CULTURAL AND LINGUISTIC COMPETENCE GUIDE CONNECTIONS WITH COMMUNITY

When patients at La Clinica Latina at the Ohio State University Medical Center first see clinic co-director Cregg Ashcraft, M.D., they see a non-Hispanic male physician and assume he doesn’t speak Spanish. Ashcraft, who grew up in Mexico, and later practiced there and in many Latin American countries, says his bilingual skills are essential to providing primary and preventive health care to a Latino population that is mostly undocumented and low income. He requires that Spanish-speaking clinicians provide the array of services offered by this clinic.

Many of the providers and staff represent the patients’ diverse countries of origin. This diversity acknowledges group differences among the Latino population. Ashcraft says his language skills and experience guide his effort to “ understand as best as I can the situation that people are in.” Ashcraft has assumed the role of cultural broker,both as a physician in his clinical practice and as an administrator influencing policy supporting the use of cultural brokers.

COMMUNITY MEMBERS HELP DIRECT HEALTH INTERVENTIONS IN DIVERSE COMMUNITY

Ray Michael Bridgewater, executive director of the Assemblies of Petworth in Washington, DC, looks to community members to lead the charge for partnerships that constitute the work of this community empowerment organization. The Assemblies’ projects take place in the most ethnically diverse wards in the city, and they require an understanding and knowledge of the cultures of Caribbean and West Indian, Latino, African immigrant, African American, and growing Eastern European communities. “ My board of directors very much resembles the community,” Bridgewater notes.

Two such projects are a telemedicine health program for Latino immigrants that involves partnerships with local libraries and a “ Mama and Baby Bus,” which provides screening and checkups. The Mama and Baby Bus program involves partnerships with the local March of Dimes; Mary’s Center for Maternal and Child Care, Inc.; and Capital Community Health Plan. Family outreach workers serve as cultural brokers and help spread the word among the community about the dates and times the bus will arrive.

For more information:

Mary's Center for Maternal and Child Care, Inc.

Capital Health Plan

 

NAVAJO HEALTH EDUCATOR MONITORS TRIBAL HEALTH THROUGH HOME VISITS

Katie Tree, community advocate and diabetes health educator for the Dineh (Navajo) tribe in Chilchinbeto, AZ, makes home visits once a week to assess community members at high risk on the Navajo reservation, such as the elderly, new mothers, and individuals with chronic illness. Tree checks community members’ vital signs and medication and refers them to the local public health nurses who visit the reservation monthly.

The home visits are a convenient and comfortable setting for patients to receive basic checkups because the closest health care facility, grocery store, or any other major retail outlet is 25 miles away from this small Northeastern Arizona town. Tree serves multiple roles within this tribal community. As a healer, she occasionally performs such indigenous ceremonies for community members as blessing, crushing, and boiling corn pollen to clear a person’s sinuses. As a cultural broker, she also helps physicians follow up with patients by educating them about how Dineh tribal members seek out different medicine men for various illnesses, “much in the way the Whiteman sees a cardiologist for heart problems and a dentist for dental problems.”

For more information

Background information on the Dineh (Navajo) nation

Further stories of the Dineh in Chilchenbeto, AZ: National Health Service Corps "Success Stories"

"We Will Not Leave Our Sacred Lands:" Traditional Navajos Stand Their Ground

CULTURAL EXCHANGES FOSTER RECIPROCITY BETWEEN SHAMAN AND PHYSICIANS

Using hand-held tape recorders, Hmong community outreach liaisons interview shaman healers   to obtain their training history and life story. This telling of stories is in a comfortable, folklore style and is familiar to shaman and the Hmong community alike. “The voice recorders allow shaman who are not literate to transmit information about their patients,” says program director Marilyn Mochel. The tape recorders also allow shaman to describe specific ceremonies performed for certain illnesses or conditions for their current patients.

Story telling provides a safe format for the exchange of cultural information. Moreover, Mochel states, “A deeper understanding of the regional variations of shaman ceremonial styles is emerging.” These stories also chronicle the shaman’s accounts of their traumatic journey from Laos to settlement camps in Thailand, and to their final destination in the United States as refugees. At the same time, the histories help local physicians to understand the shaman’s healing heritage. This knowledge allows local physicians to accept the traditional ceremonial practices of the shaman without judging them by Western medical standards.

For more information:

"Find out more about Shamanism." Shaman Links

REST BREAKS PROVIDE HEALTH EDUCATION MOMENTS FOR FARM WORKERS

Promotoras (lay health educators) in the Campesinos sin Fronteras program distribute their health care material and talk with migrant farm workers at times when the farm hands are not working—at 4 a.m. when they are waiting at local sites to be picked up for work and at lunch breaks in the fields. “ They go to the pick-up sites, find out who the foreman is, and tell them who they are, and ask permission to talk with the workers,” says project director Emma Torres.

Farm workers invite the promotoras to join them for lunch, sharing their burritos as they sit on the ground and talk. They discuss health-related issues on HIV/AIDS and high-blood pressure using Spanish-language flip cards. “ Latinos have a love of food, and sharing with others signals a bond among those who eat together,” she adds. As a result, the farm workers benefit from this transfer of knowledge in a setting that is accessible and convenient.