Cultural competency resources for training and education
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CommDoc: Indigenous Community Language App for the Northern Territory

CommDoc: Indigenous Community Language App for the Northern Territory | Cultural competency resources for training and education | Scoop.it
Hung The Nguyen's insight:

Why is using local language of indigenous people important?  Do we need to be conversant in indigenous languages to ensure desired outcomes from our consultations with indigenous patients?

It is about respect: In a remote Pintubi community a GP trainee enlisted a community member to teach him the local language - its structure, common phrases used in consultations and parts of the body.  These short daily lessons included tutorials on the local cultural norms.  The community talked about the doctor's efforts.  Although the doctor struggled to speak the local language he noted a change in community members towards him in the clinic and outside the clinic.

Its about rapport: In a remote Nunggubuyu community the resident doctor in his consultations asked the accompanying children to help him communicate with their parents, aunts/uncles and grandparents.  Often he purposefully made a fool of himself by tripping over words.  He got laughs from the kids.  It relaxes the adults.  The communication then flowed better.

Its about appropriate cultural communication: In a remote Yolngu community the phrases used in another language may not be a direct translation.  There are ways of saying things that is in keeping with the cultural values of the local community.  In a high power distance culture, it is normal for doctors to order patients to do things to help with the physical examination for example.  In a collectivist culture there may be a number of ways to say "we" or "you" (singular, 2-3 people or more than 3 people).  Understanding these nuances in the language helps to understand the indigenous cultural values.

So by all means use the local language.  This app can help if you are working in the NT of Australia.  But don't be too concerned about being fluent in the local language before you use it.  There are other reasons besides being understood that can help effective communication in a GP consultation.

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Say G'day in an Indigenous Language (State Library of Queensland)

Say G'day in an Indigenous Language (State Library of Queensland) | Cultural competency resources for training and education | Scoop.it
Hung The Nguyen's insight:

Before my road trip in Europe I consulted a couple of my patients about local culture and etiquette.  Their first tip was that the Europeans were very nice, helpful to tourists and polite.  You must say "hello", "thank you" and "your welcome" they said.

I practice this whilst in Holland, Germany and Denmark.  It was quite pleasant to greet people you don't know on the street when my eye meet theirs.  I wondered why we don't do more of this in our daily lives  at home.  The universal "Hi" (Hej in Danish, Hoi in Dutch and Hallo in German) is easy to say and with a smile it breaks the ice.  It is friendly and neighbourly to say "Hi".

Interestingly here is a list of how to say "Hi" in different Aboriginal and Torres Strait Islander languages promoted as part of NAIDOC week in Australia.

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Personal financial incentives for changing habitual health-related behaviors: A systematic review and meta-analysis

Hung The Nguyen's insight:

I have always wondered about the role of personal incentives in health promotional activities especially in deprived communities. There is evidence that in deprived communities there are greater burden of risk factors for chronic diseases.  These risk factors include smoking, alcohol excess, physical inactivity and high fat diets; all of which contributes to cardiovascular disease, diabetes and chronic respiratory disease.

Incentives are given for individuals to attend health promotional events, to achieve certain milestones by adhering to health promotional advice, attending screening, undergoing vaccinations and so on.  Incentives are usually in the form of a voucher (or cash payments), clothing (ruby shirts), food (BBQ or hamper) a lottery ticket (actual lottery ticket, a draw for a prize).

This article suggests that personal incentives has the biggest impact for smoking cessation programs and in deprived communities.  Personal financial incentives appears useful in initiating health behaviours and changes are sustained for some months after incentives removal.  However, the effects eventually dissipates and new habit do not appear to be formed.  In fact, behavioural improvements were not sustained for longer than 3 months.

"It might be worth complementing incentives strategies with behaviour-maintenance and relapse-prevention strategies after incentives removal.  A general focus on altering environments at the population level may make behaviours more likely to be sustained."

Another added thought is how can a program transfer people's motivation that start out fixated on an external reward to one that is internalised - a personal reward (health, social or status benefit).  Without an internal motivator, targeted behavioural change cannot be sustained.

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Dementia and cognitive impairment in Aboriginal and Torres Strait Ilsander people.

Hung The Nguyen's insight:

It is not often we talk about aged care in Aboriginal and Torres Strait Islander health.  It has probably got to do with the poor life expectancy rates which sees fewer people reaching the cut-off age of being old aged at 65 years old.  Unfortunately, Aboriginal people do age and they age much early in terms of their physical health and mental health.  Thus we need apply preventive activities much earlier than in non-indigenous populations.

Risks factors for premature aging include the usual chronic disease (diabetes, heart disease, high blood pressure, kidney disease, cholesterolaemia).  These risk factors are also risk factors for dementia.  So dealing with dementia we need to effective manage chronic diseases and their risk factors.

There some mention in this report but not enough on the effects of alcohol and other drug use on cognitive decline and impairment.  These substance has a huge social impact on the family and communities and will continue to have an impact long after detoxification and abstinence in the individuals old age.

To implement management and prevention we need a tool for early detection.  The usual mini-mental state examination may not be cultural appropriate.  The Kimberley Indigenous Cognitive Assessment (KICA) is a validated tool (for most states and Territories in Australia) that should be looked at as a culturally appropriate and sensitive tool for the local context outside the rural and remote area.

By documenting dementia prevalence in the local context Aboriginal communities may be enlightened and be concerned enough to take local action.  Local action in the initial phases need to include education of staff and patients.  Changes to processes such as including dementia screening and management in health assessment and care planning could take place.  Local resources need to be identified, supported  or funded in this growing area of concern for older Aboriginal and Torres Strait Islander people.  These resources include palliative care, aged care and community care packages.

Elderly indigenous people have a significant cultural and leadership function in their communities.  Premature dementia and cognitive impairment will rob or erode these important roles and role models for indigenous communities.

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The Impact of Racism on Indigenous Health in Australia and Aotearoa

The Impact of Racism on Indigenous Health in Australia and Aotearoa | Cultural competency resources for training and education | Scoop.it
Hung The Nguyen's insight:

It appears that about 20% of indigenous peoples in Australia and Aotearoa (New Zealand) experience racism depending on which self-reported survey you read.  Similarly, surveys of non-indigenous people suggest about 20% thinks it is OK to discriminate against indigenous people.

This report is useful as it highlights some of the broad ideas about racism and its impact on health.  Starting with definitions and conceptual levels, there are 3 levels of experience of racism ie internalized, interpersonal and systemic racism.  All three levels are important but the systemic level is more important in the arena of health and health policy.

The report noted that people react to racism in 2 broad ways ie flight (anxiety, shame, worry, sadness = 57%) or fight (anger = 67%).  The response to perceived racism was inaction (avoid person or situation, forget about it, keep to yourself, change yourself/your behaviour = 88%) with 30% wanting to do something about the perpetrator.

The tendency for inaction and withdrawal when face with persisting racism may translate to health behaviors - reduce and unequal access to society resources (employment, education, housing, medical care, social support); stress and negative emotions impacting on the immune, endocrine and cardiovascular systems, and negative responses to stress, anxiety and depression ie drugs, alcohol and tobacco use.

There are, however, anti-racism strategies that was noted.  These range from direct participation programs to reduce ill-informed views and perceptions, communications and social marketing against tolerance of racism, community development to build leadership and capacity within indigenous communities, workforce and staff professional development in the issue of cultural competency, racism in the workplace, advocacy, policy and law reform against discrimination and research and monitoring.

This document is a useful resource to take learners on a journey to understand racism, how it works, it impact on community health and the need for further research to build an evidence base that can influence policies and health systems.

 

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Australian aboriginal and torres strait islander health survey, nutrition results - food and nutrients

Australian aboriginal and torres strait islander health survey, nutrition results  - food and nutrients | Cultural competency resources for training and education | Scoop.it
Hung The Nguyen's insight:

This publication contains nutrition data collected in the National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey. It presents results from a 24-hour dietary recall of food, beverages and dietary supplements, as well as some general information on dietary behaviours.  It compares indigenous diets in urban and remote locations as well as the usual comparison with non-indigenous diets.

Although, it does not tell us information we don't already know, it does quantify the proportion of macro nutrients including alcohol consumptions in indigenous diets.

There is an interesting comment on food security in both urban and remote context.  Costs, transport and availability of foods are some proximal factors that drives eating behaviours and food culture.  These systemic issues will need to be addressed to close the food security gap for indigenous communities.

From the clinicians point of view we need to be mindful of our dietary advice and to be aware of the barriers to effective food choices for indigenous families.  We need to work at their level to plan and improve macro- and micro-nutrient intake.  More time and work is required in the health service.

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Can Native American Groups Combat Obesity By Returning To Indigenous Diets?

Can Native American Groups Combat Obesity By Returning To Indigenous Diets? | Cultural competency resources for training and education | Scoop.it
How Native American communities are taking food sovereignty into their own hands.
Hung The Nguyen's insight:

The culture of food is interesting to most people but it is not well taught if at all in health professional practice.  In a multiculturally diverse community health professionals need to go beyond the superficial and general advice and start to understand the food preferences of their patients.  Clinicians would benefit from knowing how their patients obtain and prepare foods, how they eat foods, why they avoid certain foods and what they understand about the foods that are presented to them everyday in the supermarkets.

In a small remote Aboriginal community, by way of an example, there was one general store that supply all the foods and other items for the home.  Foods were orientated to the western diet - both fresh and processed - and limited in range. People preferred traditional foods gained from the surrounding country side - kanagroo, emu, goanna, dugong, turtle, bush fruits, nuts, lillies, bulbs, yams etc.  But having been forcibly settled in one place all those years ago, people started relying on the local general store too for easily accessible foods especially during the wet season which limit their range to find and obtain bush foods.

The community health clinic noted that children under 5 years had anaemia - about 60% of them.  The treatment included iron supplementation (orally or by intramuscular injections), de-worming and nutritional advice.  Nutritional advice included weaning at 6 months, eating red meat and vegetables that are high in iron, use baby foods, iron fortified breads, flour and cereals.  Health advice included bringing children in early for check-ups for infectious diseases, receiving vaccinations on time and de-worming every 4-6 months.  But still the rate of anaemia in children under 5 was stable at 60% for years.

The senior Aboriginal Health Worker suggested that the clinic start of program.  The focus should be less on the medical and more on the diet and social issues.  The clinic should look at mother's behaviours towards food, nutrition, weaning and breastfeeding.  The AHW were confident with their protocols in detecting and medically responding to children with anaemia.

It turns out - after enlisting the council, aged and respite care, women's centre, homelands services and the local school - a whole of community approach to capture the attention of all clan groups in the community - one of the big issue was that mothers did not understand the nutritional advice they were given, they did not know about the foods at the store and how to use them and how to prepare them, they did not understand about age appropriateness of certain foods.  The result was avoidance of certain foods usually fresh foods, choosing processed foods, buying sweet foods that children liked and which are presented at the check-out.

With the help of the women's centre and the school some activities were organised and delivered eg the store agreed to remove sweet foods from the check-out area and replaced them with fruits, the store labelled high iron content foods with "strong blood food" to encourage people to by the foods to treat and prevent anaemia, the store stocked foods recommended to mothers of young children so they can actually find them, the women's centre organised teaching shopping trips, the women's centre enlisted a nutritionist to help staff to demonstrate how to choose and prepare foods for the under 5s, the AHWs ran anaemia workshops in all sections of the community targeting all clan groups not just mothers ie aunts, grandmothers, elders, fathers, teenagers.  In the end the council supported a day celebrating the coming together of the community on a common issue - anaemia in their children.

The relevant learning outcome was that health staff cannot assume that their patients understand the nutritional message, that their patients has the cognitive and social resources to act on the nutritional advice and that the community has the required infrastructure to assist patients make good food choices.  These issue are more important to check in the cross-cultural context and food selection, preparation and consumption is culturally based.

After one year the rate of anaemia in children under 5 years in the remote community was 40% and continued at this rate for the next 4 years without further program intervention (funding was for 1 year).  Obviously anaemia in children is complex but a nutritional program can go some way to address it.

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Lost Conversation: Finding new ways for black and white Australians to lead together.

Lost Conversation: Finding new ways for black and white Australians to lead together. | Cultural competency resources for training and education | Scoop.it

Lost Conversations asks the questions and starts the conversations that we dare not have in Australia ... until now: 

What is 'black' power?What is 'white' power? What qualifies someone to lead in this cross-cultural space? Why is this so hard to talk about? Can we start to name these things and try to shift the status quo? Can we change? Should we? 
Hung The Nguyen's insight:

We often use and teach the term, with the related definition, "cultural safety".  At the heart of cultural safety is the concept of "power".  Unfortunately, we as teachers and students we don't actually unpack the concept of "power" in black and white relationship in Australia that well.  This small book attempts to.  

The authors are a group of black and white Australian writers who reflect deeply and shared their lived experiences as white and black Australians.  They make observations from their respective communities' viewpoint as well.

Although this book can be thought provoking and challenging in the classroom, it is also useful for personal reflection by professionals and teachers practicing and teaching cultural safety in the work place.  How often have we thought about whether we are qualified to teach and work in the cross-cultural space?  What about how qualified are our peers who may be white or black?

Worth a read and worth sharing with our students and peers.

 

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RACGP - Chapter 11. Aboriginal and Torres Strait Islander violence

RACGP - Chapter 11. Aboriginal and Torres Strait Islander violence | Cultural competency resources for training and education | Scoop.it
Chapter 11. Aboriginal and Torres Strait Islander violence | RACGP
Hung The Nguyen's insight:

Abuse and violence: working with our patients in general practice, 4th edition, (the White book) was developed by general practitioners (GPs) and experts to ensure that the content is the most valuable and useful for health practitioners.

There are chapters on violence in Aboriginal and Torres Strait Islander communities and in Migrant and Refugee families.

With regards to violence in Aboriginal and Torres Strait Islander communities concepts such as lateral violence is discussed and effects of colonization and dispossession that occurred not that long ago and still has an impact on Aboriginal and Torres Strait Islander communities and families are emphasized.

Health language and the use of cultural and language interpreters are important when dealing with migrants and refugees.

One important feature throughout the book is a section on services for men highlighting that the solutions to family violence and abuse also rest on the main perpetrators - men.

An important evidence based resource for primary health care in Australia.

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Working well resources

Working well resources | Cultural competency resources for training and education | Scoop.it
Hung The Nguyen's insight:

The Working Well online resources have been designed to assist GP Registrars and other health professionals working in Aboriginal Community Controlled Health Services (ACCHSs) and is applicable to those working with Aboriginal people in general.

The key features in this resource is that it provide advice and guidance from experts in the field and from learners themselves currently going through the learning journey in Aboriginal health.  It asks important questions for the participant to reflect upon.  So to complete this task you really need to take the time to think deeply.  It expects learners to be engaged and to reflect.  Workers in the field are there to give their views and experiences.

This is not another resource about Aboriginal health facts and figures.  It avoids stereotyping Aboriginal behaviors.  It gets to the heart of matters, to guts of it all when working in Aboriginal health.  It does not beat around the bush.

Highly recommended for novices to the field in the early stages of their career and for experts to rethink their approaches in Aboriginal health services and with Aboriginal people.

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Culturally Sensitive Practice in Out of Home Care - a good practice guide

Hung The Nguyen's insight:

There is no doubt that Aboriginal and Torres Strait Islander children are over-represented in out-of-home-care (OOHC).  However, children from culturally and linguistically diverse communities also make up a comparable sizeable proportion in OOHC.  Disappointingly there is less data collected on this population and little knowledge of their needs.

Children (especially in adolescence) form their sense of self and identity using significant others ie parents as role models.  Cultural norms, expectations, values and behaviours are modelled and taught within the family and community.  Taking children out of this space disrupts their development leading to identity confusion and loss of self-esteem.  They are at risk of discrimination and prejudice if there are no safeguards and careful placement planning that caters for their cultural needs.  Their cultural needs include food preferences, religion and spirituality, traditions, customs and celebrations, language and a sense of belonging to a cultural group.

The foster carers need support and training.  They need the knowledge, capacity and motivations to attend to the child's cultural needs and should to be aware of and sensitive to the child's expectations in terms of child rearing  (how they are disciplined, protected and guided), child's role in the family (obedience and mutual cooperation), gender roles (role expectations in a family unit).

This resource provides cases of children from CALD background and refugee children for better understanding of individual cultural experiences and needs.  Importantly it proposes a raft of practice tips for practitioners in the field who may care for these children in their services.

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Everyday Racism - a challenging free mobile game

Everyday Racism - a challenging free mobile game | Cultural competency resources for training and education | Scoop.it
Challenge what you think you know about racism - first mobile app of its kind. Download to start the journey today and see how far you can go.
Hung The Nguyen's insight:

Do you really know what racism is?  Do your know what racism feels like?  Do you know how others experience racism? Do you, really?

Cultural immersion has been around and in the media for a while and has been exploited often.  Watching a movie and being immersed in the characters on screen is cultural immersion; reading a novel and visualizing the lives of other people is cultural immersion; going on placement in another community/context/country is cultural immersion eg "Go back to where you come from" TV program or "30 days" TV series.

Here is an App that does the same - allow you to be culturally immersed in a  character for 7 days.  You will receive phone calls, listen to radio, get Facebook posts, get emails from friends or work colleagues, get looks/comments from passer-bys and shop attendants etc  Some subtle and others no so subtle.  How would you respond?

Want to know more - well you just have to try it and be immersed.  

How long can you last in someone else's shoes experiencing the racism they receive?

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Culturally and linguistically diverse communities - Multicultural - Palliative Care Victoria Resource Library

Hung The Nguyen's insight:

We are just starting a project for Palliative Care Victoria and found this online library on multicultural resources for people interested in palliative care in the cross-cultural setting.  Resources are useful for managers and planners.  There needs to be more practical resources for staff who oftentimes has to negotiate an emotional and culturally confusing space to provide the best care and advice for their patients.  The meeting of minds, values and expectations needs to occur for this to happen.

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Educational Opportunities

Educational Opportunities | Cultural competency resources for training and education | Scoop.it
Hung The Nguyen's insight:

The Mitchell Institute constructed an index of educational opportunity in Australia using 4 milestones.  The Early Years describes children who are school ready in five domains - physical health, social competence, emotional maturity, language and cognitive skills and communication skills.  The Middle Years describe children and their academic achievements.  The Senior Years describes children who have completed year 12 or equivalent. Early Adulthood discusses young adults  who are engaged in education, training or work.

The index shows proportion of children meeting or missing educational milestones.  Helping young people who are falling behind to catch up is possible.  Young people can recover even for the disadvantaged.  Success at each stage varies by indigenous status, region, gender and socio-economic status (SES).  The most advantage learners are less likely to fall below expected standards in the first place and are more likely to recover if they do.

The OECD (2014) outline several policies that they view as important to promoting stronger performance and greater equity: - Target low performance by supporting low-performing schools or low-performing students within schools, depending on the extent to which low performance is concentrated by school.

- Target disadvantaged children through additional instructional resources or economic assistance.

- Apply more universal policies that raise standards for all students, such as establishing common rather than differentiated programs, and improving pedagogy and classroom instruction.

- Reverse the effects of concentrated disadvantage by removing streaming and creating comprehensive schools and classrooms that serve all students in communities.

For more read: http://www.mitchellinstitute.org.au/wp-content/uploads/2015/11/Educational-opportunity-in-Australia-2015-Who-succeeds-and-who-misses-out-19Nov15.pdf

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Flowchart:Mother's Educational Expectations

Flowchart:Mother's Educational Expectations | Cultural competency resources for training and education | Scoop.it
Hung The Nguyen's insight:

Here is map visualizing how maternal educational expectations influence their children academic achievements. The obvious questions are why and how do parental expectations influence their children's attitudes to learning, studying and achieving academically. It discounts to some extent that kids' achievements are based mainly on talent but instead attributes their success on hard work, values and attitudes to learning, work and higher education.
Another more interesting question to me is can we influence parental attitudes, values and expectations. One of the factors are mothers being born overseas and the influence of grandparents through the parent. The cultural milieu is important. Therefore this may need a generational change in attitudes? 

See: http://www.growingupinaustralia.gov.au/pubs/asr/2014/asr2014f.html

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Managing Two Worlds Together - Improving Aboriginal Patient Journeys

Managing Two Worlds Together - Improving Aboriginal Patient Journeys | Cultural competency resources for training and education | Scoop.it
Hung The Nguyen's insight:

Recently released are a series of project reports, case studies and workbook looking at remote Aboriginal patients journey through the health system and the challenges they face.  Challenges becomes barriers to positive health outcomes expected by the patient, community and the community health service.

It is easy to forget one aspect of health care access - procedural access which is the process of health delivery and how the health system is navigated.  Examples of procedural access issues include understanding and filling out registration forms, where to go for patient information, what to do to get an appointment, what to do when you have an appointment, the steps to take before a test can be performed (fasting, medications to take or avoided etc).

The patient journey is about procedural access and we as patients have all gone through it and we may have the skills and knowledge to do this successfully.  For example we know what important questions to ask of our GP.  But this is not the case for most patients.  Toss in cultural issues - communication, cultural values, cultural health beliefs, cultural obligations - then it gets a bit messy, frightening and depressing when one has to deal with the health system.

Understanding the patient journey allow practitioners to empathize with the patient and facilitate action for the patient.  The practitioner role as advocate for the patient comes into play by having to think forward to what might happen and should happen for patients to receive care in a timely manner that meet their needs and the practitioner's needs.

Understanding the patient journey in complex situations as in the case of remote Aboriginal patients' journeys through health services in regional centers and capital cities allow the practitioner to monitor patient progress for the benefit of the patient as well as their families and community at large.  In Aboriginal communities attending to the community and families expectations is just as important for patient outcomes as focusing on patient needs.

These series of reports, Managing Two World Together, target complex health problems in Aboriginal people ie cardiac, maternity care, renal health, from remote communities through to rural and city locations.

By focusing on the Aboriginal patients journey, the Australian health system has come a long way it its journey in tackling Aboriginal health.

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No Easy Talk: A Mixed Methods Study of Doctor Reported Barriers to Conducting Effective End-of-Life Conversations with Diverse Patients

No Easy Talk: A Mixed Methods Study of Doctor Reported Barriers to Conducting Effective End-of-Life Conversations with Diverse Patients | Cultural competency resources for training and education | Scoop.it
Objective Though most patients wish to discuss end-of-life (EOL) issues, doctors are reluctant to conduct end-of-life conversations. Little is known about the barriers doctors face in conducting effective EOL conversations with diverse patients. This mixed methods study was undertaken to empirically identify barriers faced by doctors (if any) in conducting effective EOL conversations with diverse patients and to determine if the doctors’ age, gender, ethnicity and medical sub-specialty infl
Hung The Nguyen's insight:

We are already a diverse population.  The trend is that we are going to be even more diverse with migration and globalization.  The discussion of end-of-life issues in a cross-cultural setting will be more common.  Already we are seeing doctors and other health professionals struggling with cross-cultural barriers in end-of-life (EOL) care.  This article provide some insights into the issues and the barriers in EOL discussions from the doctors' perspective.

Doctors and patients understand on the whole that the medical consultation is a medical space.  The doctor feels comfortable in this space and the patient yields.  Patients suppress and limit cultural behaviors and values out of respect for the doctor, his comfort and his views.  The patient then acknowledges what he/she has heard and utilize advice that fits with his/her own world view and health perspectives.  If the doctor fails to understand and seek the patient's perspective then so be it.  The patient, however, has a difficult choice whether to respect the doctor and follow the advice or disregard some or all the advice.  This may impact on their relationship.  Maybe, the patient will avoid seeing the doctor again to save face.

There is less luxury for patients to withhold their views, beliefs and prejudice during EOL discussions.  It is  an emotionally challenging time.  Patients may be more direct.  They may be less concerned about their relationships with their doctors than with their families.  They have a greater obligations to their families than to the health professionals.  The won't be any leeway given in the cross-cultural encounter.  No benefit of the doubt.  Misunderstanding during the medical interview could be more widespread and challenging for both doctor and patient.

This article highlight 6 barriers or challenges for doctors and by inference by the patients and their families:

language and medical interpretation issues

patient/family's religious and spiritual beliefs about death and dying

doctors ignorance of patients' cultural beliefs and practices

cultural differences in truth handling and decision making

patient/family's limited health literacy

patient/family's mistrust of doctors and the health system

More professional development is required for health professionals in EOL care to address these barriers.  Doctors are aware of these barriers and feel uncomfortable with their limited skills.  Doctors are trained to have good communication skills but do they possess adequate cross-cultural competencies during EOL care.

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Ten Myths About Affirmative Action

Ten Myths About Affirmative Action | Cultural competency resources for training and education | Scoop.it

playUnderstanding Prejudice and Discrimination

Hung The Nguyen's insight:

At a recent communication workshop I participated in I was asked to roleplay an older politician, an alpha male who is opposed to affirmative action based on gender.  I/he was a board member with 9 others board members who needed to decide on a successor to the outgoing CEO.  It was difficult to play the role as I had none of those traits that I was meant to display.  Nevertheless, it was fun.

Why should minority groups get special treatment?

Are we inadvertently seeing people up to fail when we allow to enter a course having missed the mark?

It must be a blow to your self-identity knowing you got in by stealth and not merit?

This experience made me reflect on the concept of affirmative action in education, academia and in management.  I had to ask - Does it work?  Does it help or does it harm the individual who is the recipient of such policies?  I guess I was asking these question because of the role I took on, a role that challenge the validity of affirmative action in a simulated board room.

This article captures a lot of my and my peers concerns and it is worthwhile reading in detail.  Also check out the whole site for some pearls applicable to the teaching space.

 

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Indigenous eyesight - seeing is believing

Indigenous eyesight - seeing is believing | Cultural competency resources for training and education | Scoop.it
Prince Harry is training with the largely Indigenous NORFORCE unit but he might struggle to ever be anywhere near as good at spotting enemies as they are.
Hung The Nguyen's insight:

A good thing about cultural immersion experiences is that it tends to stay with students for a long time after the lesson.  Cultural immersion is a process of placing a student from a culture into another cultural space.  But that is not all, cultural immersion programs need to encourage its students to reflect-in-action and reflect-on-action. and develop skills for these reflective activities.  Skills that will last a lifetime of learning.

This article prompt recalls of the sharpness of Aboriginal eyesight in a very remote Aboriginal community placement.

I was invited to accompany a group of women and children on their bush hunting trip after light rain had fallen in the middle of the Gibson Desert.  We had to drive in a truck for 10 kilometres from the community.  There were 15 of us packed like sardines in a space made for 8 people.

Hunting that is practiced by Pintubi women of the Western Desert of Central Australia is all about gathering fruits and roots.  It is also about digging and chasing small game like goanna, bush mouse, blue tongue lizards and non-poisonous snakes.

And so it was that I found myself following an old woman in 40 degrees heat amongst the spinifex grass across the red sand looking for fresh goanna tracks and collecting bush raisins along the way.  We communicated with simple gestures of the mouth, eyes and hands.  Well at least she was whilst I mimicked her gestures and talked too much.

All of the sudden the desert air was pierced mercilessly with her shriek, "Goanna!".

I was excited from my daydream of water flowing through the desert.  "Really? Where?"

"Over there, over there."  She started to walk briskly in the direction she was pointing.

I looked and looked onto the ground and was bewildered and confused.  There were no goanna tracks.  She stopped pointing, probably annoyed with me that I can't see what she was pointing at.  I dutifully followed her across the red sand, brushing my legs against the sharp spinifex grasses.

I suddenly realised that she was pointing into the horizon, at the woman in the distance at least 200 metres away.  What, all the way over there?"  I exclaimed in disbelief.  "How do you know?"

I thought she must have been still annoyed with me.  "She told me."

I contemplated in those minutes of power walking for 200 metres or so, that her sister "told" her through hand signalling that she has found goanna tracks and to come over.  This woman in front of me could see and recognised the message to come and assist her sister.

People are not born with better acuity but through environmental necessity, improved visual acuity developed through hard wring from the retina to the brain; through training and experience; through hours and days on bush hunting trips from their childhood where covering, seeing and communicating at a considerable distance was a necessity.

By the way, the goanna was rich with fat after rain and was delicious.

 

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Aboriginal and Torres Strait Islander perspectives of Home Medication Reviews.

Hung The Nguyen's insight:

Home Medication Review is one of the better tools in chronic disease management especially in the cross-cultural context.  Western medication and treatment can be foreign and intimidating to non-western thinkers with other perspectives on health and well-being.  The HMR provides an opportunity for patients and their families to engage with a pharmacist in a safe place - their home usually - to go through the different medications that has been prescribed for them.  The pharmacist is able to assess patient's understanding of individual drugs, self-administration in the home, explain side effects and safety issues, address fears about the medications, know what other non-prescribed medications are being use concurrently or instead of prescribe medications.

Unfortunately, the people that would benefit from the HMR ie vulnerable people with chronic and complex problems don't always have access to this service (they have not been told or offered a HMR, they don't know about it, they don't understand it).

This article is a reminder of it use and explores the perspectives of Aboriginal and Torres Strait Islander people of HMR.  Key cultural findings were:

- the importance of being referred by a respected health professional that they trust - an Aboriginal health worker from their community health service

- the pharmacist need to have adequate cultural competency and experience when engaging with the patient and their family

- have the choice of the HMR being performed in the home or at another location like the Aboriginal health service

- a preference for other family members to be involved during the HMR

These issues all relate to cultural safety.  The HMR is about medication safety, quality and adherence through engagement and medication literacy through the process of "yarning" in a safe environment.

 

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Using Interpreting Services

Hung The Nguyen's insight:

What are the roles and value of professional, paraprofessional and recognized interpreters?  What about the roles and value of language aides and family and friends when providing services to people with limited English in Australia?

This resources explains who these people are and how they fit into service delivery to people from Culturally and Linguistically Diverse communities.

Preparing for interpreting, arranging an interpreter and working with an interpreter are chapters that provide useful best practice guidelines for workers assisting people from  CALD communities when using an interpreter.

In high risk situations we need to get the communication right.  Teaching best practice in using interpreters to novices is an important aspect of effective cultural communication.

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Network for Indigenous Cultural and Health Education

Network for Indigenous Cultural and Health Education | Cultural competency resources for training and education | Scoop.it
Activities, Resources & Case Studies for health professionals working in Indigenous health.
Hung The Nguyen's insight:

Nicheportal provides a central information point for educational resources for medical specialists who care for Aboriginal and Torres Strait Islander communities and patients.
There is certainly a lot of resources out there that needs to be curated.  But the site has more than curated educational resources and activities.  There are reports, news items, interviews and conference proceedings.  

Sometimes to be too inclusive a site can feel like a maze  where users can get lost.  There are categories based on state related resources and activities.  But there are limited medical and health categories at the moment.  Hopefully this will be addressed in future.

The site is a collaboration of specialist colleges and so the resources might be skewed towards resources from these colleges or target those specialist colleges.  For workers in primary health care for example there may be many resources in the community that are not captured on this site.  Resources that focus on social, welfare and community programs that are useful to primary care health professionals.
If you register you can join the forum to talk to other health professionals in the network - a community of practice.

The Nicheportal is a great idea that need continual support for its development and to be useful for wider range of workers who tries to improve the health and well-being of Aboriginal and Torres Strait Islanders in Australia.

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The relative effectiveness of ACCHS compared to mainstream health services.

Hung The Nguyen's insight:

The main points in this interesting summary of the effectiveness and impact of ACCHS on Aboriginal health wellbeing are:

1. there is very little robust evidence for the relative effectiveness of ACCHS compared to mainstream services;

2. the care of aboriginal clients in ACCHS may be different - complex and chronic presentations, holistic care including social welfare and cultural needs, more time is needed for each client and their families;

3. costs of ACCHS service are higher due to greater effort, time and holistic nature of the practices.

4.  cost-benefit analyses is difficult and requires more robust data.  Even with more robust data it would be difficult to quantify the value of ACCHS functions eg cultural safety, relationship and trust, flexibility, empowerment, family-centred care

5. partnerships between ACCHS and mainstream service should be considered and promoted to further add value and synergise health service delivery and care.

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Mortality inequalities in Australia

Hung The Nguyen's insight:

Australia is one of the healthiest countries in the world. However, despite relatively high standards of health and health care in Australia, not all Australians fare equally well in terms of their health and longevity.

I wonder if there is a cultural basis to this inequality.  Culture in its many facets informs and dictates health and social systems and population health is determines by health systems and social determinants.

There is inequality in mortality outcomes between men and women due mainly to risky behaviors demonstrated in rates of suicides, accidental injuries, land transport accidents and coronary heart disease (CAD).  Interestingly the gap between males and females mortality rates are closing perhaps as the perspectives on the roles of women and men are changing.

People in more remote areas have higher mortality due to diabetes and transport related accidents.  What are the influences on behaviors here - geographic isolation and distance, food security and quality, infrastructure to encourage physical activity?

People of lower socioeconomic status are more likely to die compared to those who are better off.  The leading courses of death are preventable diseases like diabetes, CAD, COPD, lung cancer and cirrhosis of the liver.  We know energy dense foods are cheaper.  The role of employment and education can not be underestimated in this group whose young people need role models.  The use of alcohol and other drugs may be more prevalent as a way to cope and access to these services in areas of need may be lacking.  The latter highlights communities perspectives on the poor and unemployed.

Interestingly overseas born Australians have  lower mortality rates in diseases like cancers,  CAD, strokes, Alzheimer and dementia.  This may be due to the healthy migrant effect - this is evident if we compare UK/Irish migrants (whose mortality rates are a little better) to the Australian-born.  The greatest difference in mortality rate is in the Asian migrants who bring with them different ways: of relating to each other; of eating; food practices and food preferences; values relating to education and employment.

Of courses there is a wide gap between indigenous and non-indigenous Australians in mortality rates.  This has been attributed to a number of factors including lower SES, remoteness, and prevailing impact of Australia's contact history and related policies.  The latter have a significant impact on group and individual behaviors.  Recently, racism in Australia and its impact on specific groups (especially Aboriginal and Torres Strait Islander peoples) and their community members is in the spotlight.

 

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Mobile apps - 5 Geert Hofstede cultural dimensions GPS

Mobile apps - 5 Geert Hofstede cultural dimensions GPS | Cultural competency resources for training and education | Scoop.it
Hung The Nguyen's insight:

A Global Positioning System to navigate through intercultural differences based on the 5-D model of Professor Hofstede.

The Lite version gives you a quick look at how a national score in the 5 cultural dimensions of power distance, individualism, masculinity, uncertainty avoidance and long-term orientation.  This is probably all you need.

The cool features of comparing 2-3 countries can be gained by visiting the website directly - you don't need this info on the go or if you do, you can save the website to your home screen on your iphone easily.

- Travel wisely.

Educationally you can use the app in class as an activity after presenting the theory on cultural dimensions then hone in on specific countries for discussion.

- Back-up your teaching.

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