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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