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Working with Hispanic Elderly. America was once envisioned as “the melting pot”. U.S.A. Health Care. “In a complicated health care system where there are rulers …, the needs of vulnerable populations suffer” (55). Christina Aguierre-Molina Health Issues in the Latino Community.

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America was once envisioned as “themelting pot”

U.S.A.



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“In a complicated health care system where there are rulers …, the needs of vulnerable populations suffer” (55).

Christina Aguierre-Molina

Health Issues in the Latino Community


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Immigration from Mexico to the United States rulers …, the needs of vulnerable populations suffer” (55).

In 2000, Latino population in the U.S. was 66.1% Mexican (Aguierre-Molina 4).

“Mexican Americans have been more persistent than any other ethnic group in maintaining their language and culture” (172).

Sybil Lassiter

Multicultural Clients: A Professional Handbook for Health Care Providers and Social Workers


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Learning Outcomes rulers …, the needs of vulnerable populations suffer” (55).

  • Following this presentation we hope that you will have a clearer understanding of:

  • Who are Latinos?

  • What are the various barriers which Latinos face in obtaining health care?

  • c. How Latino culture and health care provider culture impact health care services.


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For the Latino Community, rulers …, the needs of vulnerable populations suffer” (55). barriers to health care include, but are not limited to:

Lack of understanding of U.S. health care system

Lack of transportation to facilities

Exorbitant health care costs

Lack of health insurance

Limited knowledge of English language

Cultural Conflicts


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Health Insurance rulers …, the needs of vulnerable populations suffer” (55).

Many Latinos lack health insurance because of the language barrier, but

MOST lack health insurance because: they work in low-paying, less stable, often hazardous jobs that do not offer employee benefits.

“Latinos are the most likely to be uninsured” (Aguierre-Molina 50).


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The Language Barrier rulers …, the needs of vulnerable populations suffer” (55).

Spanish-speaking community is: one of the largest minority groups in the U.S.

However, there are few Spanish-speaking deliverers of health care.

“One way to sensitize young students to the severity of the language barrier is to have them present a health problem to a person who does not speak or understand a word of English. It’s often difficult and embarrassing.”

Rachel Spector

Cultural Diversity in Health and Illness


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“I can’t understand what the doctor and nurses are saying! They speak a foreign language!”


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A hospital can be a saying! They speak a foreign language!”frightening place …

Non-English-speaking patients can feel intimidated and vulnerable.


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Interpreter Services saying! They speak a foreign language!”

Families often use children or friends to interpret.

Chicago Study:

84 hospitals surveyed about interpreter services

Results:

71 said they do not hire interpreter services

(utilize staff, housecleaning persons, clerks)

20 hospitals request that patients bring their own interpreters

2 hospitals require patients to bring their own interpreters or go elsewhere for treatment.

J. Dunlap and Faye Hutchinson

America’s Newcomers: Health Care Issues for New Americans


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While Interpreters are helpful, the use of interpreters is not without its problems:

Interpreters can often …

construe their own meaning of certain words or phrases:ahora = “now” or “at this time” (most Spanish-speaking countries) ahora = “24 hours from now” (Mexico)

be a hindrance in obtaining information that a Latino patient feels is very personal or sensitive.

interpret incorrectly if the interpreter is a child.


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Potential Consequences of the Language Barrier not without its problems::

Patient dissatisfaction;

Poor comprehension and understanding of messages from providers;

Non-adherence to physician instructions;

Lower quality of patient care;

Poorer health outcomes.


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Latino Cultural Values not without its problems:

  • Preferred personality

  • Time orientation

  • personalismo

  • familismo

  • machismo

  • curanderismo


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personalismo not without its problems:

“formal friendliness” or personalized approach

Value is placed on how individuals work together as a group versus individual accomplishment.

Often refer to health care workers by name rather than by job title or name of institution.

Individuals should be kind, agreeable, flexible, loyal, honest, generous, willing to help others.

Mary


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Through not without its problems:personalismo …

Latino patients often expect to form a personal, friendly relationship with their health care provider.

Some bring food as a personal gesture, and expect the provider to graciously accept it.


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familismo not without its problems:

  • Places goals of the family above those of the individual.

  • Family placed at the CENTER of daily life:

family ties

close-knit unity

dependence upon each other

family

extended family


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Latino patients often view their illness and treatment as a FAMILY MATTER.

Include family in decisions regarding treatment.

Western Culture

Illnesses as well as decisions about treatment are often kept private and away from family and friends.

Through familismo…


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machismo FAMILY MATTER.

“macho”= male, one who carries great honor, responsibility and respect

  • Male considers himself the sole provider and back- bone of the family.

  • Responsible for well-being of family … will often sacrifice his own medical needs to make sure those of his family are met first.


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The “downside” of FAMILY MATTER.machismo

  • For most Latino males, succumbing to illness is not considered “macho.”

  • Often seen as “weak” by others if a man cannot work due to illness.

  • Latino culture views “illness” as something one simply must endure.

  • Illness often reflects moral and physical weakness.

  • Often results in physical abuse of spouse.


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Due to fear of Western medical practices along with a feeling of intimidation of large medical institutions, many Latinos turn to:

curanderismo

curandero“

Aztec

Holistic Healer

Spanish

Spiritualistic


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Who is the curandero? feeling of intimidation of large medical institutions, many Latinos turn to:

Religious figure or specialist who receives his/her gift of healing in 3 ways:

1. Born to heal

2. Learn through apprenticeship

3. Through a trance or dream during adolescence or midlife.


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In feeling of intimidation of large medical institutions, many Latinos turn to:curanderismo, rituals include (but are not limited to)

  • Laying on of hands

  • Performing massages

  • Lighting candles

  • Going to confession

  • Doing penance


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curanderismo feeling of intimidation of large medical institutions, many Latinos turn to: OR doctor??

curanderismo

Westernized Care

versus

Close, personal relationships

De-personalized care


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“Culture” of the Health Care Provider feeling of intimidation of large medical institutions, many Latinos turn to:

Just as a certain race or ethnicity lives according to its own cultural beliefs, providers of health care follow a set of rules and principles from which they carry out specific practices, habits, and norms.

What happens when providers of health care from one culture encounter recipients of health care from another culture?


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Health care providers often expect Latino patients to willfully submit to invasive testing without prior discussion or verbal preparation.

Often ask outright explicit and often embarrassing questions with minimal preamble.

CultureClash!

The results are often…


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Health Care Providers willfully submit to invasive testing without prior discussion or verbal preparation. include:(but are not limited to)

  • Physicians

  • Nurses

  • Social workers

  • Dietitians

  • Lab professionals


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Latino Health Practices willfully submit to invasive testing without prior discussion or verbal preparation.

According to the American Public Health Association (APHA), Hispanics and Latinos are commonly distrustful of physicians and modern medical practices.

About 33% of Latinos believe that home remedies are more effective at treating illness than prescribed medications.


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Home remedies often include: willfully submit to invasive testing without prior discussion or verbal preparation.

Different forms of alcohol

Honey

Various teas


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Bridging the Gap Between willfully submit to invasive testing without prior discussion or verbal preparation.HCP Culture and Latino Culture

By integrating home remedies with prescribed treatments, health care providers can often win the trust of the patient which can then increase patient compliance to treatment.

American Public Health Association


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Type I: willfully submit to invasive testing without prior discussion or verbal preparation.

Type II:

Deficiency in pancreatic secretion of insulin: < 5% of diabetes cases in the United States.

Insulin deficiency and/or insulin resistance: > 90% of diabetes cases in the United States.

Diabetes and I.D.E.A.L. Latino Patients

Diabetes

Fifth cause of death for Latinos


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I.D.E.A.L. willfully submit to invasive testing without prior discussion or verbal preparation.(Initiative for Diabetes Educational Advancement for Latinos)

  • Intensive and Expensive.

  • Requires frequent trips to health care facilities.

Main obstacle to treatment:

Language barrier


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How Do We Resolve Linguistic and Cultural Differences?

“… identifying the differences among people will enable better understanding of one’s own culture, as well as the ethnic culture of others” (77).

Rachel Spector


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In conclusion and Cultural Differences?

The most important things to note:

Confianza

Fatalismo

El Cliente