Classroom chats provide an opportunity to respond to the videos, readings and presentations in the module. This is also a good place for you to share your personal experience as it relates to the course content. You should write at least a paragraph. While we will not be grading on grammar, spelling, APA etc. in this board, you are expected to write well and in your own words. Copy and pasted material will not be accepted. You will be expected to have a total of 2 classroom chat posts during a module. One of them should be initiated by you and one should be a response. We encourage you to question your classmates and push them to think of issues in depth and with complexity. We will be doing this too. With that said, make sure you post in a way that is respectful of others.
Please respond to the peer post
Out of all of the videos and reading, the video where the woman talked about her island and cancer was the video that stuck out to me. A lot of the things she said were shocking to me. As she was saying, back in her island, no one is truly educated about health and taking care of themselves. They think that being skinny means they are unhealthy and their husband does not take care of them. Being fat means they are rich as well as having a lot of children. This woman decided to come to America to learn about medical help to bring back to her country for people who are sick.
As this woman is traveling the United States, she is specifically learning about Breast Cancer. She is learning about warning signs, mammograms, and treatments to be able to bring back her country and help these women. She said most women in her country do not even know how to check themselves for signs of Breast Cancer. This truly makes me think about my own life considering both my mom and my grandma had gone through Breast Cancer treatments. It makes me feel like I am truly blessed to be in a place where they were able to get help and defeat this horrible disease.
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UNFORMATTED ATTACHMENT PREVIEW
#$%&’$!()’$*+!,!(-.!//”0! -$12)!.3)4)5*’*1%5!(‘52%6*! -$12)!”! ! Introduction to Multicultural Medicine The biggest challenge in reducing medical errors and making hospitals safer places is changing the culture of medicine. James Bagian, Director, VA National Center for Patient Safety ! The best student-centered learning experience in America -$12)!/! ! View the first video (the second is optional). Think about the roles culture and behavior play in health and health perceptions in this video. Gavage: an example of culture and health • http://www.youtube.com/watch?v=25DxHXz 8ZUQ&feature=relmfu • http://www.youtube.com/watch?v=X6VrzGW Cq2I&feature=relmfu ! ! -$12)!7! Culture is a shared belief system, a shared world view (way of looking at the world). Culture provides a set of rules which direct the way we live our lives and the way we interpret the world around us. Culture defines everything big and small. Culture can be as big as appropriate public policy or appropriate ways to choose public officials. It can be as small as how we eat our food, how and when we clean our bodies, and everything in between such as child rearing practices and modes of dress. What is culture? • Culture is a learned and shared belief system • We all fill multiple cultural roles • Culture ! ethnicity ! race ! minority ! While culture reflects shared beliefs, people will vary in the degree to which they follow cultural rules and traditions. We all fill multiple roles, ethnic cultural identity, national, student, ! “! professional. Culture is not something that only exists if you are different from the mainstream population. When thinking about culture and heath, remember that culture influences behavior and perceptions about appropriate or normal behavior. When people are taken out of their context, behaviors that are suited to one context may not be suited to another. -$12)!8! ! Think about how these factors may influence an individual’s worldview (keep in mind that these are generalizations – there is much variation!). Factors that influence cultural perceptions • • • • • • • Nationality Ethnicity Race Minority status Age Gender disability • Sexual orientation • Education • Socioeconomic status • Geography • Migration • Acculturation • Religion For example: American culture can be said to be different from Japanese culture; Japanese culture is much more formal than American culture. When Japanese people discuss illnesses they are often not freely discussed outside the family. The principal of Enryo (self restraint in interacting with others) may come into play when discussing a particular medication or assistance. This may be described by an American physician as polite refusal or hesitation when a patient may refuse certain treatment if embarrassing or inconvenient for patient or health care professional. ! Ethnicity: Hmong: an ethnic group from South East Asia (S. China, Laos, Vietnam, Burma & Thialand), believe that illness is caused by soul loss (as opposed to Vietnamese who believe in balance ! /! philosophy of ying/yang and hot & cold). Age: because cohorts go through time together, there are cultural attributes with age. A 70 year old is likely to have a somewhat different worldview than a 20 year old. E.g. depression, many older people have strong stigma with depression; have belief that you should pull yourself up by your boot straps; don’t discuss feelings freely. Migration: immigrants (from any country) share many things in common based on their experiences of moving to a foreign country. Encounters with the healthcare system in the US can be quite a shock for recent immigrants. Encounters may be dangerous for illegal immigrants (which could lead to incomplete information being shared during history). Religion: religion in many ways shapes cultural practices and beliefs, may affect dress, food, views of illness and medical treatment. For example, Christian scientists do not believe in using medicine (for the most part), and believe that no disease is beyond the power of God to heal. On the other hand, Jehovah’s witnesses forbid faith healing but oppose blood transfusions. Catholics have no prohibitions on blood or blood products. Most surgical procedures are acceptable except for abortion. Major amputated limbs may be buried in consecrated ground. Acculturation: As groups move in the US (or any country), as they learn more about the US culture, they begin to adapt to and adopt US customs. This is referred to acculturation. Very often ! 7! acculturation increases with time but there are groups that stay fairly cohesive and have low levels of acculturation, E.g. some groups who live in China-Towns, or Little Japan, Little India etc. or Amish etc. Often acculturation increases over generations. So, waves of immigrants can have very different practices and different levels of integration of western medical practices. ! -$12)!9! Cultural competence is a buzz word in healthcare. It has been defined in many ways. I prefer to think of it as willingness and ability to communicate across cultural lines. It has been described as a continuum: Cultural competence • What does it mean? • Generalization vs. stereotyping • Ethnocentrism vs. relativism ! • • • • • understand one’s own cultural background acknowledging the patient’s different culture, value system, beliefs and behaviors recognizing that cultural difference is not synonymous with cultural inferiority. learning about the patient’s culture adapting optimal health care delivery to an acceptable cultural framework. The difference between generalization and stereotypes is assumption. You can understand that in general x population has these attributes and inquire as to whether a patient fits that generalization. With a stereotype, you assume that a person fits a specific set of attributes. Ethnocentrism is a practice of unconsciously or consciously privileging one’s own cultural perspective over others. This involves judging other groups by ! 8! your own personal world view. Relativism on the other hand suggests that cultures cannot be judged or evaluated from a single or absolute ethical or moral perspective. Evaluations are relative to the background from which they arise. No culture’s values, ethics or morals as a whole may be judged as inherently superior or inferior to another’s. -$12)!:! Sometimes it is hard to be relativistic and some would argue that for some health issues is inappropriate to do so. !! Kleinman: taking a culturally competent history Cultural competence & different models of illness • http://www.youtube.c om/watch?v=jT96NPU gWZ4 • http://www.youtube.c om/watch?v=dNLtAj0 wy6I • Western biomedicine • Balance • – Yin/yang – Hot/cold • • • • Soul loss Spirit possession Breach of taboo Object intrusion • • ! • • • • • What do you think caused your problem? Why do you think it started when it did? What do you think your sickness does to you? How severe is your sickness? What are the chief problems your sickness has caused you? What do you fear most about your sickness? What kind of treatment would you like to have? What are the most important results you hope to get from treatment? Kleinman’s 5 major explanatory model • Question’s explain the etiology or cause of problem • What the patient considers to be the onset of symptoms • The patient’s description of the problem as a pathophysiological process • The patient’s understanding of the course of the illness in terms of severity, acuteness or chronicity ! 9! • What the patient believes is the appropriate length & type of treatment. ! -$12)!;! ! Table 6.1: Selected Examples of Cultural Explanations of Disease Adapted from Scrimshaw SC. Culture, Behavior, and Health. In: Merson MH, Black RE, Mills A, eds. International Public Health: Diseases, Programs, Systems, and Policies. Sudbury, MA: Jones and Bartlett Publishers; 2001:53-78. -$12)!
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