Paulo N. Correa and Alexandra N. Correa- 'Global Warming': An Official Pseudoscience
NEREIDA CORREA, MD ASSISTANT PROFESSOR
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CULTURAL COMPETENCE : RACE AND ETHNICITY
NEREIDA CORREA, MD ASSISTANT PROFESSOR
OBS/GYN & FAMILY PRACTICE ALBERT EINSTEIN COLLEGE OF MEDICINE
JANUARY 24, 2001
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CULTUREINTEGRATED PATTERN OF HUMAN BEHAVIORINFLUENCES THOUGHT, ACTIONS, CUSTOMS, BELIEFS AND VALUESRELATED TO ETHNIC, RACIAL RELIGIOUS OR SOCIAL GROUP
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CULTURES IN THE BRONXWHITE -ALL ETHNIC GROUPSBLACK- ALL ETHNIC GROUPSASIAN - ALL ETHNIC GROUPSINDIAN- EAST AND WESTHISPANIC- MOST GROUPS
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COMPETENCEACQUISITION OF KNOWLEDGEDEVELOPMENT OF SKILLSEXPERIENCEAPPLIED TOWARDS INTERVENTIONS ADAPTIVE TO THE DIFFERENT GROUPS SERVED
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CULTURAL COMPETENCECONGRUENT BEHAVIORS, ATTITUDES AND POLICIESCOME TOGETHER TO WORK EFFECTIVELY IN CROSS CULTURAL SITUATIONSSERVICES PERCEIVED AS RELEVANT AND HELPFUL
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DIVERSITY TRAININGACCEPTANCE AND TOLERANCELOWERS PREJUDICEDEVELOPS CULTURAL AWARENESS AND SENSITIVITYIS A BEGINNING TOWARDS SHOWING THE DIFFERENCES BUT DOES NOT GIVE TOOLS
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COMPETENCY TRAININGPROMOTES SKILLS AND KNOWLEDGECONTENT BASEDDIFFICULT TO TEACHINDIVIDUALIZED TRAININGDEVELOPS PRACTICAL SKILLS
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CULTURAL AWARENESSGENDERAGEETHNIC IDENTITYRACESOCIAL STATUSROLES
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CULTURAL ASSESSMENTBIRTH PLACE AND ETHNICITYSUPPORT FAMILY MEMBERSLANGUAGES AND NONVERBALSRELIGION AND PRACTICESECONOMIC SITUATIONHEALTH/ILLNESS BELIEFSBIRTH/DEATH BELIEFS
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COMMUNICATIONINTERPRETORSCONVERSATIONAL STYLEPERSONAL SPACEEYE CONTACTTOUCHTIME ORIENTATION
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DIVERSITY ISSUESMIGRATION STATUSETHNICITY/RACIAL GROUPSOCIOECONOMIC STATUSSEXUAL ORIENTATIONDISABILITY
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BELIEFSHEALTH AND WELLNESSBIRTHING PRACTICESUSE OF ALTERNATIVE SYSTEMSDEATH AND DYINGBEHAVIOR WITH HEALTH WORKERSRESPONSE TO HISTORY TAKING
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NYC POPULATIONSBLACK AMERICAN 2.8 MPUERTO RICAN 1.O MRUSSIAN 455 KWEST INDIAN 452 KCHINESE 285 KEAST INDIAN 133 K
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POPULATION UNDERCOUNTING
IMMIGRANT GROUPS GREATLY UNDERCOUNTEDSELF DESCRIPTION VS ASSIGNED GROUPSTATE NET UNDERCOUNTING : 272K ADULTS, 113 K CHILDREN IN ‘90BY GROUP: 1.9K WHITE, 186K BLACK, 136K HISPANIC, 23K ASIAN,
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NYS UNDERCOUNTINGNET UNDERCOUNT 272,036NET CHILDREN 113,486WHITE 1,972BLACK 185,873HISPANIC 136,010ASIAN 22,760NATIVE AMERICAN 1,763
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LEARNLISTEN WITH EMPATHYEXPLAIN YOUR PERCEPTIONACKNOWLEDGERECOMMEND TREATMENTNEGOTIATE TREATMENT
MODALITIES
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DISPARITIESMATERNAL AND INFANT MORTALITYACCESS TO HEALTH CAREEMPLOYMENTEDUCATIONPREVALENCE OF DISEASES RELATED TO DIET AND EXERCISEHOMICIDE AND SUICIDE
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HEALTH PROFILE ON MINORITIES
BREAST CANCER INCREASED 3.9% FOR BLACK WOMENTUBERCULOSIS INCREASED BY 51% FOR ASIAN AMERICANS AND 30% FOR HISPANICSAIDS/HIV DISEASE INCREASED FOR BLACKS, HISPANICS, ASIANS AND NATIVE AMERICANS
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HEALTH PROFILEINFANT MORTALITY RELATIVE INCREASELIFE EXPECTANCY 6.6 YEARS LESSHEART ATTACK DEATH DECLINED 21% FOR BLACKS VS 29% FOR WHITESDEATH FROM HIV DECLINED 13-22% VS 32% FOR WHITES
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HEALTH PROFILEHOMICIDE AND SPINAL CORD INJURY DOMESTIC VIOLENCEEXPOSURE OF CHILDREN TO DRUGSCIGARETTES AND ALCOHOLTEEN PREGNANCYSCHOOL FAILURE AND DROP-OUT
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INTERVENTION STRATEGIES
INVOLVEMENT IN COMMUNITY GROUPSINVOLVEMENT IN LEADERSHIP OF PROFESSIONAL GROUPSMENTORING OF YOUTHPOLITICAL ACTIVISMRESEARCH
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VIGNETTES
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RACE AND ETHNICITYPRACTICE VIGNETTES
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PRACTICUM: RISKSStereotyping can occurOversimplification of true valuesMay be misinterpretedMay offend members of the group
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PRACTICUM: BENEFITSIncreases awareness of behaviorInculcates sensitivityPromotes understanding between groupsDevelops strategies in practitioners that will help them to give care to diverse populations
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OBJECTIVESDemonstrate by illustration how culture impacts on the physician-patient interactionProvide examples of various ethnic groups in the Bronx and some common beliefs with in the cultureExplore the impact of a lack of understanding on the therapeutic relationship
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ETHNIC GROUPSAfrican-AmericanArab HaitianMexicanPuerto RicanVietnameseWest Indian
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AFRICAN-AMERICANA 14 year old teenage boy is brought in for a routine physical exam His mother wants routine exams done and is concerned about school performance
Beliefs: Strong family links; demanding of respectIssues around gender identity, expected roles and independence
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AFRICAN-AMERICANAssess developmental level and institute age appropriate counseling regarding safety issues, sex and pregnancy prevention, career issuesProvide flexible access for questionsAppreciate gestures such as lack of eye contact and looking down related to respect
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ARABA 24 year old woman pregnant for the first timeVisit with her husbandEstablishing plans for her care
BeliefsConcernsOutcomes
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ARABBeliefs: Birth is a natural process
Modesty to be conserved-privacy, veilsHusband, father, brother make decisionsChildren are sacred
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ARABSConcerns:
Usually requesting female providerMale family member to be involved in decision makingPrefer natural delivery, will accept pain medicationPrayer time essential for strict MoslemsAmulets: blue stone to ward off evil eye
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ARABPrenatal care with female providersDelivery plan made with negotiations regarding the need for some male practitionersActual delivery with husband present-involved in decisionsPatient wore veils and robes when in halls
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PUERTO RICANCouple seen for evaluation of infertilityPartner has one child from previous marriageSuspicion is male factor infertility
Beliefs: Male sexual productivity is indication of masculinityConcerns: Inability to impregnate partner can be interpreted as lossOutcomes
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PUERTO RICANAssurance of language competence and use of translator if needed, not family memberPresentation of data on infertility and the facts related to male factorReassurance that there is no correlation with sexual performancePrivacy
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VIETNAMESEA 5 year old girl brought in for fever and a coldBruising noted on chest wall in reddish streaksSeveral cup marks seen on her back
Beliefs: Hot and cold theory of medicine and use of alternative medicines; illness related to sins of past lifeConcerns: Distinguish injury to child
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VIETNAMESEAssurance of language competency; use of translator unless fluent in EnglishHistory taking to include beliefs and practices in an open-ended wayNegotiate plan to include parental belief to improve complianceHelp family to deal with guilt at illness
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HAITIANA 50 Year old man diagnosed with cancer of the stomachHas experience gradual illness and now is dying
Beliefs:Illness a continuum
Kompa bonMoin maladmoin malad anpilmoin pap refebon die vs loa
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HAITIANAssurance of language competencyDiscuss beliefs about illness and death; believer in spiritualism, or catholic or bothAllow space for as much family as possibleFinal bath given by family memberPrefer to die at home
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WEST INDIAN35 Year old woman with new diagnosis of hypertensionSees herself as healthy, has no painTold to avoid salt and fatty foods in diet
Beliefs: Diet with strong broths and organ meats will build up the bodyFatigue and pain are symptoms of diseaseHot and cold foods
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WEST INDIANNutritional interventions with cultural beliefs in mind; hot and cold combinations and restrictionsDiscussions regarding asymptomatic nature of her diagnosis and the need for preventive interventionsRegard for issues of respect, eye contact and touching
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MEXICANA 15 year old girl brought in by her mother for amenorrheaHistory of recent arrival to cityConcerns regarding pregnancy
Beliefs: Family loyalty, concerns regarding respect, family reputationCuranderos:Maladies such as mal de ojo, susto. Empacho, caida de mollera, antojos
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MEXICANAssurance of language competencyIncluding mother in the interviewSpeaking to the teenager aloneExploring cultural beliefs and issuesProviding interventions and bridging cultural gap
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UNIFYING PRINCIPLESDiversity vs. SimilarityLanguage competency essentialRespectful InquisitivenessNegotiation to improve complianceNon-verbal communication is universal