Methods of Diagnosing Among Navajo Indians
In the United States, there are currently 574 Indian tribes or groups that are federally recognized and eligible for services offered by the Bureau of Indian Affairs. Of these groups, the Navajo, also known as Diné, are one of the largest, accounting for approximately 332,129 people (Source). In this blog post, we will be covering some of the traditional healing methods practiced by the Navajos.
Among the Navajo people, the cause of disease and the course of treatment are often determined by divination. A diagnostician is called on to perform the divination, determine the cause of the disease, and recommend the best course of treatment along with the medicine man/woman to perform it.
The three types of divination employed by the Navajos are motion in the hand, stargazing, and listening (Spector 9e).
Motion in the hand, otherwise known as hand trembling, is the most common method of divination and is often practiced by women. During this practice, the diagnostician sits with their face turned away from the patient. Pollen or sand is sprinkled around the ill person and a healer’s hand moves during a song. The diagnostician thinks of certain diseases and causes during the time the healer’s hand moves. Once the healer’s hand moves in a certain way, the diagnostician knows that they have discovered the correct disease and cause. The diagnostician proceeds to prescribe the correct treatment. Motion in the hand is not a process that can be learned or inherited; it must come as a gift to the person. Other forms of motion in the hand may also involve the use of sand paintings (Wyman, 1966, p.14).
Stargazing is another divination practice used by the Navajo people. In this practice, the stargazer prays the star prayer to the star spirit and asks it to show the cause of illness. Singing occurs during stargazing, and the star shines a ray of light that determines the cause of the illness. The patient is expected to recover if the ray is white or yellow. The illness is serious if the light is red. If a white light falls on the ill person’s home, then they will recover. If the home is dark, the patient is expected to die (Wyman, 1966, p. 15).
Listening, the third type of divination, is mostly performed by a woman. The listener may or may not meet with the ailing person’s family before going to a secluded location and listening for the cause of an illness and proper cure. The practice of listening is similar to stargazing except that the diagnosis is revealed through auditory rather than visual means (Source).
By: Sreenidhi Saripalli
Barriers To Healthcare: LGBTQ+
Eliminating disparities and enhancing efforts to improve LGBTQ+ health is essential to ensure that the people in this community can lead healthy lives. Healthypeople.gov states that some of the benefits of addressing these disparities and health concerns include reduction in disease transmission and progression, increased mental and physical well being, reduced healthcare costs, and increased longevity. However, there are certain barriers people in the LGBTQ+ community face when trying to obtain healthcare treatment.
The first is limited access. Many LGBTQ+ patients who cannot afford healthcare are often denied it as a result. In 10 US states, transition-related health care is expressly excluded from Medicaid coverage, limiting options for low-income transgender people. LGBTQ+ patients also have a harder time obtaining healthcare insurance in the US. As of July 2018, 37 states do not expressly ban health insurance discrimination based on sexual orientation or gender identity. Some states, such as New Jersey, prohibit discrimination based on gender identity but not sexual orientation, decreasing the likelihood of LGBTQ+ patients obtaining healthcare services (Source).
Next is the refusal of care. LGBT patients are often refused services outright because of their sexual orientation or gender identity. In a nationally representative survey conducted by the Center for American Progress in 2017, 8 percent of lesbian, gay, and bisexual respondents and 29 percent of transgender respondents reported that a healthcare provider had refused to see them because of their sexual orientation or gender identity in the past year. Interviewees described being denied counseling and therapy, refused fertility treatments, denied a checkup or other primary care services, and in one instance, told that a pediatrician’s religious beliefs precluded her from evaluating a same-sex couple’s 6-day-old child (Source).
Another barrier to healthcare for LGBTQ+ patients is negative experiences with the healthcare system. For example, Trevor L., a gay man in Memphis, recalled an incident when he took an HIV test at his annual checkup in 2016: “and they sat down and started preaching to me – not biblical things, but saying, you know this is not appropriate, I can help you with counseling, and I was like, oh, thank you, I’ve been out for 20 years and I think I’m okay. It’s almost like they feel they have the right to tell you that it’s wrong.” Both providers and LGBT people noted that concerns about discrimination and mistreatment led LGBT people to delay or forego care. A 2015 survey of almost 28,000 transgender people found that, in the year preceding the survey, 23 percent did not seek the care they needed because of concern about mistreatment based on gender identity (Source).
Lastly, some doctors do not have experience in treating transgender individuals, which may lead to inadequate health services. Despite both guidelines and data supporting the current transgender medicine treatment paradigm, transgender patients report that the lack of providers with expertise in transgender medicine represents the single largest component inhibiting access. Transgender treatment is not taught in conventional medical curricula and too few physicians have the requisite knowledge and comfort level.
By: Sreenidhi Saripalli
Medical Restrictions: Jehovah’s Witnesses
Although the number has never been confirmed, it is estimated that there are around 4,000 religions practiced in the world, each having its own medical beliefs, values, and practices.
It is important that as a future healthcare provider, you have some background knowledge about the medical beliefs among prominent religions in the United States in the likely event that one of your future patients follows them. In today’s blog post, we are going to go over the medical restrictions among Jehovah’s Witnesses.
When learning about the medical restrictions of a certain religious group, it is important to know that different people practice religions to a different extent. This concept is known as heritage consistency (Spector 9e). For example, a person of Islamic faith may choose to pray 5 times a day and eat only halal foods. Another person of Islamic faith may also choose to pray 5 times a day, but they may not always eat halal foods.
Additionally, many people interpret religious scriptures in vastly different ways. It is important to note that medical restrictions for a certain religion may vary among people who practice the same religion. Therefore, it is imperative to never assume anything about the patient unless it is clarified.
The first medical restriction, and the most widely known, is that Jehovah’s Witnesses do not accept blood transfusions since they believe that taking blood through the mouth or veins violates God’s laws.
This includes transfusion with whole blood, packed red blood cells (RBCs), and plasma, as well as white blood cells (WBCs) and platelet administration. Furthermore, each individual must decide if they want to employ the use of albumin, immune globulins, and hemophiliac preparations since the use of these are not fully prohibited.
Additionally, those who are Jehovah’s Witnesses are not allowed to have abortions or autopsies without reason. They are, however, allowed to donate organs, receive transplants, vaccines, and serums. In the case of minor blood fractions such as vaccinations and serums, an individual Witness may choose to refuse them although they are not explicitly prohibited.
Physicians are aware if their patient is a Jehovah’s Witness by an Advance Medical Directive/Release that is carried on the patient. This directs that no blood transfusions be given under any circumstances while releasing physicians and hospitals of responsibility for any damages that might be caused by the refusal of blood (Source).
A hypothetical example of treating a Jehovah’s Witness with cultural competence is in a Grey’s Anatomy episode titled “Bad Blood”. If you’re a fan of Grey’s anatomy, you might remember this particular episode in which a patient who is a Jehovah’s Witness is brought into the hospital. The surgical team quickly identifies the patient’s religious belief from the dog tag necklace the patient wore and realizes they will have to form a bloodless operation.
In this episode, cultural competence was highly demonstrated by the physicians. They knew exactly what to do, made sure to not give the patient blood, and thereby respected the patient and family’s wishes.
By: Sreenidhi Saripalli
Yoga and Healing
Can yoga heal the body? Many people are familiar with the concept of yoga as it becomes increasingly popular in the United States. We commonly associate it with meditation, downward dog, and lululemon among other things.
But what is yoga? Where did it originate? Is it a form of healing? In today’s blog post, we’re going to be exploring these questions and answering them.
First, let’s start with what yoga is. Yoga is a form of alternative or traditional medicine that has been practiced for many thousands of years. Yoga itself is a healing system of theory and practice; it is a combination of breathing exercises, physical postures, and meditation (Science daily).
So, when did this practice even begin, and how did it arise? Yoga is such an ancient practice that no one knows when it began. Although there are only approximations of when yoga first started, we can agree that yoga originated in India from Hindu culture and began when people were trying to understand what life was all about.
A set of ancient scriptures known as the Bhagavad Gita was the first to outline the yogic philosophy, and it focused entirely on the spiritual aspect of yoga(Source). Back then, yoga was all about meditation and achieving enlightenment; there were no complex poses or breathing exercises. However, yoga has largely evolved to include exercises to strengthen the mind and body in addition to the soul.
Now that we know what yoga is and its origins, let’s dive into the benefits of yoga. Yoga is considered a mind-body intervention that is used to reduce the health effects of generalized stress. It is believed to calm the nervous system and balance the mind, body, and spirit. It is also thought that yoga prevents diseases and maladies by keeping the energy meridians open and life energy (prana) flowing (Science daily).
Yoga is also a holistic form of healing that can help you relax and release tension, as well as strengthen weak muscles and stretch tight ones.
In these uncertain times filled with panic, zoom, and masks, school and life can be difficult. It’s no secret that taking a test online while your parents are in meetings, your dog is barking in the other room, and your neighbor is cutting their grass is mind-blowingly frustrating. In fact, I was in that exact position a few weeks ago. To cope with stress and anxiety, I decided to join an online yoga class and the difference it made was unbelievable, hence why I’m writing this blog post. As future health care professionals, we are often so focused on learning about how to take care of others that we neglect ourselves in the process. Even if yoga may not be the thing for you, find something that makes you happy and eases some of the tension in your life.
If you want to learn more about yoga, I have attached a few helpful links below:
Yoga: Fight stress and find serenity: https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/yoga/art-20044733
The origins and history of yoga: https://www.yogiapproved.com/om/origin-of-yoga-history-of-yoga/
20 minute guided yoga session: https://www.youtube.com/watch?v=KEYSO-Tc2Go
By: Sreenidhi Saripalli
Barriers to Healthcare
Most of us have a certain understanding of what happens when we get injured. Typically, we first call an ambulance and explain the situation. Then, we get transported to the hospital to get treated. And finally we go through a recovery period.
Although it sounds simple to follow, obtaining access to healthcare isn’t necessarily that easy. There are many barriers certain groups of people face when trying to get healthcare treatment. In today’s blogspot, we will go over some barriers people face when trying to get healthcare.
The first barrier to healthcare is provider stereotyping, which is when the provider may assume things about the patient based on their appearance or faith. This can lead to a barrier in the quality of healthcare received by a patient. According to an article published by the national institute of health, research shows that when a healthcare provider stereotypes a patient, the patient can sense the bias and feels dissatisfied with their care. This feeling of dissatisfaction can lead to harmful health effects; for example, patients may avoid seeking healthcare treatment. If the patient feels unwelcome or devalued, it is only natural to avoid the situation entirely.
The communication between a patient and a healthcare provider can also be impacted by stereotyping. Communication is essential between the patient and provider since the provider must know the background of the patient such as medical history, habits, and symptoms. Stereotyping greatly hinders this communication, especially if the patient is uncomfortable conversing freely with the provider or if the patient wishes to present themselves in a manner that refutes the stereotype.
For example, a patient of south Asian heritage visits a healthcare provider. The healthcare provider is aware of the stereotype about the positive correlation among south asians and diabetes and stereotypes the current patient in this manner. In an attempt to portray their image to counter this stereotype, the patient may lie about their exercise regimen and diet. Since the provider does not have a completely truthful evaluation of the patient, problems may arise later on.
Next, and largely overlooked, is geography, which occurs when there’s a lack of healthcare facilities near a patient's area and a lack of transport to these facilities. This can cause numerous issues to patients.
Suppose a patient lived in Montana, the fourth largest state in the U.S. Although the state has a lot of land, the average travel time to the closest hospital is the highest in the country, about 16 minutes according to PEW Research. That may not sound too bad, but keep in mind that this is an average and that it's very likely that some people have to travel at least an hour to reach the closest hospital (Pew Research). Residents in the Northern Plains have the longest travel times to hospitals than those of any other region. If the patient had an emergency, the amount of time it takes to get to the hospital might be the difference between life or death.
When gaining access to healthcare, there are numerous barriers that people face. Costs of healthcare, language, provider stereotyping, and geography are only a few to name. As future healthcare providers, it is important to recognize these barriers and help eliminate them.
By: Sreenidhi Saripalli
Schools of Medicine
Have you ever gone to the chiropractor when your back was aching? Or made herbal tea when you had a cold or cough? Did you know that these methods of healing do not fall under Western/ allopathic medicine?
There are multiple healthcare philosophies (see healthcare philosophies) practiced in the United States, and each philosophy has many schools of medicine under them. Today we will learn about four different schools of medicine and the healthcare philosophies that encompass them.
First, we’ll take a look at homeopathic medicine. Homeopathic medicine started in the late 18th century in Germany, and it is a form of medicine that utilizes plants, minerals, and animal substances in order to stimulate a person's immune system. In homeopathy, the person, not the disease, is treated. It follows a belief that if a substance that is used to treat a specific set of symptoms is the same substance that, if given to a healthy person, would cause the symptoms. This is more commonly known as the Law of Similars. Homeopathic (alternative) medicine also administers medicine in extremely small doses. These medicines are said to provide a gentle but powerful stimulus to the person’s defense system, helping the person recover.
Next, is Osteopathic medicine. Osteopathic medicine was created in the late 19th century with the intent of not using surgery or drugs to cure patients. Osteopathy is the knowledge of the structure, relation, and function of each part of the human body applied to the correction of whatever interferes with the body’s harmonious operation. Doctors of osteopathy ( DOs ) can now practice in all areas of medicine and surgery in all 50 states. The lines of distinction between a medical doctor and the osteopath arises because the osteopathic healer, in addition to using modern scientific forms of medical diagnosis and treatment, uses manipulation of the bones, muscles, and joints as therapy. The osteopathic doctor has the same legal power to treat patients as a medical doctor and typically goes through the same amount of schooling. Note that osteopathic and allopathic forms of medicine are the only schools of medicine that have a standard curriculum in the United States and can qualify to become board certified doctors (source).
One of the most popular forms of alternative medicine is Chiropractic medicine. Chiropractic medicine is a form of healing that focuses on the body's structure (mainly the spine) and its functioning. Chiropractic medicine was developed in 1895 by a storekeeper named Daniel David Palmer who was also known as the “magnetic healer”. The theory underlying this form of healing is that the interference with the transmission of mental impulses between the brain and body organs caused the disease to occur. The source of the interference is the misalignment of the vertebrae of the spine, decreasing the flow of energy throughout the body. Chiropractic treatment consists of manipulation of the bones to eliminate any interference and increase the flow of energy. One fact to note about Chiropractic medicine is that it is incredibly controversial among allopathic practitioners. Many disputes emerge when discussing the effectiveness of Chiropractic medicine, with some allopathic practitioners arguing that it is very helpful and others arguing that it can be very harmful. However, there is no empirical evidence that chiropractic medicine can restore or maintain health by itself (source).
Lastly, Christian science is a scientific system of divine healing that consists of two parts: discovering healing through a spiritual sense of scriptures, and the miracles of Jesus that exhibit a divine principle. Chrisitan science as a system of spiritual healing was first introduced by Mary Eddy Baker in her book called “Science and Health with Key to the Scriptures”. Christian Scientists are free to choose the method of healthcare they prefer and feel most effective, and their choice is not compelled by a church. They can take their stance on important social health matters such as abortion, birth control, blood transfusion, and organ donations. Christian scientists turn to the bible and the book “Science and Health with the Key to the Scriptures” for answers to humanity’s deepest questions (Spector 9e).
To conclude, there are numerous schools of medicine around the world, each embracing a healthcare philosophy.
By: Sreenidhi Saripalli
Healthcare Philosophies
True or false: there is only one universal health care philosophy.
Many of us share similar experiences when visiting the doctor’s office. We are accustomed to the particular scent of a hospital, the cleanliness, and the organized chaos that takes place. We are familiar with the process of scheduling appointments, waiting to be treated by a nurse, and having the doctor visit us breifly before moving on to another patient. To many of us, that scene is allopathic or western healthcare, and it is generally the only way we know health and healthcare treatment. However, most of us disregard the other primary health care philosophy. Today we’re going to learn about the two primary health care philosophies around the world and what makes them so unique.
The two distinct healthcare philosophies that determine the scope of health beliefs and practices are known as dualistic and holistic. Each of these philosophies encompasses unique methods of maintaining, protecting, and restoring health. Dualistic healthcare focuses on the mind and body and is represented in allopathic or western healthcare. Holistic healthcare, in addition to focusing on the mind and body, also includes the spiritual component of healthcare and is represented in homeopathy. Holistic healthcare is included in alternative and traditional forms of healthcare (Spector 9e 88).
The dominant health care system in the United States is predicated on the dualistic philosophy of allopathy. Allopathic medicine is a conventional system of medicine that embraces all methods of empirical science. Some examples of allopathic healthcare are acute care, chronic care, public health, mental health, and rehabilitation. Today, allopaths may show little or limited tolerance and respect for providers of health care who follow a different philosophy, such as homeopaths, osteopaths, and chiropractors, and for traditional healers such as midwives, and herbalists (Spector 9e 88-89).
Under the holistic philosophy, there are two more branches of healing: alternative and traditional.
Alternative therapies are defined as healthcare treatments that are holistic but not a part of one’s religious or cultural heritage. An example would be a European American electing to use acupuncture, which is a Chinese traditional method of healing, as a form of treatment. Another common example would be if a person’s back started to hurt, and they visited a chiropractor. These methods of healing are interventions that are not typically taught in medical schools and are not widely available in US hospitals or other settings. (Spector 9e 89).
More common forms of alternative healthcare include Aromatherapy: an ancient science that uses essential plant oils to produce strong physical and emotional effects in the body. Biofeedback: the use of an electronic machine that measures skin temperatures and the patient controls responses that are usually involuntary. Hypnotherapy: the use of hypnosis to stimulate emotions and involuntary responses such as blood pressure. Macrobiotics: a diet and lifestyle that consists of balancing yin and yang energies of food. Massage therapy: the use of manipulative techniques to relieve pain and return energy to the body, and Reflexology: the natural science dealing with the reflex points in the hands and feet that correspond to every organ in the body (Spector 9e 90).
In contrast to alternative care, traditional healthcare is specific to one’s traditional, cultural, or religious heritage. An example would be if a Chinese man elected to use acupuncture or moxibustion. One traditional holistic healing practice is Ayurvedic medicine. It is a 3,000-year-old method of healing that originated in India and is the most ancient medical system. Ayurvedic medicine consists of diet, natural therapies, and herbs; its chief aim is longevity and quality of life. Another example of a traditional healthcare system is Curanderismo. This is a traditional Hispanic system of healthcare, and it originated in Spain. It is derived in part from traditional practices of indigenous Indian and Spanish health practices (Spector 9e 89).
Qi Gong is also a traditional practice of healing, and it is a form of Chinese traditional medicine that combines movement, meditation, and regulation of breathing to enhance the flow of qi (vital energy) to improve circulation and enhance the immune system. Reiki is a Japanese form of healing based on the belief that when spiritual energy is channeled through a practitioner, the patient’s spirit is healed, in turn healing the physical body. Lastly, Santeria is a form of healthcare observed by the practitioners of the Santeria religion. There are hundreds of examples of traditional holistic healing since there are hundreds of traditions, cultures, and religions (Spector 9e 90).
To conclude, the answer is false: there are two primary health care philosophies that each branch into further forms of healthcare.
Spector, Rachel E. Cultural Diversity in Health and Illness.Pearson, 2017.
By: Sreenidhi Saripalli
The COVID-19 Disparity
It goes without saying that everyone, from their neighbor’s pet fish to their great grandmother, has been affected by the coronavirus pandemic. Schools are shut down, team sports are canceled, and hospitals are flooded with patients. Everyone seems to have some aspect of their lives altered by the pandemic; however, there are certain groups of people who have been impacted more than others.
This inequality of impact is known as a disparity (see What is a Disparity? for more information). In today’s blog post, we will go over how the coronavirus pandemic has affected some more than others and what we can do about it.
First, we will start with a statistical overview of the incidence and mortality rates of the coronavirus by racial groups. According to the Center for Disease Control (CDC), in June, 205 counties in 33 states were identified as hotspots for COVID-19. 96.2% of these counties had disparities in one or more underrepresented racial or ethnic groups. Additionally, the mortality rate for African Americans was 2.4 times that of white Americans in 40 states (Source). Latinx individuals were also found to be 2 times more likely to die from COVID-19 than whites (Source). The CDC also stated that hospitalization rates for non-Hispanic black and non-Hispanic American Indian/ Alaskan natives were 4.5 times that of non-Hispanic whites; Hispanics/ Latinos have a hospitalization rate 3.5 times that of non-Hispanic whites.
It is made clear from the data above that the coronavirus pandemic is affecting minority populations at high rates. But why is this happening? There are a few main social and economic factors to consider why this disparity is occurring which I have explained below.
First, the accessibility to COVID-19 testing, prevention, care, and treatment varies depending on one’s socioeconomic status. Areas in which the population is poorer and the hospital is not equipped to effectively respond to COVID-19 will see an increase in mortality and incidence rates. Lack of availability of masks, hand-sanitizer, and educational outreaches will also dramatically increase the disparity in an area.
An additional factor to consider is insurance rates. The number of uninsured African Americans is 1.5 times higher than that among White Americans. The number of uninsured people in the Latinx community is 2.5 times higher than that among White Americans. Native Americans and Alaskan Natives have the highest rate of uninsured people at over 21%. Typically, people without insurance are less likely to seek preventative healthcare and may not be aware of any pre-existing conditions (Source). This means that there is a greater likelihood of mortality from disease among those who are uninsured.
The COVID-19 disparity has also increased among minority populations since Latinx, African American, and Native Americans are overrepresented in the frontline workforce. Frontline jobs include food service, grocery stores, home health care, public service, transportation, etc. Workers in these positions are automatically at a higher risk than others since it is harder to practice social distancing and limit contact with the public while maintaining these positions.
Oftentimes, it seems like these are factors we cannot control. How are we supposed to change company policies to provide free testing or paid family leave? How are we going to ensure that high-quality data on COVID-19 gets collected to accurately assess disparities? How are we going to provide funding to programs that aid minority groups in attaining healthcare? How are we supposed to change the structure of the healthcare system? Although we might not be able to immediately change certain factors that impact the COVID-19 disparity, there are still plenty of measures we can take to limit this disparity from worsening.
The first step to take when tackling the COVID-19 disparity is to help prevent the spread of the disease. Maintain effective social distancing, avoid large gatherings, always wear a mask, and comply with the CDC guidelines to prevent the spread of coronavirus. Secondly, we must take the necessary steps to educate ourselves. Learning about the effectiveness of safety measures can help us understand why these steps are necessary and help prevent the spread of false information. We can also learn more about our healthcare system and how we can improve to respond more effectively to unexpected situations as well as government policies or programs that can reduce healthcare disparities and the COVID-19 disparity specifically.
Lastly, we must take action and let our voices be heard.
Show support for programs that distribute masks, hand sanitizers, and other materials to prevent the spread of coronavirus and safely volunteer. Donate to organizations that help minority populations gain access to healthcare. Research government policies that have been effective in reducing the spread of coronavirus and be aware of political decisions that have harmed the country’s efforts to end the pandemic. Do your part to make a change.
HIV Medicine Association. "COVID-19 and Health Disparities in the United States." The Infectious Diseases Society of America, 16 June 2020, www.idsociety.org/globalassets/idsa/public-health/covid-19/covid19-health-disparities.pdf. Accessed 20 Sept. 2020.
Moore et al., Jazmyn T. "Disparities in Incidence of COVID-19 among Underrepresented Racial/Ethnic Groups in Counties Identified as Hotspots during June 5–18, 2020 — 22 States, February–June 2020." Centers for Disease Control and Prevention, 21 Aug. 2020, www.cdc.gov/mmwr/volumes/69/wr/mm6933e1.htm. Accessed 20 Sept. 2020.
By: Sreenidhi Saripalli
5 Steps to Cultural Competence
Cultural competence in healthcare encompasses a variety of knowledge. From the patient’s socioeconomic background to the various medical restrictions among certain religions, healthcare providers must somehow have the necessary knowledge and mindset to provide the best possible healthcare. Although this might initially seem daunting, it can be quite simple.
Below I have outlined the 5 steps to cultural competence as originally stated by Rachel E. Spector. This clear outline will guide your journey to cultural competence in a straightforward way.
Step 1: Understand your personal heritage. Who are you? What is your heritage?
Heritage is defined as the family culture, ethnicity, and/or religion into which one is born. It is an inherited legacy as opposed to culture, which refers to the beliefs and behaviors of a group of people. It is important to know your own heritage to understand the traditional views of health and illness throughout your family history. It is also important to recognize that people of different heritages may have different views regarding healthcare.
Step 2: Know the heritage of others
Knowing the heritage of the people in the community in which you practice healthcare can make a radical difference in the way you treat a patient. For example, if you are an obstetrician-gynecologist practicing in Dearborn, Michigan, which is a city known for its large Muslim population, and a pregnant Muslim woman comes into your clinic, you may have to take into account that Muslim women are usually known to be more modest, so they may prefer a female physician over a male physician.
Step 3: Recognize the various health beliefs and practices
There are many health care philosophies practiced in the world. You should note that patients may choose to follow a healthcare path other than allopathic/western medicine. Some of your patients may go to a chiropractor, others may prefer an osteopathic approach to healthcare, etc. Possessing knowledge about the different philosophies of healthcare your patients follow is critical as it may impact the medical procedures recommended to the patient. Hence, you should create an environment in which the patient is comfortable telling you that they might follow other healthcare philosophies in conjunction with the allopathic way.
Step 4: Be aware of the healthcare culture and system
The healthcare culture and system refers to the current way of functioning in western allopathic hospitals. Allopathic healthcare is a conventional system of medicine that embraces all methods of proven science (ex. community/public health, psychiatric/mental health, and rehabilitation). It encompasses the beliefs, practices, habits, customs, and expectations of the healthcare system. This may include the belief of technology, emphasis on diagnostic procedures, the use of a systematic approach and problem-solving methodology, promptness, organization, and recovery no matter the cost. You should know the way the western healthcare system typically works in order to recognize shortcomings with it and suggest improvements.
Step 5: Know the traditional healthcare systems
Traditional healthcare systems refer to the way health was viewed before the advent of technology. It could include past views of healthcare that have carried into the present. Some examples include Ayurvedic medicine, Qi Gong, Voodoo, among other traditional healthcare systems. Similar to knowing the various health beliefs and practices, a patient who practices traditional healthcare systems along with allopathic medicine might be recommended different healthcare procedures.
Spector, Rachel E. Cultural Diversity in Health and Illness.Pearson, 2017.
By: Sreenidhi Saripalli
What is a Disparity?
Despite the numerous technological advancements and efficiencies of today’s healthcare industry, many are unable to gain equal access and quality of healthcare. The present and future healthcare professionals must step up to ensure that disparities in healthcare are eradicated.
But first, what is a disparity?
A disparity is simply defined as “a lack of similarity or equality (Dictionary 2020)”. In the context of the healthcare industry, a disparity is known to be “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantages (Healthy People 2020)”.
Health disparities are often prevalent among groups of people who have difficulty receiving the best possible healthcare for themselves based on discrimination or exclusion.
Health care disparities are largely influenced by multiple factors regarding the conditions of the environment in which one lives. These factors are better known as the social and physical determinants of health.
To put a physical determinant in context, an American who earns less income might live in a residential area that is close to a power plant. As a result of the poor air quality, the residents’ lung problems quickly exacerbate and a lung cancer disparity is more likely to emerge. By contrast, wealthier Americans may have the luxury of living in an area of their preference, far from places containing large amounts of air pollution. These citizens are not exposed to bad air quality on a daily basis and do not have to worry about lung health being affected by external factors.
A situation in which social determinants of health are at play is in a community in which the culture is homophobic. The LGBTQ+ community living in this area may consequently develop mental health issues and feelings of isolation, especially the younger population. However, a child who recently discovered they identified as LGBTQ+ may have a much easier time coming out to a community that has shown their support and acceptance. The child will be less prone to depression, anxiety, or other mental health illnesses and isolation.
As you can see from the examples above, the physical and social environment in which one lives is a massive indicator of the probability of a disparity occurring.
Now that you have an idea of what a healthcare disparity is, you might be wondering what this has to do with cultural competence. Think of cultural competence as the foundational pillar to reduce disparities. Through knowledge of cultural sensitivity and unbiased care, physicians have the ability to provide healthcare of the same quality to those who need it. By understanding that a disparity is occurring among a certain group of people, you can then apply cultural competence to target the cause of the disparity and eventually eliminate it.
By: Sreenidhi Saripalli
Why is Cultural Competence Important?
The United States is known to be a melting pot. With a vast amount of races, ethnicities, religions, beliefs, and values, future healthcare professionals must understand the need for cultural competence in healthcare facilities.
12.9% of the US population is comprised of foreign-born people, those who are not US citizens at birth(Census Bureau 2010). This number is only increasing, and it is predicted that international immigration will soon overtake natural increase as the main source of population growth(Vespa 2).
Moreover, even though Census Bureau does not track religious affiliation, it is estimated that there are over 4,000 different religions practiced around the world; there are also at least 350 different languages currently spoken in this country(Census Bureau 2015).
The diversity in our country allows for so many different situations that may come up when treating a patient, and it is more than plausible that a healthcare provider’s patients come from an array of different backgrounds. So h
ow in the world do healthcare professionals deliver quality care that accounts for patients’ unique situations? The answer is simple: cultural competence.
Through knowledge of different healthcare practices in various cultures, ethnicities, and religions found across the world, the healthcare provider can develop a special relationship of mutual respect and understanding with the patient. The ability of the healthcare provider to be accepting of the patient’s cultural background can lead to higher levels of trust as well as a greater likelihood of patient compliance with the medical regimen.
Cultural competence can also increase the quality of care a patient receives. Since the provider has taken into account the entirety of the patient’s background including language, religion, race, gender identity, sexual orientation, along with other social determinants of health, they have a better understanding of what the patient is likely to prefer in terms of healthcare. The physician can then work with the patient to come up with the best healthcare routine that satisfies both parties.
In addition to improving patient care, cultural competence can help reduce the prevalence and severity of disparities in healthcare. As more healthcare workers become aware of the disparities that are prominent among minority groups, they are able to identify changes they can make to reduce those disparities.
Consider the breast cancer disparity among black women. A significant reason why the breast cancer disparity is so prominent is that healthcare workers do not follow up with black women as quickly as they do with white women. By acknowledging the systematic racism underlying this disparity, healthcare workers will be able to address the problem, target this disparity, and eliminate it.
Without cultural competence in the healthcare setting, numerous harmful misunderstandings can occur. Take the story of a 2-year-old Latino girl who was brought into the hospital after sustaining multiple severe injuries. The girl’s mother told the attending resident, “Se pegó, se pegó,” which the resident interpreted as the girl was physically struck. After looking at previous hospital records, the physicians suspected child abuse and took the girl away from her mother. Nearly two hours later, the DSS (diplomatic security service) brought a fluent translator and interviewed the mother, discovering that the girl fell off of her bike and got hurt. They concluded that the child was perfectly safe at home
(Hoffman 2015).
This entire misunderstanding could have been avoided entirely if the physicians applied cultural competence and requested the help of a translator. Instead, a family was almost wrongly separated.
This is, unfortunately, one of the many examples of a situation in which cultural competence was not demonstrated and the patient had to suffer because of it. By strengthening the patient-provider relationship, improving the quality of care provided, reducing the prevalence of disparities, and so much more, cultural competence has proven to be an integral component of modern healthcare practice.
By: Sreenidhi Saripalli
What is Cultural Competence?
Before learning about how to gain cultural competence, it is important to have a foundational understanding of what cultural competence is.
Envision a woman who strictly follows Islamic beliefs. Say that the woman has diabetes and seeks insulin from a healthcare professional.
Cultural competence would be demonstrated in this scenario by the healthcare professional clearly explaining the ingredients in the insulin to the woman, knowing that those who follow the faith of Islam have certain dietary restrictions. If the woman is not okay with non-halal insulin, the provider will know to recommend non-porcine synthetic insulin or another halal option (Qureshi).
Now picture a scenario in which a patient who follows the teachings of Confucius is recommended surgery. Cultural competence would be displayed in this situation by the healthcare professional being understanding of the patient’s hesitance of surgery.
The healthcare professional would have an underlying knowledge of Confucianism beliefs about keeping the physical body whole and sound and would respect why the individual would not want to undergo such a procedure (Spector 9e 176). Additionally, the healthcare provider would be aware if the patient had any preference of herbal treatments or natural procedures, and with this in mind, the healthcare provider and the patient could work together to seek viable alternatives.
It is extremely important to recognize that the healthcare professional does not assume or stereotype these patients based on their appearance or faith and merely respects the patients’ decisions and understands their reasoning in these examples. These two hypothetical scenarios also emphasize the underlying knowledge the physician must possess along with the correct application of that knowledge.
This in turn will lead to a better patient-provider relationship, and the patient will be more likely to comply with the medical regimens suggested by the physician. The situations described above are just some out of the many demonstrations of cultural competence in a healthcare setting.
Some concrete definitions essential to understanding and gaining cultural competence are as follows:
Culturally competent: Within the delivered care, the provider understands and attends to the total context of the patient’s situation, and this is a complex combination of knowledge, attitudes, and skills (Spector 9e 10).
Culturally appropriate: The provider applies the underlying background knowledge that must be possessed to provide a patient with the best possible health/healthcare (Spector 9e 10).
Culturally sensitive: The provider possesses some basic knowledge and constructive attitudes toward the health traditions observed among the diverse cultural groups found in the setting in which he or she is practicing (Spector 9e 10).
Culture: The set of shared attitudes, values, goals, and practices that characterizes an institution or organization (Merriam-Webster 2020).
Ethnicity: an ethnic group; a social group that shares a common and distinctive culture, religion, language, or the like (dictionary.com 2020).
Religion: a specific fundamental set of beliefs and practices generally agreed upon by a number of persons and sects (dictionary.com 2020).
Want to learn more about what cultural competence is? Here are a few of my favorite websites that give further clarity on this concept:
By: Sreenidhi Saripalli