Download Culturally Competent Health Care for Vietnamese American Patients

for
Vietnamese
American
Patients
Culturally
Competent
Health Care
• Practical
Definition: “I
think my way of
looking at the
world is correct.”
• Major barrier
to working with
people of
another culture.
Ethnocentrism
• Need to realize that
all do not fit
stereotype.
• Need to distinguish
between stereotype
and reality.
Cultural Stereotyping
• This show highlights cultural
awareness (Vietnamese
culture).
• Awareness is the first step of
full cultural competence.
• In treating patients, providers
must strike balance between
repecting culture and ensuring
safety/health.
Respect and Safety
TIME is the key
element as each
statement has to be
spoken twice.
– History can be 80% of
the diagnosis.
– Take time in obtaining
the history.
REMEMBER -
Using Interpreters
– Do the patient and
interpreter know
each other outside
the clinic?
– What about using a
family member to
interpret?
Confidentiality Issues
Using Interpreters
Female patient with
male interpreter
Makes it difficult to
impossible to obtain
information on
menstrual periods,
family planning
–
–
Gender Issues
Using Interpreters
– Talk to the patient,
not the interpreter,
e.g. “Do you have any
pain” not “Does he
have any pain?”
– May not be
comparable words in
both languages.
Talking to patients
Using Interpreters
• These same patients
have no intent to
follow your directions
or recommendations.
• Patients will nod and
say “thank you,” as a
gesture of politeness.
Using Interpreters
– Written language
developed in 16th
century by French
– French is common
second language
– French domination
• Southeast Asian
• 80 million people
• 19th Century
About Vietnam
• Saigon renamed Ho
Chi Minh City
• South Vietnam
taken over by
North Vietnam
• Ended in 1975
Vietnam War
• In total, 500,000
(previous military,
government officials)
fled to US.
• In US,they became
refugees (not
immigrants).
• US helped 100,000
flee southern Vietnam.
After the War . . .
• Majority of
Amerasians do
not know
their father.
• Offspring of a
US soldier and
Vietnamese
mother
Amerasians Given
Refuge
• Actually, these
were labor camps
or prisions.
• Many military men
were put into “reeducation” camps
(up to 15 years) to
be taught
Communist thinking.
Reeducation Camps
• Father or
other family
members
would join
family later.
• Families split
apart.
Families Were Split
• Elderly are
respected.
• Family is
paternalistic
• Family is very
important.
Culture
• Christian/Catholic
(missionary
presence)
• Confucianism
(Chinese
influence)
• Buddhism
Religion
• Important to maintain
dignity/honor – avoid
embarrassment.
• Show respect by
avoiding eye contact.
• Vietnamese are modest
in speech and action.
Other Cultural Features
• Chinese medicine
• Traditional medicine
(“eastern” philosophy)
particularly in rural
areas
• Some “western”
medicine due to
French influence
Health and Disease
Can be caused by:
• Physical agents (injury, bad
food)
• Supernatural causes (spirits,
powers, fate/good or bad
luck)
• Metaphysical causes
(disruption in universal
order, Yin and Yang)
Disease
Beliefs
• Restores Yin/Yang
balance.
• Treatment is the
opposite “hot” or
“cold.”
• Many illnesses are
ascribed to be “hot”
or “cold.”
Hot and Cold Diseases
Beliefs
• Many will talk
about allergies to
fish or beef.
• Some foods are
thought to cause
skin disruptions.
• Food can also be
hot or cold.
Food and Health
Beliefs
– They are weaned of bottles
at very late ages 3 – 4.
• Children sleep with bottles.
• Little breastfeeding
– They want to give milk (rice
milk) all the time.
• Parents think milk contains
good nutrition.
Food and Health
Beliefs
– Often expressed
physically
– Sometimes
attributed to
spirits, demons, sin
– Is stigmatized
(suicide worst)
• Mental illness
Mental Illness
Beliefs
• Leaves them weak
and tired
• Perceived as giving
a large amount of
blood
• Taking blood samples
often very traumatic
Blood Samples
Expectations
– Do want antibiotics for colds
– Do want vitamins (self and
children) to increase appetite
and gain weight
– Do want pain medication
– Do not want medicine for
diabetes, hypertension,
chronic illnesses
• Patients expect prescription
Medications
Expectations
• Do not worry about high
cholesterol or blood pressure
or effects of uncontrolled
diabetes.
• Medicine is more important than
health maintenance (pap smear,
mammogram), dieting,
exercising.
• Focus on treatment, not
prevention.
Prevention vs. Treatment
Expectations
• Vietnamese patients
worry more about the
liver than other
organs.
• Parents do not
understand that
asthma episodes are
life threatening.
Other Expectations
– Often leaves bruises,
marks and ecchymosis
that looks like hickies
or abuse
– Sometimes hot oil used
Coin Rubbing
Common Practices
– Placing a hot cup
(often on the torso) to
draw out an illness.
– This leaves circular
marks.
Cupping
– E.g. pinching skin on forehead
to pull out pain of a headache.
Skin Pinching
Common Practices
– Medicine that can be
purchased at local
pharmacies to treat a
variety of conditions.
Chinese Medicine
– “Tiger balm”
– Herb steam
Topical Preparations
Common Practices
– E.g. Take ibuprofen for a
headache and do skin pinching
on forehead.
• Many people from Vietnam
combine traditional and western
medicines.
Common Practices
– 10 – 13% may be
chronic carriers
with no symptoms.
• Hepatitis B
– Most have old infections
with no symptoms.
– Some have been treated.
– TB is common in Vietnam.
• Positive TB tests
Refugees Medical Problems
• Dental caries
– Common
– Intentionally blackened
teeth (often
in elderly)
• Intestinal parasites
– Many have worm or other
intestinal infections.
– Many are asymptomatic.
Refugee Medical Problems
– Higher
percentage
than other
patients
• Lactose
intolerance
Refugee Medical Problems