Cultural CompetenceDifferences in Attitude Towards Western Medicines

Eric Ho

Community Pharmacist

28 June 2014

Cultural Competence

Population in New Zealand has increased mainly by migration

2013 New Zealand census, 5 largest ethnic groups : 1) NZ European : 74% 2) Maori :15% 3) Chinese 4) Samoan 5) Indian

Smallest group are Greenlander, Sardinian, Latin American

Cultural Competence

• Population demography

Cultural Competence

Ethnic population increase since 2006:

Chinese – up 16 percent to 171,000

Indian – up 48 percent to 155,000

Filipino – more than doubled to 40,000.

Cultural Competence

Population is diverse in culture, linguistic, education back ground, health beliefs, value, religion practices, social back ground, behavior and expectation towards treatments.

Cultural Competence

Waitemata DHB Health Survey 2006

Immigrant patients request Support for : Helpline Interpreter Services Asian Health Support workers Asian Health Professionals Health Information in their Language

Cultural Competence

Health Professionals encounter difficulties in: Language Cultural differences Mental Health- Cultural perspectives

differences Helpful resources:

Pamphlets printed in Asian language Helpline in Asian Asian Health supports and Health professional The need of training in cultural competence

Cultural Competence

Difficulties faced by

Immigrant Patients:

Language

Cultural background

Disease Perspective

Different healthcare

system than home country

Western Versus

Traditional Medicines

(TM)

Barrier to Care

Misperception of Western Medicines

(WM)

Problems Associate with Traditional Medicines (TM)

Stigmatisation of Mental Health

Misunderstanding of Chronic Diseases

Cultural Competence

Misperception of Western Medicines limited understanding of health issues. language difficulty. Mentally fear of being judged. Western doctor poses authoritative, patient’s behavior to be

‘accommodative’ instead of negotiating •Case Report:

• A compliant and obliging T2DM Indian patient with a poor diabetes control. Doctor speaks patient’s dialect, She accepted the diabetes diagnosis and the use of insulin and medicines in treatment. However, she did not response to treatment as expected. GP later found the she did not adhered to her insulin medicines as prescribed because her mother told her that “insulin is addictive and she will not be able to come off the medicines”.

Cultural Competence

Stigma Around Mental Health Mental Health illness is shameful and perceive as a

punishment by the supernatural for wrong doing. View as weakness and failure Keep ‘quiet’ and denying their condition. Refuse to seek

medical help. Isolate themselves from friends and family Denying and Rejecting all forms of helps. Older migrants are at high risk of mental health condition

due to cultural differences, language difficulty, lack of family contact, recent lost of partner and lack of social supports.

Cultural Competence

Case study:A 31 year old Chinese engineer. Moved to NZ when he was 7 year old and he was 22 when he first diagnosed with depression and anxiety disorder.He believes with his cultural background of strong and hard working mentality, high self-expectation and achieving unrealistic goal are the many factors that contribute to his condition. He trust no one and think no body understand him. He concealed his condition and distant himself from friends and family and he even refused to consult a doctor. He constantly feeling ‘shameful’ and people think that he is ‘Crazy’. His depressive disorder later caused him his job. He thought of suicidal but it did not eventuated. Later, with the help of his mother, he started to receive helps from medical professions. he started to seek helps by learning about the condition, other helps available either online or clinic base. His condition is well managed now.

Cultural Competence

Problem Associated with Traditional Medicines (TM) Skeptical towards Western Medicines (WM) WM too strong and damaging to bodily organs. TM are often used first or as a ‘supportive’ ailment to WM Lack of literature and data in use of WM in conjunction with

TM May potentiate the adverse effect of the drug or causes a drug-

drug interaction•Case study:A young Asian lady in her early 20, diagnosed with Endometriosis. Rx Tranxanemic acid and anti-inflammatory. Mother later took her to consult a Traditional Chinese Medicines (TCM) practitioner, Rx mixture of herbs and powder to elevate her condition by restoring the balance in the her body (Ying/Yang). She took both medicines from her GP and TCM practitioner, After the first couple of doses, her pain intensify and bleeding became heavier. She was then rush to the hospital. Drug-drug interaction or experienced adverse effects of the drug or TCM.

Cultural competence

Misunderstanding of Chronis Disease

“It hurts, you go to the doctor, If not, you don’t”

Many Culture have specific treatment for acute illness, but not asymptomatic Chronic Diseases.

Without an understanding of how to manage Chronic Diseases, patient may discontinued their treatment once symptoms has disappeared.

Educator to raise patient’s and family’s health literacy •Case study:

• Treatment of Asthma in children. Request for reliever inhaler but not preventer.

• Treatment of Hyperlipidemia. Stop statin drug once lipid profile become normalise. Disease is cure.

Cultural Competence

How to be responsive to some of the health beliefs that an individual patient may have about their medicines:

1) Build rapport before discussing medical issues.2) Demonstrating awareness of individual cultures3) Recognising how different cultures perceives the status of doctor and how this affect open communication4) Empathic and encourage question and giving silence a chance5) Awareness of traditional remedy used without judgment.6) Involve Family members

Cultural Competence

• Working in Collaboration with Other health Professionals:

• Hospital specialist• Pharmacist (Hospital or Local community)• Nurses• Case or social workers• Interpreter • DHB funded Cultural competence Online training

programme: CME accreditation.

Cultural Competence

Useful Resources and online programmes

Link: http://www.healthnavigator.org.nz/centre-for-clinical-excellence/cultural-competence/

• Cultural Competency Guidelines The Royal New Zealand College of General Practitioners

• Engaging Pacifica programme- Pacific cultural• Foundation Course in Cultural Competency

online course. Free to all health professionals.• Pacific Cultural Competencies

overview of the literature on Pacific cultural competence including definitions, rationale, benefits, competence measures and mechanisms, and role of Pacific cultural competence in service quality and recommendations for the New Zealand health and disability sector. (Ministry of Health, 2008)

Cultural Competence

• Culturally and Linguistically Diverse (CALD) Resources & CALD Cultural Competency TrainingWaitemata, Auckland and Counties Manukau DHB region.

• Visit http://www.caldresources.org.nz/  Contact cald@waitematadhb.govt.nz for more information.

• Toolkit For Staff Working In A Culturally And Linguistically Diverse Health EnvironmentAn excellent toolkit in both electronic and online format

• Refugee Health- Auckland Regional Public Health Services• Refugee Health Collaborative – Auckland DHB and PHOs

Activities and resources collated as part of a refugee health collaborative.Additional Websites

• Asian, Migrant and Refugee Health Publications• Health Information in Multiple Languages• Asian, Migrant and Refugee Culture-Specific Services,

Programmes Initiatives• Aotearoa NZ Refugee Research Directory – health and wellbeing

section

Cultural Competence

Science

Important to distinguish Stereotyping and Generalisation. Every patient is Unique, Individualised care.

Cuktural Competence

Bibliography:• CALD website:

http://www.caldresources.org.nz/info/Home.php• Health Navigator NZ:

http://www.healthnavigator.org.nz/centre-for-clinical-excellence/cultural-competence/

• BPAC: http://www.bpac.org.nz/BPJ/2008/February/maori.aspx

• Statistic NZ: http://www.stats.govt.nz/Census/2013-census.aspx

• http://www.asianhealthservices.co.nz/index.html