This webinar, from 8/18/2010, features Dr. Elzbieta Gozdziak from the Institute for the Study of International Migration at Georgetown University.
This webinar is presented as a part of the National Capacity Building (NCB) webinar series. NCB is a project of the Center for Victims of Torture.
This webinar confronts issues that health care providers must face when working with members of indigenous populations from around the world. Because western medical practices are not common to these groups of people, they are often wary of treatments. Dr. Elzbieta Gozdziak suggests that providers become educated on the traditions and cultures of their patients, to better accustom the patients to the ways of western treatments. Understanding the patient’s views on healing can lead to better outcomes. She states the most essential need is an appreciation of the legal, physical intellectual, spiritual, and emotional implications of being a torture survivor. The links below offer further information on specific groups and regions around the world.
“Guatemala and Kenya are both countries that have recently experienced political violence in the context of long histories of colonialization [sic], oppression and poverty. The current study examines focus group responses of indigenous faith-based relief providers in Guatemala and Kenya describing how they utilized religion to cope with their own experience of political violence as well as to cope with stress related to providing relief services to others.”
“In recent years, a growing body of knowledge about the relationship between culture, grief and bereavement has emerged from the literature. A 1996 study of individuals from specific cultures revealed that people’s intrapersonal experiences of grief are similar across cultural boundaries.3 However, other research has made it clear that cultural traditions, beliefs and values do make a difference in how people outwardly express their grief and how they try to cope with it. To provide culturally sensitive care, health care professionals must possess an understanding of cultural practices and how they impact the overall grief experience of the patient.”
“Impact of Culture on Trauma:
Cultural perspectives can shape people's reaction to a traumatic experience. Specifically, culture:
a. Influences what type of threat is perceived as traumatic
b. Influences how individuals and communities interpret the meaning of a traumatic event and how they express their reactions to the event
c. Forms a context through which traumatized individuals or communities view and judge their own response
d. May help define healthy pathways to new lives after trauma”
This article review many beliefs of different groups that have immigrated to the United States.
“Death and grief being normal life events, all cultures have developed ways to cope with death in a respectful manner, and interfering with these practices can disrupt people’s ability to cope during the grieving process. While health care providers cannot be expected to know the mourning ceremonies and traditions of each family’s culture, understanding some basics about how different cultures may prepare for and respond to death is important.”
Cultural Awareness and Emergency Care via American College of Emergency Physicians. “Emergency physicians routinely encounter patients from diverse cultural backgrounds representing various customs, practices or beliefs. Cultural awareness is the ability of the health care providers to understand and respond to the unique cultural needs brought by patients to the health care encounter. The physician should consider the patient's culture as it relates to the patient's history and presenting symptoms in recommending a treatment plan that is mutually agreed upon by the patient and physician. The American College of Emergency Physicians believes that:
•Quality health care depends on the scientific competence of physicians as well as their cultural awareness.
•Cultural awareness should be an essential element in the training of health care professionals and to the provision of safe, quality care in the emergency department environment.
•Health care providers should encourage patients and their representatives to communicate cultural issues that may impact their care.
•Resources should be made available to emergency departments and emergency physicians to assure they are able to respond to the needs of all patients regardless of their respective cultural backgrounds”
Out of Africa: Coping Strategies of African Immigrant Women Survivors of Intimate Partner Violence(available for purchase, or summary if desired)
“We explored the coping behaviors of 15 immigrant African survivors of intimate partner violence (IPV) in the United States. Similarities and differences in coping strategies between African and other immigrant women were noted. Results from the qualitative analysis are that African immigrant survivors utilized multiple coping strategies including beliefs in spirituality and divine retribution, a future orientation, and a sense of self-efficacy. Acceptance/ endurance of abuse, which they believe was “normal” in male/ female relationships; minimization of the abuse; and avoidant behaviors and thoughts also were used. Informal and formal support/help seeking, and knowledge of available services empowered women. Implications for policy, practice, and future research are discussed.”
A first-hand account of an Ethiopian who has lived in the US for 20 years (and admits to becoming Americanized) on the rituals in Ethopia
“Death, although a dreaded event, is perceived as the beginning of a person's deeper relationship with all of creation, the complementing of life and the beginning of the communication between the visible and the invisible worlds. The goal of life is to become an ancestor after death. This is why every person who dies must be given a "correct" funeral, supported by a number of religious ceremonies. If this is not done, the dead person may become a wandering ghost, unable to "live" properly after death and therefore a danger to those who remain alive.”
South East Asia:
“Efforts to introduce western medical technology in non-western cultures have frequently met with disappointment. One of the reasons is that differences between the new technology and indigenous ways of perceiving illness were often ignored. An example is the mother who believes that her child is afflicted by the evil eye and is told by the doctor that no such illness exists. Without efforts to bridge the gap, the mother may very likely leave the office without having gained the confidence in the doctor to return. Analogies can be drawn to the situation of the Southeast Asian refugees in the United States.”
“One of the major problems refugees face upon their arrival to this country is conflict with the US medical system. This conflict arises from misunderstanding and mistrust from both health professionals and refugee patients. With refugee children, misunderstandings can escalate. A more comprehensive understanding of Southeast Asian peoples and their cultures, especially their views regarding illness, can help make this transition much easier both for refugees and health care providers.”
South and Central America:
“The 16th meeting of the Latin American network of health institutions working against torture and other violations of human rights took place in the last week of September, in the Andean city of Quito, Ecuador. Twenty-seven representatives of 16 organizations, almost all them IRCT members, from 13 Latin American countries met to exchange experiences and discuss strategic issues related to their work.
One of the issues discussed in the meeting was the intercultural approaches to prevention, rehabilitation and access to justice related to victims of torture. This is an important matter because in several countries indigenous people and others as Afro-descendants are significant proportion of the population. Latin American centres are using different methodologies and strategies to face this issue.”
“Diagnostics in traditional medicine go beyond the parameters known to biomedicine, extending the classification of conditions beyond the biomedical model. Indigenous healers, who are knowledgeable in many folk conditions that are unknown to biomedicine, may, in fact, be able to more adequately treat illness by considering both the natural and supernatural elements of causation.”
“In this article we will review both theory and data pertaining to the emotional effects of collective remembering
by means of social sharing and funeral rituals. Data is based on the experience of Guatemalan
Mayas, who were victims of a genocide during the nineteen eighties. Results show that that Mayan
subjects did not report lower levels of subjective and emotional reactions compared to the Latino
community. A finding which contradicts the idea that this is a less expressive and emotional culture.”
“Indigenous healing is commonly practiced in Middle East. Little is known about trends of indigenous therapies among patients with psychiatric disorders in Iraq. To determine and compare rates and predictors of indigenous healings by individuals with psychiatric disorders, and the practiced rituals among Arabic and Kurdish ethnicities in Iraq, patients aged 18 year and older attending outpatients in Erbil and Najaf were assessed for their prior contacts with indigenous healers.”
“Middle Easterners approach life differently in significant ways from Westerners i.e., in terms of time control, power distance, male/female roles, personal space, and privacy. Similarly, problems in providing health care also develop around family involvement with patient care and ways of handling “bad news.” This article provides some general guidelines in understanding the cultural characteristics of Middle Easterners, but as always, it is crucial to see the individual in any health care encounter.”