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Working with the Marshallese Community in Cancer Care & Prevention
Transcript of Working with the Marshallese Community in Cancer Care & Prevention
Amanda Tran, Jenny Hooker, Hanna Dinh,
Christi Quilligan, Yulia Arbuzova Works & References Cited People tend to give priority to the moment and many operate on “island time” which can be difficult regarding health care settings. Marshallese culture is one based on reciprocation and mutual respect. Taking time to learn a little about their culture is greatly appreciated. Illness and suffering are often accepted as inevitable experiences in life, and this outlook can influence decisions to seek care. Most migrants learn about health care system norms and rules from their social networks. They learn how to make appointments, fill out applications and arrange transportation services for them. Christianity is a large part of Marshallese culture and much of their community is based around it.
Some Marshallese work with magic and/or prayer to influence outcomes. In contrast, disease can also be seen as originating from supernatural causes. 'imi hale - native hawaiian cancer network. (2008). Retrieved from Williams, D., & Hampton A. (2005). Barriers to health services Aitaoto, N., Braun, K. L., Estrella, J., Epeluk, A., & Tsark, J. (2012). Design Carucci, L. M. (1993). Medical magic and medicinal cure: Manipulating Buenconsejo-Lum, L. (2010, September 30). Improving the health of Pacific regional comprehensive cancer control plan 2007-2012. (2007, Choi, J. (2008). Seeking health care: Marshallese migrants in Hawai'i. perceived by Marshallese. Journal of Immigration Health, 7, 317-26. Ethnicity & Health, 13(1), 73-92. doi:10.1080/13557850701803171 http://www.imihale.org/education_materials.htm meanings with ease of disease. Cultural Anthropology, 8(2), 157-168. Retrieved from http://www.jstor.org/stable/656468 Pacific Islanders: Leveraging resources through communityacademic partnerships. (2010). Retrieved from http://www.americantelemed.org/files/public/MemberGroups/PICATA/PICATA_Buenconsejo-Lum_-_Improving_the_health_of_Pacific_Islanders_-_9-30-10.pdf March). Retrieved from http://cancercontrolplanet.cancer.gov/state_plans/Pacific_Regional_Cancer_Control_ Plan.pdf and results of a culturally tailored cancer outreach project by and for Micronesian women. Prev Chronic Dis, 9(100262), doi: http://dx.doi.org/10.5888/pcd9.100262 Marshallese focus groups and individuals have suggested ways to enhance communication and build trust and compliance:
Examples of visual aids: http://www.imihale.org/pubs/brochures/Shower%20cards/Marshallese.pdf
http://www.imihale.org/pubs/brochures/Cancer%20Brochures/BeadNecklace.pdf Have only same-gendered staff discuss personal or taboo information, and apologize for having to use “offensive” language.
Conduct home visits for health education and discussing sensitive issues
Patience, lack of judgement and taking time with the patient shows respect.
Due to financial and logistic reasons, offer samples of prescriptions and follow-up appointments over the phone
Aim to make healthcare education programs and materials available in the native, Marshallese language Example: http:///www.imihale.org/education_materials.htm Provide translators and interpreters. Ideally someone with understanding of the culture. Speaking in short phrases with minimal jargon will get the message across best and quickest. Visual aids can also be helpful.
Incorporate patient-navigators in hospitals and clinics By definition, individuals from the patients’ own culture or community that went through the same health experience or has been very involved in or understand the healthcare system that will be able to explain the health processes to the patients “if an individual needs medical care or advice, they will first go to someone they feel they can trust and provide interpretation services, rather than first seek Western medical care” i.e. a known community leader or pastor
Culturally Health Tailored Care In essence, education and health programs will be more effective when they are culturally appropriate for the population that is being served.
To create a fitting program, healthcare providers must be able to identify and describe cultures/subcultures and understand how each relates to health behavior, and then apply this knowledge in planning and developing of appropriate activities.
There are five categories for creating a culturally appropriate health care plan: peripheral, evidential, linguistic, constituent-involving, and sociocultural categories.
Peripheral strategies seek to give programs or materials (healthcare) an appearance of cultural appropriateness by packaging them into ways that would be ideal and likely to appeal to a certain group. For example, colors, images or pictures of group members might be useful and influential tools. When this material seems familiar to the patient, it will make them feel more comfortable. Unlike text, there are no linguistic barriers, and such images can be perceived instantly. It also establishes credibility with the chosen cultural group. By matching and making an effort to be culturally sensitive, the group will be more receptive and accepting of the treatment, and any of the healthcare messages might be enhanced.
Evidential strategies enhance and make medical information more relevant by presenting evidence to the group. Most of the time, the evidence is epidemiological or other data that relates to the specific group (20% of Marshallese women are affected by cancer, for example). These statements will raise awareness, and make the data more relevant, and will cause the patients to think seriously about the healthcare problem that they might be experiencing, and encourage them to take preventive action.
Linguistic strategies aim to make healthcare education programs and materials more accessible by providing them in native language. At the very least, this may involve having an interpreter or a translation program.
Constituent-involving strategies are those that draw on the experience of the same member of the group. Training of professionals or “natural helpers” that can provide valuable insights into the cultural characteristics that are not as obvious as language.
Sociocultural strategies involve discussing health related issues in the context of a broader social and/or cultural values. Using this approach, the group's cultural values, beliefs, and behaviors can be recognized with ease and reinforced and built upon. In addition, it will allow the extraction of useful and meaningful information and messages about a given health problem or behavior.
Subgroup that takes into account characteristics shared by the subgroup’s members. For example, people feel more comfortable talking about cancer to those who shared their views on it, talked similarly about it, and who even looked like them.
"Whenever I translated, it seemed that the doctors were always impatient and in a hurry. Sometimes it seemed like they wanted the session to be over quickly. It's understandable because they're busy and have more patients to see. Interacting with a non-English speaking patient is hard, and they see it as more work"
To complicate things, there is a third individual—the interpreter—and building trust between three people is rather hard. However, as an interpreter, I provided relevant information that helped the doctor communicate with the patient and build trust. That way, it becomes easier to work with the patient.