CULTURE, COMMUNITY, AND TB CARE

Transcription

1 TB CASE MANAGEMENT AND CONTACT INVESTIGATION INTENSIVE MAY 8-11, 2018 CULTURE, COMMUNITY, AND TB CARE LEARNING OBJECTIVES Upon completion of this session, participants will be able to: 1. Explain the impact of culture on tuberculosis care 2. Identify 5 ways that people might culturally identify themselves 3. List 3 resources to learn more about how to work effectively with patients from different cultures INDEX OF MATERIALS 1. Culture, community, and TB care slide outline Presented by: Kay Wallis, MPH PAGES 1-33 SUPPLEMENTAL MATERIALS 1. Resources for TB Care Across Cultures, UCSF 300 Frank H. Ogawa Plaza, Suite 520 Oakland, CA; Office (510)

2 Culture, Community, and TB Care Kay Wallis, MPH Special Projects Manager Oakland, CA, USA I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon s knife or the chemist s drug. Hippocratic Oath (modern version,1964) May 8-11,

3 During our time today Culture and its powerful impact on TB care During our time today Many layers of cultural identity May 8-11,

4 During our time today Ways to learn more about the cultures of your patients My ulterior motives That your interest in cross-cultural learning will be reignited That you will be inspired to express this interest within your work settings That you and your agencies will become even better equipped to create cultural safety for your patients May 8-11,

5 One last motive To whet your appetite for the next session! Enhancing Skills for Cross-Cultural Patient-Centered Care Stephanie Spencer Cross-cultural skills WHY? May 8-11,

6 We all know the reasons Improved use of health services Better compatibility between western and traditional health practices Improved adherence Reduced delays in seeking care Gathering important information from the patient Developing treatment plans that will be followed by the patient and supported by the family Improved patient satisfaction Improved staff efficacy and morale Cost savings (sometimes) We live in a time of division and upheaval May 8-11,

7 May 8-11,

8 The challenge we now face To deepen our understanding of culture and its impact on TB care To maintain an ongoing curiosity for learning about our patients cultural identities To commit to a continuing process for enhancing our cross-cultural skills May 8-11,

9 What is culture? Culture is a social construct DNA sequences: Humans are 99.5% similar. May 8-11,

10 What is Culture? Culture is a group s design for living; its assumptions about the world, about other people and the meaning of life, about what is right and wrong. What is Culture? Culture is the integrated pattern of human behavior that includes thought, speech, action, and artifacts. May 8-11,

11 What is Culture? Culture takes into account the customary beliefs, social norms, and material traits typical of a population or community at a given time. Cultural identity can be based on geography language ethnicity May 8-11,

12 Cultural identity can be based on religion Cultural identity can be based on interests May 8-11,

13 Cultural identity can be based on socio-economic status Reuters Cultural identity can be based on ranges of physical ability; neuro-diversity May 8-11,

14 Our patients also come from vulnerable SUB-POPULATIONS Immigrants May 8-11,

15 J.B. Handelsman, The New Yorker, 4/10/06 substance users May 8-11,

16 incarcerated homeless May 8-11,

17 Cultural Competence Cultural Humility Cultural Sensitivity Cultural Proficiency Cultural Flexibility Which CULTURES do your patients represent? May 8-11,

18 What is Cultural Proficiency? A set of behaviors, attitudes, and policies that enable us to work effectively in cross-cultural situations. Cultural Humility I am sensitive about the impact that culture can have on a situation; I am knowledgeable (or learning) about culture and its impact; I am skillful at managing that impact; and I realize that cultural humility is a lifelong pursuit. May 8-11,

19 Cultural humility is an INPUT Cultural safety is an OUTPUT Cultural Safety When patients feel safe and accepted as who they are in terms of their cultural identities and behaviors How respected and assisted do our patients feel? Are patients cultural values and preferences taken into account during our encounters? Jessica Ball, MPH, PhD, U. Victoria. May 8-11,

20 Cultural safety is part of patientcentered care (PCC) PCC improves health status Cultural safety recognizes power I see the power imbalances that exist in the patient-provider dynamic. I acknowledge that members of dominant groups have inherent privileges (social power) that others do not have. I understand that oppression blocks patientcentered care. I commit to being an ally to oppressed groups in our collective struggle for justice. May 8-11,

21 Before we focus on the other May 8-11,

22 RECOGNIZE: my own cultural identities Share with your partner: 1 cultural identity that applies to you. Discuss with your partner: - Could this cultural identity impact my interactions with patients? - If so, what might the impact be? May 8-11,

23 We can t be experts about all cultures, so we work with people who can explain, interpret, and mediate between us and a patient from another culture. AT THE SAME TIME If we learn as much as possible about our patients cultures, we can work effectively with interpreters and cultural mediators, and we can build trust and rapport with patients. May 8-11,

24 Learning more about my patients cultures I m a busy public health nurse, not Margaret Mead! May 8-11,

25 General info about Culture X Health info about Culture X TB and Culture X How can we learn more about Culture X? May 8-11,

26 Google (with a grain of salt) TB Centers of Excellence and CDC materials Ethnomed; The Cross Cultural Health Care Program Other health programs that work with this culture Community agencies, churches, schools that work with this culture Movies, books, television from that culture Festivals, special events Wherever this group congregates (cafe, temple, park, etc.) May 8-11,

27 May 8-11,

28 Cultural challenges in your program (worksheet) What should we learn about Culture X? May 8-11,

29 Etiquette that generates trust Types of healers Roles of healer/patient Illness beliefs, explanatory models Treatment practices Learn the history of the group s experience with government policies and health care The Tuskegee Study Indian residential schools Forced sterilization (incarcerated patients; patients with mental illness) May 8-11,

30 Country Guides (free from the Southeastern National TB Center) 19 countries to choose from Download or order from: Promoting Cultural Sensitivity: A Practical Guide for Tuberculosis Programs (free downloads from the CDC Division of TB Elimination) 6 countries to choose from Download from: May 8-11,

31 Translated patient materials 와결핵에대한실상 BCG 는무엇입니까? BCG 는 bacilli Calmette-Guerin" 백신의약자입니다. BCG 는결핵을방지하기위해주어집니다. 결핵이흔히있는나라에서는, 많은사람들이 BCG 백신을받습니다. 미국에서는자주사용되지않습니다. 저의결핵피부검사가양성인것은 BCG 백신때문입니까? Don t assume literacy or comprehension in any language Are your materials literacy sensitive? Are alternatives to written communication available? May 8-11,

32 Words matter Accept that common terms can be hurtful or stigmatizing to certain groups, and learn new terms Illegal alien: Undocumented HIV infected: HIV positive TB suspect: Person to be evaluated for TB Words matter May 8-11,

33 A final note People are complex. Share with your partner: One thing I will do in the next two weeks to continue creating cultural safety for patients is May 8-11,

34 Thank you for all you do to help people to heal. May 8-11,

35 Resources for TB Care Across Cultures Health-Related Cultural Information The Cross Cultural Health Care Program Cultural Clues EthnoMed Management Sciences for Health, Providers Guide to Quality & Culture National Center for Cultural Competence (NCCC) TB-Specific Cultural Information Country Guides (Brazil, Cambodia, China, Colombia, Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, India, Indonesia, Mexico, Myanmar (Burma), Peru, Philippines, Somalia, South Korea, Vietnam) Southeastern National Tuberculosis Center Ethnographic Guides (Burma, China, Laos, Mexico, Somalia, Vietnam); CDC Division of TB Elimination TB & Cultural Competency Newsletters; Rutgers Global Tuberculosis Institute Translated Patient Education TB Resources EthnoMed Georgia Department of Public Health Harborview Medical Center, Seattle Massachusetts Health and Human Services Department Minnesota Department of Health National Library of Medicine, National Institutes of Health National Prevention Information Network (NPIN) Educational Materials Database New South Wales Health Refugee Health Information Network (searchable database) TB Education and Training Resources (CDC) (Web addresses verified 4/27/18) Kay Wallis, MPH