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Cultural Sensitivity and Communication with the Hispanic Patient

Cultural Sensitivity and Communication with the Hispanic Patient. Tamina Winn-McMillan M.D. December 2, 2010. Objectives:. Discuss cultural professionalism and communication when dealing with Hispanic patients Use knowledge of some Hispanic cultural beliefs to guide anticipatory guidance.

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Cultural Sensitivity and Communication with the Hispanic Patient

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  1. Cultural Sensitivity and Communication with the Hispanic Patient • Tamina Winn-McMillan M.D. December 2, 2010

  2. Objectives: • Discuss cultural professionalism and communication when dealing with Hispanic patients • Use knowledge of some Hispanic cultural beliefs to guide anticipatory guidance

  3. La Familia

  4. Family • The belief is that family is important. • Include extended family as well as multi-generations. • Strong sense of community; therefore, resources are shared: transportation, medical advice, left-over medicine, medical equipment, etc. • As clinicians, please ensure that the medical history specifically include questions that tease out the use of medical therapy that has not been prescribed by you. • Also, welcome the opportunity to include Abuelas, Tias, etc. in the medical discourse.

  5. Te Da Aire

  6. To Give You Air • Belief that air can enter the body to cause malaise, pain, illness. • The practice is to overdress children, especially newborns, with multiple layers of clothing as well as blankets. • Mothers who have recently given birth may present with cotton balls in their ears to prevent air from entering the body. • As the pediatrician, discuss how patients become ill; talk of proper layering and ambient temperature; discourage use of blankets in cribs/bassinets and the risk of SIDS; wait to undress patients immediately prior to performing the physical exam.

  7. Leche Maternal, Pecho

  8. Breast Feeding • Belief that breastfeeding does not provide adequate nutrition, that the baby will not get full. • Belief that angry moms, emotional Moms can not breastfeed because the baby will “eat your anger” and get sick. • Supplement with formula or give up breastfeeding altogether. • Discuss the importance of early breastfeeding to ensure good supply; reassure moms that adequate intake can be measured by duration of time on the breast as well as quantity of wet/soiled diapers produced

  9. Fajeros

  10. Abdominal Binding • The belief is that a cloth belt can prevent “outie” belly buttons and cure umbilical hernias. • Mothers will place a cloth around the belly. Also, the use of tape, coins adhered to the umbilicus to “push the belly button back in.” • Acknowledge mom’s concern regarding the belly button’s appearance(“outies” are normal, too); reassure her that the majority of umbilical hernias are self-resolving; discuss how fajeros can be too restrictive, especially after feeds and cause discomfort.

  11. Empachado

  12. Impaction • Belief that the stomach is too big from bloating, constipation, etc. • Belief that if a baby doesn’t have daily bowel movements, the stomach and intestines can “gum up” and stick together.  • The practice is to position the baby prone, place olive oil onto the lumbar region of the back and pull the skin until a popping sound is heard. Also, babies are given a mixture of olive oil mixed wit either baking powder/baking soda to ingest. • Reassure parents that the abdomen is one of the biggest parts of a baby; ingestion of oil in babies <one year of age increases risk of aspiration.

  13. Cólicos

  14. Colic • Belief that the baby cries too much from too much gas, abdominal discomfort, incorrect formula, etc. • The practice is to use herbal remedies such as chamomille tea, seek medical treatment (Mylicon, Gripewater), try multiple formula changes. • Discuss colic and obtain good history: Is it normal sleep-wake cycle reversal? Crying is a baby’s form of communicaton. When should formulas be changed. Alternative soothing techniques.

  15. Te De Manzanilla

  16. Herbal Tea • The belief that remedies have medicinal effect. • The use of herbal teas for the treatment of colic, upset stomach, even for conjunctivitis. • Permissive guidance: limit amount of tea/free water especially in neonatal period (uncertainty of how much free water a baby should consume). • Please advise to not use HONEY nor corn syrup as sweeteners because of increased risk for Botulism.

  17. Mollera Caida

  18. Fontanelle • Belief that it is dangerous to have the anterior fontanelle “fall”. • Belief that pulling a nipple out too quickly can cause the fontanelle to fall • The baby is placed upside down, and the baby’s feet are slapped/tapped to “shake” the fontanelle to back into place. • Also, nipples are pulled very slowly from the oral cavity. • Discuss the anatomy and purpose of the fontanelle, sign of severe dehydration with fontanelle depression, sign of meningitis with fontanelle fullness.

  19. Ojera • Manchitas, Párasitos

  20. Dark Under-Eye Circles • Skin Marks, Parasites • These are all believed to be signs/causes of decreased appetite, vitamin deficiencies and anemia. • Older Mexican parents/family members may have had frequent parasitic treatment and believe that this treatment is necessary. • Education and reassurance regarding pathophysioloy of dark under-eye circles, Pityriasis alba, normal skin color, decreased likelihood of parasitic infection in the U.S. • Check hemacue at the 9 months well child exam; obtain CBC with manual differentiation, lead screening at the 12 months and 24 months well child exams; anticipate decrease appetite after a year of age; obtain good dietary history.

  21. Mal De Ojo

  22. Evil Eye • Belief that babies must be protected from the evil eye. • Various objects placed onto babies’ clothing/bodies for protection such as Saint Christopher’s medal, bracelets de ojos/ojo de venado, red strings used as bracelets and necklaces.  • Education about choking hazard, ligature risk and strangulation hazard. • Acknowledge the importance of protecting the infant, but perhaps safer to pin onto articles of clothing.

  23. Estrenimiento

  24. Constipation • The belief that a baby must have daily bowel movements, or even have BMs several times daily.  • Parents treat constipation with suppositories, herbal teas, use same treatment for empachado; request formula change. • Reassure parents that the frequency of BMs is variable based upon many things such as diet (formula vs. breast milk), age of the patient, etc.  Have parents focus more on the texture of the stools (soft is good).

  25. Algodoncillo

  26. Oral Thrush • Literally Cotton Mouth • Belief that thrush is painful and can cause interference with eating, decreased appetite. • A green tomato is burned, the skin is removed, and placed onto a gauze. This is then rubbed vigorously onto the oral cavity very until it ulcerates thereby getting rid of the white patches. • Education about what causes thrush, it’s not a sign of bad hygiene. Decrease sucking time (pacifier breaks), wash in nipples/pacifiers in hot water and use of anti-fungal therapy.

  27. Calentura, Fiebre

  28. Fever • The belief that fever can cause infection, convulsions, and even death. • The practice is the liberal use of antipyretics such a acetominophen, ibuprofen, aspirin. Also, frequent visits to the office and/or E.R. • Explanation of fever, worrisome signs/symptoms, long duration of fever. Also, please discuss the actual use of a thermometer, proper measuring techniques, proper dosing of anti-pyretics. Finally, give specific instructions in terms of when to return to the clinic versus to the pediatric E.R. • No aspirin in children, especially in the context of viral infection!

  29. Farmacias

  30. Pharmacies • The belief that ALL illnesses need pharmacologic intervention. • Parents will find medicine: left-over/borrowed medications, medications brought in from their respective countries, illegal farmacias that exist here in Las Vegas. • Instructions on when medical intervention is necessary; discuss potential dangers of self-diagnoses and self-medication. • “NO HIZO NADA!!!!” (You did nothing for me!!!)

  31. Chillón /Llorón

  32. Cry Baby • The belief that a crying baby is a sad baby, a “pobrecito”. • Also, the belief that a caretaker who allows a baby to cry is a bad caretaker. • The parents/caretaker will comfort a crying baby at all costs. • Reassure parents that crying is a normal manner of emotional expression; discuss normal crying versus inconsolable crying; give parents permission to allow babies to cry, assuage the guilt. • Discourage practices that lead to Milk Bottle Caries, over-feeding, emotional eating and obesity.

  33. Conclusions: • One should remain open minded and nonjudgemental. • Arm yourself with cultural knowledge. • It is the practitioners’ responsibility to acknowledge parents’ fears and to guide families within their cultural framework in order to minimize harm.

  34. Thank You!!!!!

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