethics, and the Medical Encounter," Bioethics Forum 16 (3). Depression in US Hispanics: Diagnostic and Management Considerations in Themes common to Latino participants were: "We are put off to one side"; "If I can't work, I can't survive"; and "Without documents, you are no one." Her face lights up when you share this. Substance Abuse Treatment for Latino and Hispanic Adults Although most Latinos living in the U.S. do speak at least some English, 60 percent of Latino adults speak primarily Spanish at home.6 According to the U.S. Census, more than half of U.S. Latino residents age 5 and older speak English "very well," but a nevertheless significant number of Latino adults speak English "not well" or "not at all. Qualitative data analysis of the 75 symptom and treatment statements was completed, and data were grouped according to symptom and complexity of treatments. Allow extra visit time for patients with limited English proficiency, Hire bilingual staff and physicians, and encourage existing staff to learn Spanish, Make printed and Web-based cultural information available to staff, Offer flexible scheduling: patients may be seen in sign-in order rather than fixed appointments, Post bilingual or Spanish-language signage, Provide cultural sensitivity training for staff (e.g., monthly lunchtime discussions, in-service training, a bulletin board devoted to cultural issues, ethnic food potlucks), Provide culture-specific interventions in nursing care plans, Provide interpretation services for patients with limited English, proficiency (required under Title VI of the 1964 Civil Rights Act); whenever possible, try to avoid using patient's family or friends as interpreters, Provide Spanish-language medical handouts and patient forms, Recognize Latino holidays (e.g., Cinco de Mayo [May 5], Day of the Three Kings [January 6]). Publicaciones de SAMHSA disponibles en espaol (Additional SAMHSA Spanish-language publications). Our Future. Modern Mexicans turn to old ways of childbirth Lack of third party reimbursement for professional interpreter services exacerbates this problem. Each person is unique and simultaneously formed by a variety of cultures and subcultures, not to mention personal choices and socioeconomic circumstances. It is the primary method used in hospitals. Although patients of all cultural backgrounds warrant kindness, a personal connection, and respect, the consequences of omitting these traditional values may be more problematic with Latinos. To sign up for updates or to access your subscriber preferences, please enter your contact information. Copyright 2013 by the American Academy of Family Physicians. It is important to explore the use of alternative therapies and belief in traditional folk illnesses, recognizing that health beliefs are dependent on education, socioeconomic status, and degree of acculturation. Physicians cannot assume that all Latinos share these beliefs; many do not. She says that since her husband died, she has lost interest in what might happen to her in the future. Compared to White people, Hispanic/Latino people are less likely to receive treatment for depression, anxiety, and other behavioral problems. These may include antioxidants, probiotics, or a combination of medications to target any of the contributing factors. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Cold linseed tea and hibiscus flower tea for diabetes. Most, although not all, alternative therapies in the Latino community are not harmful and may be combined with conventional care. The point deserves emphasis: Health care providers must be cautious not to oversimplify the values, customs, and beliefs that characterize any ethnic group-especially one as heterogeneous as Latinos. al., "Culture, Illness, and Care," 252. Culturally Competent Care for Latino Patients 9Carmen DeNavas-Walt, Bernadette D. Proctor, and Jessica Smith, "Income, Poverty, and Health Insurance Coverage in the United States: 2006," Current Population Reports, U.S. Census Bureau, August 2007; and Mead et. Emotional distress often presents with headaches (dolor de cabeza) or other physical symptoms instead of depressed mood.9 Consequently, a high index of suspicion is needed to recognize adjustment reactions or depression. For those who have a serious mental health disorder, around 44 percent did not receive treatment. According to a study done at UCLA, 15.7 percent of non-elderly Latinos in either fair or poor health, who are covered under MediCal or Healthy Families (both California low-income health insurance programs), report having no usual source of care but rather obtain their clinical health care on an ad-hoc basis, if at all.11, Some Latinos find their health care in non-clinical places, relying on folk medicine and traditional healers. They Hear You is SAMHSA's underage drinking prevention campaign that helps parents and caregivers start talking to their children early about the dangers of alcohol. Latinos are far more likely than the overall population to live in poverty; the poverty rate in 2006 was 20.8 percent, compared to 12.3 percent for the overall U.S. population. The teach back technique should be incorporated into the cross-cultural patient encounter to ensure patient understanding of discharge instructions. A wide array of herbs offered at La Botanica Orquida in northeast Georgia. In fact, compared to both white Americans and African-Americans, Latinos generally report feeling less listened to and understood by their doctors, as well as less able themselves to understand their doctors; and they are twice as likely to leave a doctor's office with unasked questions. 8Holly Mead et. Visit the SAMHSA YouTube channel, Visit SAMHSA on LinkedIn One way of describing the distinction is that modern Western doctors are primarily trained to diagnose and treat diseases (in a purely biomedical sense), while traditional healers approach the patient as one suffering from an illness-that is, a culturally located experience of sickness.12 Among some Latino subcultures, folk illnesses such as empacho (a digestive ailment), mal de ojo (the "evil eye"), mollera caida (fallen fontanelle), susto (fright illness), and nervios (vulnerability to stressful experiences) are commonly described; and traditional healers range from curanderos (Mexican healers) and sobadores (traditional masseuses and bone setters) to yerberos (herbalists) and espiritistas (spiritual healers).13 Reliance on folk medicine certainly is not to be found in every, or even most, Latino communities; but it does exist as part of the health care landscape and is found among many patients from Mexico, as well as from various other regions within Latin America. Your efforts pay off at the next visit, when Maria expresses much more interest in controlling her diabetes and shows personal warmth that was missing from earlier encounters. In Santa Clara County the figure is 25.7 percent-over a quarter of the total population. Latinos often lack access to healthcare and have poor - Brookings 4 Another. Latino/Hispanic families can provide much support to a child with the disorder and protect him or her from the development of conduct problems (Bauermeister et al., 2005). Master the basics of the Virta Treatment and understand the full patient experience. Latino healing traditions include curanderismo in Mexico and much of Latin America, Santeria in Brazil and Cuba, and espiritismo in Puerto Rico.19 Curanderos, traditional healers, distinguish between hot and cold illnesses (Table 220 ) and occasionally between natural and unnatural (sorcery-related) diseases.19,20 Patients may seek out the care of brujos or brujas (wizards or witches) for the latter conditions. SAMHSA Blog. Hispanic Health | VitalSigns | CDC Mexico's rate of C-sections is 30 percent above the rate recommended by the World Health Organization. Recent immigration trends have contributed heavily to the increases in the U.S. Latino population. | Mar 1, 2011. Materials are available in English and Spanish. The term "Latino" has become more commonly used in recent years to describe those whose primary ethnic heritage stems from Latin America. Latinos' belief in alternative treatment is affected by many factors, including education, socioeconomic class, and time spent in the United States (acculturation). Key Facts on Health and Health Care by Race and Ethnicity National Prevention Week is a SAMHSA-supported annual health observance dedicated to increasing public awareness of, and action around, substance use and mental health issues. Personalismo, a personal connection, can be achieved by asking about the patient and his or her family. Hispanics have different degrees of illness or health risks than whites. Latinos are a diverse ethnic group that includes many different cultures, races, and nationalities. Additionally, within this family-centric decision making structure, there may be particular gender-based roles. Again, it is imperative to stress that these values represent broad generalizations that may or may not apply to any individual patient or in any given situation. Indeed, such a patient's silence might best be interpreted as an indirect and nonverbal form of disagreement. We sought to describe the prevalence, awareness, treatment, and control of hypertension in Hispanic/Latino adults with CKD. Use of Folk Remedies in a Hispanic Population | JAMA Pediatrics | JAMA ", In 2007, the total U.S. Hispanic or Latino population surpassed 45 million, or 15 percent of the total U.S. population. Demographics and Addiction. Recent immigrants may face additional obstacles to care, including illegal immigration status (fears of deportation), illiteracy, and a radically different set of health beliefs. JCM | Free Full-Text | Systemic Disease Associations in a Cohort of After some negotiation, she agrees to see a dietitian and a bilingual counselor, and agrees to take just two medications, metformin (Glucophage) and lisinopril (Zestril), although she understands that they will not make her feel better right away. Chartbook for Hispanic Health Care (Agency for Healthcare Research and Quality) This Hispanic Health Care chartbook is part of a family of documents and tools that support the 2014 National Healthcare Quality and Disparities Report (QDR). What are the treatments for heroin use disorder? 1 The term does not refer only to Spanish speakers, however; many people usually thought of as "Hispanic"-the people of Brazil, for instance, or those from indigenous Mexican communities-often do not speak Spanish at all, or at least not as their primary language. Substance Abuse/Addiction Among Hispanic-Latina/o Americans The Immigration Reform and Control Act of 1986 granted amnesty to immigrants who came to the U.S. before 1982; but the northward trend from Mexico and other parts of Latin America has continued since then, and many who have crossed the U.S.-Mexican border now live in the United States illegally. Methods We conducted a retrospective cohort study of antiretroviral-naive patients 18 years and older attending their first visit at Thomas Street Health Center in . Psychiatry.org - Working with Latino Patients The Concurrent Integration of Treatment Modali-ties in Social Work Practice." D.S.W. 1. Caring for Latino Patients | AAFP In fact, the number of Latino physicians dramatically lags behind Latino population growth; and, according to cross-cultural health care expert Larry Purnell, Latinos are the most underrepresented major minority group in the entire U.S. health care workforce.5 This discrepancy contributes to many different linguistic and cultural hurdles for Latino patients, as well as for their health care providers. Today, one in three farm workers are newcomers to the United States, with most of these coming from Mexico. 17.4% were Hispanic, and 49.1% were White. The LEARN technique can facilitate cross-cultural interviews. Similarly, a patient's silence when presented with a difficult treatment plan, rather than conveying agreement, may in fact indicate that patient's desire to maintain a polite relationship with the health care provider and avoid difficult or conflictual situations. You then schedule a return visit, during which an interpreter will be available. The Role of Black and Hispanic Physicians in Providing Health Care for In today's United States, these terms are often thought . You recommend a compromise treatment plan for her diabetes and grief. Hispanic/Latino Resources, Reports, Initiatives & More | SAMHSA Hispanic Ethnicity and Breast Cancer: Disaggregating Surgical Among Hispanics who needed but did not receive treatment in the past year, 95.8% did not feel the need for it, 2.2% felt the need for treatment but did not make an effort to get it, and 2.0% felt the need for treatment and did make an effort to get it. This traditional food is high in fiber and pectin and lowers lipid levels by binding bile acids; when eaten with other foods, it reduces the glycemic index of the meal by 50 percent. "7 In the context of a hospital or medical clinic, where medical terminology can be complicated and communication often takes place quickly and amidst elevated emotions, this language barrier can be especially problematic. The agency is contracted with the leading insurance carriers and works diligently to secure contracts with additional funding sources on an on-going basis. Hispanics progress against racism but have long way to go - UNM Newsroom The specific herbs mentioned in this study for use of treatment of diabetes included: nopal (cactus), aloe vera, nispero (loquat leaves), garlic, and diabetina. Using don or doa with the given or full name indicates even greater respect for older patients. These terms are often used interchangeably, including by the U.S. Census Bureau, although "Hispanic" is more often utilized in governmental and market research and statistical record keeping, while "Latino" perhaps enjoys more popular usage today. These include simpata (kindness), personalismo (friendliness), and respeto (respect).25 Simpata emphasizes politeness and conflict avoidance. You use teach back to ensure that Maria understands your directions, and you provide her with Spanish-language handouts about the benefits of controlling her diabetes and hypertension. 1 This change resulted in a substantial increase in the prevalence of hypertension from ~32% to ~46% in the United States (US) adult population. Trauma-Focused CBT for Effective PTSD & Trauma Treatment Keeping these cautionary notes in mind, the cases and commentaries in this section seek to address numerous issues that arise in the course of providing clinical health care for Latino patients of various backgrounds. www.behaviorfrontiers.com. 58, Journal of . Substance Use and the Hispanic/Latino Population: What to Do? Still, at the risk of oversimplifying, several trends emerge: -simpatia-politeness and the avoidance of hostile confrontation -personalismo-the value of warm personal interaction -respeto-the importance of showing respect to authority figures, usually including health care providers -familismo-collective loyalty to extended family and commitment to family obligation; -fatalismo-the belief that individuals cannot do much to alter fate15. Data Synthesis: Hispanics were identified homogenously in some studies and more correctly as a heterogeneous population in others. Culturally competent care necessitates cross-cultural training, which is increasingly included in medical education, but with the realization that cultural competency is a lifelong learning process rather than an end in itself.8. Oregano tea for coughs. Adherence Barriers to Antidepressants among an Urban Female Latino Objective Breast cancer is the leading cause of cancer death among Hispanic women. A little more than 45 percent of all births in Mexico are Cesarean sections, which makes it one of the world's leaders in the practice. This resulted in a rich compilation of remedies that Hispanics use in home treatments, with the emergence of a pattern comparable to the nursing process. Job Application for Bilingual Health Coach Manager at Virta Health Bridging such cultural gaps, wide or narrow, will result in better physician-patient relationships and more effective care. (PDF) Grieving and death rituals of Latinos - ResearchGate Apart from these language and socioeconomic disparities and variation in the way health care is envisioned and sought out, differences in the way values are ordered and articulated can also strain the clinical health care encounter for Latino patients. Yet Latinos are at particular risk for diabetes mellitus, tuberculosis, hypertension, HIV/AIDS, alcoholism, cirrhosis, and death from violence.4 There is also a disproportionately high prevalence of acute care in the treatment of Latinos; that is, too often patients delay medical care until their conditions worsen and necessitate immediate attention. 13 Kaiser, "A Provider's Handbook," 6-7. In this article I will make use of both terms, relying more heavily, however, on "Latino. Patients should be actively involved in their care rather than passively acquiescing to instructions. Interferon gammarelease assays are preferred to tuberculin skin testing in immigrants with a history of BCG vaccination. Latino Culture: Natural Medicines & Alternative Treatments Adding to the language barrier is the pitfall of false fluency, when physicians mistake the meaning of a Spanish word because of unfamiliarity with cultural or linguistic subtleties. One suggestion she readily agrees to is to include nopales (prickly pear cactus pads), a favorite from her childhood in Mexico. Very often they have faced extremely hazardous conditions crossing the border-enduring hunger, dehydration, violence from vigilantes, rape, abuse, severe weather conditions and harsh treatment by border agents. Mexican Americans are much less likely to be treated for hypertension than non-Latino whites (35 versus 49 percent).11 Targeted public health campaigns are needed for hypertension, diabetes prevention, and weight control. They are a starting point, not an ending point; in other words, they call practitioners to look more deeply into the particular cultural, linguistic, and socioeconomic contours of their patients' backgrounds and to open themselves to alternative ways of understanding and interpreting their patients' actions and requests. A few candles were lit in the dark, curtained bedroom. Cultural Health Beliefs and Practices Among Hispanic Parents Exposure to U.S. media is changing traditional Latino perceptions of health, diet, and body image, even as non-Latino Americans are influenced by Mexican cuisine and culture. Other healing specialties include yerberas (herbalists), hueseros (bone setters), parteras (midwives), and sobradores (similar to physical therapists).21, Symptoms are often interpreted differently based on cultural presuppositions. The American Psychological Association (APA) found that only one percent of psychologists identified themselves as Hispanic even though Hispanics represent 20 percent of the U.S. population as a whole. US Hispanics, currently the largest minority group in the country, face disparities in the recognition and treatment of major depression. The ethnic terms Latino or Hispanic refer to a diverse population of Latin American descent that includes many nationalities and races. Conveying medical instructions to patients with limited English skills can be frustrating. The National Standards for Culturally and Linguistically Appropriate Services address these concerns with recommendations for culturally competent care, language services, and organizational support. Plants are used on their own, or mixed together to form herbal remedies.
