ADVOCACY FOR AN IMBALANCED WORLD

May 22, 2016

CULTURE AND ILLNESS:IMPLICATIONS FOR HEALTH CARE INTERPRETERS

Adapted by James L.Mason.PhD
OCCAT Portland,Oregon
March 14. 215
HCI Self-Assessment Questions:

  1. Describe the language groups for whom you provide health care interpreters services. Are you equally effective with all segments of the community?
  2. Describe some of the cultural barriers,environmental determinants,or community-based factors that impact health and health services provided tothe above average groups?
  3. Describe the community you currently serve in terms of how they view illness and seek help, and what they might look for in providers and organizations.
  4. Do you talk about or share cross cultural "success stories" practice exemplars ? Why? replicable.
It might  be easy to get a pack of cigarrets than to get a fresh fruits such as vegetable or apples and oranges.
Always learn to acknowledge because if you don't you made an enemy right there and then. What is the difference of bien and bueno? Learn to ack in different languages. What causes illness when someone is illness As I travel to the world I tought there was an evil eye. Teas,cleansing my spirit and  it may get well. Trangressions get you cancer and get you kill.
I was tought to believe those things as I traveled around the world. What are some of the things that make you successful? typically we don't talk about those things.

DIMENSION OF DIVERSITY
Ethan-cultural Groups

  • Black of African Americans
  • Hispanic or Latino Americans
  • Asian American
  • Native Hawaiians and other Pacific Islanders
  • Native Americans and Ameericans Natives
  • Bi-or Multi-Ratial
  • Euro-ethnic groups
  • NON-ETHNIC CULTURAL GROUPS
Women,igbtqi,people w/disables,people in poverty,people who are homeless,religious minorities,etc
  • REFUGEES AND IMMIGRANTS
  • Survvival vs.Opportunity
  • Documented vs. Undocumented
we know that women in the US are freer than they used to be. What is gender mean in your community? In the last five years we have been protecting the LBGT in the US. Be sensitive about that group, I'm asking you to be sensitive about those subjets. 
Refugees come to these land for opportunity. 

CULTURAL FACTORS THAT INFLUENCE DIVERSITY AMONG INDIVIDUALS AND GROUPS

Internal Factors

  • Culturals /Racial Identity
years and years
I knew of some that adopetd a kid from another country and he went to college and when he grew up. his dad took him back to his country and presented to his country

  • Socioeconomics Status
the education that they have in their country it might be different. some of us speak English formal and some of us it is not. Nationality what type of chemicals that we know make a fetal developmental in the US. Language is very sophisticaded. Bilingual and bilaterate would be more sophisticated so, two different things.

  • Nationality
  • Language
  • Family History
  • Help-Seeking behaviour 
  • General Status
  • Age and Life Cycle Issues
don't have children until you can afford. If you have a child out of the weedlock we kick you out of the family. I went to college and I went to get my first degree and then I went to another graduate school I got my child when I was 35 years old. My sister scubadives all over the world I hate her. If you have a child at a younger age don't judge peopl, too early.

  • Spatial & Regional Patterns 
 do they understand credit? do they understand money?

  • Gender and Sexuality
  • Religion & Spiritual Views
  • Political Orientation
Other aspects of who we serve? homeless you should not smoke or practice safe sex if shorten your lifes. Women have not rights in Egypt. It is a very poor country as oppossed to Saudis. Immigrants living around Portland are Iraquies and .
generate a question for them like do you know the secondary side effects of this medicine. or should I take it on an empthy stomach? Are you smart to know if you understand?
Don't ignore when helping a couple. Respect the culture because you might make an enemy.

Where is  drive by when you need one? As an interpreter you don't correct a medical doctor but as a human being it bothers me. When someone disrespects or invalidates others abilities. But, as an interpreter you don't have the power dynamic to correct a MD. You go the administrated to report the MD. integrity issue,ethical issue,we have a brouchere at the hospital that says that if you don't like something "speak up"

We try to make feel families welcome, patients right,the other think that happened because you have a disability, because you are wearing farm clothes in the city, because you have dirt under your nails, you treat me like this because I'm black or you treat me like this because I'm a woman. This is a new feel that have arisen in the 21st Century.

If you can say it to their face don't say it when you are here. It may put you in a negative way.

have they asked about.
Do make information available?
The largest Somali community in Minnesota.
The largest Somali in Seattle.
Orange County Public Health has a lot of information in Vietnamesse.
Is laso embeded in the languge a disease really behind but also make it seven languages that we focused in Portland. Institutional biases
ESTEM science technology carriers a form to get out of poverty.
Sience technology but she tought it was her own life so she went into the field of journalism.  I was in DC about 15 years ago. I was in DC when it happened we should send an aircraft and blow them up. If there was an explosition is the Saudis but sensitive about Cultural differences.
 I would also ask you.

External Factors

  • Institutional Biases
  • Community Economics
  • Public Safety & Infrastructure
  • Behavioral Health
First time home buyers don't be afraid to send Who are the Community Ecomics that we are serving?

Lets try to steer how to manage their finances so that they make it in the US.
Being multiligual,empower to best that you can be
You have the dirties room in America
keep kids out of gangs,drugs,sexual violence, behavioral health,

  • Geographic/Cultural isolation
Keep the Portland Weird is to keep it "White"

  • Intergroup Relations
  • Natural Networks of Support
  • Community History
  • Political Climate 
  • Workforce Diversity
  • Community Demographics 
 Asians came to that part of Eastern Oregon University to play football.  If you have an economic hardship then don't drink and/or smoke because that diminishes your persona.
I would not take my Mom to the bathroom. Where is my sisters when I needed her.  A  bunch of thinks can happen across the dynamics of genders. Are you hitting on me? When I was helping in Arizona and New Mexico and South West.
Relationship and Health Care when Interpreter meets clients. Next time when you are at the mall ask a public or bypasser about him/her such as tell me about your: mental health,alcohol abuse, sexual, and if they are telling you about themselves almos turn away because you see that almost gets in the way for you to have a personal relationship. Instead, ask other questions.

ILLNESS AND ETIOLOGY
Supernatural causes:

  • Soul loss-trauma resulting in soul leaving body
  • Spirit intrusion-evil spirits in the body,malicious
  • Sorcery magic or spell caused by skill humans
sining but not all cultures see
  • Object intrusion bones,hair,insect,not in term of Clements pahogen theory
  • Violation of a taboo-punishment for violation of religious/social norm;often known to sufferer. 
A interpreter was hired for delivery I started family as family theraphy a lot of young people felt mistreated or suicide. Ethnicity racial all day long. We don't talk about sexuality.


  • DISEASES AND ILLNESS

HOW CULTURE MATTERS
  • Patients contributes to their
  • Comprehensive of a problem or illness
  • View and understanding or symptoms and problems,and 
  • Reactions or response to that illness
Physician,contributes to their
  • Personality
  • Belief system
  • Interaction and communications styles
  • Organization
  • Traditions and practices (time,social order,access)

Stein (1993)individualism,control,mastery over nature.
IMPLICATION: UNINTENDED CLASH POINTS OR CONFLICTS

ADDTIONAL ASSESSMENT DOMAINS

  • Respect
  • Greeting 
  • Name
  • Birth/Death
  • Modesty
  • Decision-making 
  • Family
  • Aesthetics
  • Faith/Religion
  • Food
  • Others
talking about death it really brings it on. I had a friend that left work because he taught a friend had to go. I was raise Judeo Christian
Activity2Values Assessment

  • What values do you see in the patients and families you see?
  • What values do you see in the health professionals and systems in which you work?
  • Describe any value conflicts you have seen as result of such conflicts?
  • What has been successful in mediating or adressing such conflicts

  • Next Sat Code of Ethics
  • On the 21st we have final test


GOALS AND OBJECTIVES
Visualization 
Visualize Numbers in Patterns
1581039264

Practice
  • Count off in class (2 by 2 by 2 etc)
  • Listen to the sentence by the instructor
  • Write down what you have heard
  • Use symbols or abbreviations that you understand
  • Share the bit of information
Notes a form of discipline and have to be accurate!
Good Morning Mrs. Perez my name is Mrs. Simone
I understand that you came to the practice beacause you dont' feel really well and you have several
I have been feeling very tired over the last several months. I ve noticed. I ve been very thirsty. I have been urininating a lot my blood sugar. I have been ranging from 200-400 daily.

I don't feell lighheaded or nausated but my vision is a little bit blurry. The pain starts in the back of my neck and moves up into my head;it is really strong.

Diabetes cause the sugar in your blood to go up this buildup in your sugar to go blind...loose you foot have an amputation or even kill you
Diabetics causes the sugar in your blood to buildup. This build up of sugar in your blood can cause you to go blind,suffer a heart attack,lost your foot or let to amputation,stop your kidneys from working or  even kill you.

Diabetes is a disease  that affects a way your body uses food. In your body food turns in your body, food, food turns into sugar for energy. Diabetes keeps your body from using some or all of the sugar in your blood for energy.

Mrs Perez I'm going to explain to you about hemoglobin  A1C testing.  As you know keeping your diabetes testing in good control is the key to staying healthy. You need to check your blood sugar several a different times a day
this testing shows what your blood sugar level is in one day

Hemoglobin is  a protein inside your RBCS cells it is part of the  rbcs that carries oxigen to the lungs to the rest of your body. it also carries blood sugar, becaue these stick to all kinds of proteins  of your body. 

LISTEN AND GROUP CONCEPTS
 Why take Notes
  • First, the purpose of note-taking is to increase memory efficiency
  • Second,the interpreter's notes are specially individual in character. Practicing interpreters develop their own techniques for note-taking.
  • Jean  -Francois Rozan (Rozan Seven Basic Principles)
  • Note the idea rather than the exact words used.
  • Abbreviate long words  by noting the first two and the last two letters only.
  • Alternatively. find a short word with the same meaning
  • Negation (ok to approve, no ok to disapprove)
  • Be prepared
  • know your subject matter
  • look up words before the interpreting even.
  • Bring paper and pen
  • IDENTIFY KEYWORDS AND IDEAS
  • Before you can have your Surgery.yu will need to see your prim,ary care physician to have a full 
  •  INSERT A PHOTO
Na 126 
GLUCOSE 120
Ca 110
POTASSIUM 4.
K4
BUN15
HEMATOCRIT 45
PLATELY COUNT 150,000

  • Mrs chan was admitted to intensive care unit un for diabetic was ketoacidosis last month. She was found at home on the floor and her husband called 911. Mrs Chan recovered very quickly after getting her blood sugars regualted with insulin. Mrs chan nos is in the clinic as she is complaining of digestive disorders  that are commonly associated with diabetes . The nurse Janet is going to do some homecare teaching about gastroparesis so that Mrs. Chan can understand this problem.


  • Diabetes can wreck havoc with your gastrointestinal tract just as it can afect other major organs of your body . Problems caused by diabetes can occur all along the the GI tracthabit with your intestinal tract just as it can other organs with your body

  • Mrs. Chan: Is this what I have? Is this why I'm having difficulty in controlling my blood sugar?

Your gastrointestinal tract is a very complicated dynamic organ and each sectin has its own food processing function. The movement of your
the movement of your GI tract cordinates the process the movement of 
it controls the delivery o food at the top
elimination and the mixing of processing of food 
this movmt is what control  by muscles your GI tract can  control diabetes can damage this nerves and can cause gastrointestinal problems
  • how do you know that the diabets is the sole  cause of nerve damage in the stomach?
  • First off, many peple with GI problems  all an evidence of problems in other of other 
Many of the people have other symptosn in other organs such as seeing unusual sweeting

Mrs. Chan


since we did not have this problem since  l left this hospital

CHALLENGES ENCOUNTERED IN MENTAL HEALTH INTERPRETING
DAVID CARDONA,MD,MPH
ANDREA CANO,MDIV,BCC

Jose Mejia Poch
Behavioral Health Clnics

Workshops Goals
At the end of thistraining the participant will be able to;
Identify the cllanges
Challenges for Mental Health Provides

  • Not knowing how to work with interpreters 
  • No being culturally competent to understand that patients beliefs and social practices may affect health care outcomes
  • Not enough time to conduct a complete initial interview,assessment (i.e. primary care,ER) 
  • Not knowing competency to the interpreter

Challenges for Health Care Interpreter

  • Mental Health Care interpreting is not their specialty,lack of formal training,terminology,protocols
  • Not enough experience working in mental health setting (ER,clinic psychiatry ward,ambulatory care and hospitals)
  • No clear standards of professional practice 
  • They are not qualified nor certified with the State
Challenges for Patients

  • Unfamiliar with western health care systems
  • Unsure fo competence of health care provider or the health care interpreter
  • Suffering cultural and social stigma of mental issues,possible family issues
  • Bias by health care providers and health care interpreters
  • No medical insuracne due to many factors 
  • Not working their patients's rights in regard to provisions of interpreting services and HIPAA
Challenges for Institutions

  • Budget Cuts
  • Practice not producing enough revenue
  • Paying for provision
Using Tech in Mental Health Interpreters
  • Telephonic Interpreters
  • Video Remote Interpreting
  • On line training resources for providers and patients (CDs, online training courses) 
  • Using speaker phones with psychotic patients and other mental conditions
LANGUAGE  BARRIERS WHEN DELIVERING HEALTH CARE
  • English speaker ma
FIRST PERSON INTERPRETING
The Interpreting will begin by explaining guidelines for interpreting the session for health care provider an dthe patient
The interpreter will speak int he first person when interpreting in health

On the Phone Interpreting Services
Tegh current health care trend is to provide interpreting services over the telephone.
it is 
ON THE PHONE INTERPRETING SERVICES
Dissuade

Cultural barriers Wehn Delivering Health Care
there are also many differences in world views, spirituality and religion.language and vernacular,healing






























































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