Revised Title "Curanderismo: Healing Holistically in Latino Communities"

The article name has been changed to "Curanderismo: Healing
Holistically in Latino Communities"


Curanderismo is a Latino holistic — mind, body and soul — approach to health, originating from the early colonial period Catholicism and pre-Columbian indigenous medicinal practices in Latin America. Because of the widespread dissemination of Catholicism during the early Spanish conquests of Mexico, the Caribbean, Central and South Americas, most Latinos are familiar with the basic practices and precepts of curanderismo. Within these geographical regions, there is diversity from one nation to another as well as intraethnic diversity in the practices and beliefs of curanderismo. Also known as Mexican folk medicine in the Southwestern U.S., it incorporates physical as well as spiritual and soul-related explanatory models of health and illness. There are no discrete lines between physical and mental health, similar in this respect to some traditional Eastern medicinal views. Treatable ailments encompass social, emotional, mental and physical problems.

A curandero, "male healer" in Spanish (or a curandera, “female healer” in Spanish), is often a respected and revered elder with spiritual gifts, whose job it is to tend to the health and psycho-spiritual needs of his community. Typically full of compassion, affection and good will, this person is an essential member of the local community who develops life-long bonds with the families he/she serves. He or she is the first person who people turn to in crisis, distress or spiritual discontentment, seeking consolation, understanding and, in some cases, divination. Prescribed treatments can range from herbs, massage, manipulation of body parts, spiritual rituals, exorcisms, and prayer — in combination or singly. A curandero consults and treats the entire family for an issue affecting one individual in the household as the ailment, curse, or spiritual issue may be viewed as affecting all members of the family.

Medical anthropologist Renaldo Maduro, PhD, states in his article, “Curanderismo and Latino Views of Disease and Curing,”  West J Med. 1983 December; 139(6): 868–874 that:

“There are eight major philosophical premises underlie a coherent curing world view of Latino patients: disease or illness may follow..

(1) strong emotional states (such as rage, fear, envy or mourning of painful  

      loss) or

(2) being out of balance or harmony with one's environment;

(3) a patient is often the innocent victim of malevolent forces;

(4) the soul may become separated from the body (loss of soul);

(5) cure requires the participation of the entire family;

(6) the natural world is not always distinguishable from the supernatural;

(7) sickness often serves the social function, through increased attention and rallying of the family around a patient, of reestablishing a sense of belonging (resocialization) and

(8) Latinos respond better to an open interaction with their healer.”

While many Latino-Americans believe in curanderismo as a healing modality, most also value the power of conventional Western medicine, routinely seeking the care of a medical doctor when sick, according to one Los Angeles study. In one particular area of Los Angeles, most Mexican-Americans sought medical treatment for their mental illness, rather than seeking the care of a curandero. Though curanderismo is, and has historically been, an inherent part of Latino culture, it would be incorrect to presume that every Latino embraces the beliefs and practices of curanderismo. Some understand it as folk medicine, which means that they see value in it for certain ailments while they feel other issues may require attention from allopathic professionals.

            In other academic research, curanderismo is postulated to be the reason why Latino-Americans are underrepresented in California’s mental health system, constituting only 3% of the patient population when they constitute more than 10% of the state’s general population. Dr. Maduro hypothesizes that many Latinos often are consoled and taken care of by their local curandero and their family, protective mitigating factors in mental health.
            If health care providers are to maintain their effectiveness, their knowledge of their patient’s cultural milieu is critical in the delivery of care. Understanding a patient's explanatory model of illness enables providers to formulate a culturally appropriate response, and also anticipate, identify and resolve any potential treatment compliance issues before problems arise. For example, if a person believes his mental illness is a result of a curse or spirits, he may choose not take his medication. A person’s explanatory model of his illness affects their health-related behaviors and their willingness to comply with treatment plans. By 2050, the largest ethnic minority in the U.S. will be Latino-Americans with 29% of the population, who currently constitute about 14%.

What do you think about curanderismo?  How you witnessed any spiritual practice?  Please share your thoughts.

Guest Blogger:
Pearl Ji-hyon Park
lightfisharts@gmail.com
Please visit our website: amongourkin.org.
Blog: can-documentary.blogspot.com

INDIGENOUS HEALTH PRACTICES IN EL SALVADOR

Helen E. Dao, MS 

INDIGENOUS HEALTH PRACTICES IN EL SALVADOR 

This article relates to the medicine practices of El Salvador, Central America.  People from El Salvador are divided into two social groups.  The poor and the rich, the gap between both groups is significant. 

About half the population lives below the national poverty line, able to buy food but not clothing and medicine. Over half of these families live in a situation of extreme poverty. Forty-seven percent of the population does not have access to clean water.  The difference between the incomes of the wealthiest and the poorest are extreme and increasing. The poorest 20 percent receive only 2 percent of the national income, whereas the richest 20 percent receive 66 percent. The distinction between the rich and poor is no longer ethnic, as the vast majority of the population is now mestizo, a mixed race (about 97 percent)

PEOPLE
El Salvador's population numbers about 7.2 million. Almost 90% is of mixed Indian and Spanish extraction. About 1% is indigenous; very few Indians have retained their customs and traditions. The country's people are largely Roman Catholic and Protestant. Spanish is the language spoken by virtually all inhabitants. The capital city of San Salvador has about 1.6 million people; an estimated 37.3% of El Salvador's population lives in rural areas.

BRIEF HISTORY
The Pipil Indians, descendants of the Aztecs, and the Pocomames and Lencas were the original inhabitants of El Salvador.

There are few studies that addressed the indigenous health practices and the integration of modern medicine in the Salvadoran health care system but are not comprehensive and do not provide in depth information of traditional healing practices by the indigenous communities.  Because of the violence against the indigenous groups of El Salvador, many tribes felt obligated to assimilate into society and hide their traditional practices and beliefs. 

In 2006, the Center for International Development Conflict Management conducted an assessment for Indigenous people in El Salvador, found that indigenous people begun to hide their traditions and to assimilate into the dominant ladino society as a product of the 1932 massacre “La Matanza” where 35,000 to 50,000 indigenous were killed as the government retaliated again the indigenous for killing 35 ladinos during protest against government policies.  The abandonment of indigenous people tradition and practices accelerated during the 1980-1992 civil war, when death squads killed thousands. Many indigenous people were discouraged from their traditional customs and culture for fear of being associated with targeted grassroots organizations. “ 

The health of indigenous people of El Salvador continues to be tremendously affected not only due to their diet, lack of health care access, and transportation, but also to environmental factors such as industrializations, urbanizations, cultural barriers, etc.  In a join effort to understand and strategize ways to reach out to the indigenous people not only in El Salvador but of the Americas, Pan American Health Organization (PAHO) and World health Organization (WHO), indigenous from Central America Countries representatives, and other organizations agreed to create a framework of health care access for indigenous people through “Strategic Framework and Action Plan 1999-2002 of the Health of the Indigenous Peoples Initiative”.  How this indigenous health care system translate to the modern medicine it is important to understand.  Even though indigenous groups have assimilated the mainstream health care system, there still some cultural beliefs and traditions that have survived through out the years.  Not specific details are found in the literature of those traditional practices.  However, one practice that has gone for many generations is that of the curanderos (Healers) for instance, they treat children who in their opinion have the “evil eye” and are treated by hanging the child upside down from his/her feel and slap their soles so the “evil eye” can be spelled.    This is not welcome and/or accepted by medical doctors due to the fatal consequences associated to such practice, brain hemorrhage.

Less and less traditional healing practices are done in public; many indigenous send sick children to the health care worker or a medical doctor to treat more serious conditions.  However, traditions, values, systems of beliefs will always be part of a group and will be passed from generation to generation, perhaps at a lesser level, but will always remain with them.  More research needs to be done about indigenous health practices and how appropriate health care services can reach them.  Some of the indigenous people that have migrated to the United States may seek Western medicine as a last resource due to their cultural beliefs, but also related to health literacy, health insurance, and legal status.

______________________________

REFERENCES

1.     Every Culture: Julia Dickenson-Gomez, May 13, 2011. Retrieved June 19, 2011.

2.     Bureau of Western Hemisphere Affairs, March 30, 2011.  Retrieved June 19, 2011 (http://www.state.gov/r/pa/ei/bgn/2033.htm)

3.     PROYECTO PARA EL FORTALECIMIENTO DEL SISTEMA PÚBLICO DE SALUD MARCO DE PLANIFICACION PARA PUEBLOS INDIGENAS (MPPI).  EL SALVADOR, FEBRERO 2011. www-wds.worldbank.org › Publications › Documents & Reports , retrieved June 20, 2011.

The difference Between a Cultural Broker and a Community Health Worker

The difference Between a Cultural Broker and a Community Health Worker

The difference is that cultural brokers are individuals who do not need a formal certification.  A cultural broker can be a doctor, a nurse, front desk staff, patient’s relative, clergy, in some cases which is not preferable, children.  Have said that it is important to understand that a cultural broker depending at what level they are needed, they will need extensive training in understanding and building skills as a cultural broker in order to work with a specific ethnic groups of individuals. 

A community health worker needs a certification or a more formal training in order to perform this task here is the link to the Texas Department of State health Services www.dshs.state.tx.us/mch/chw.shtm, here you can see the application.  It contains information on the core sections of the training curriculum.

However, both a cultural broker and a community health work have many things in common such as training specific in communication, advocacy, bilingual skills, provide culturally and linguistic appropriate health education, serve as mediators, and others.

A cultural broker focuses more on how he/she can bridge the gap of communication between patient and the health care system (health care providers) through knowledge and understanding of cultures by serving as a mediator of agent of change.  There is a lot of intensive training on cultural and linguistic competency for non-natural support systems such as family.  Here is the link to the National Center for Cultural competence which provides a case of cultural brokering between Western health care professionals and healer or shaman Hmong http://www.culturalbroker.info/appendix_A/3_appendixA.html.

One point I want to make is that cultural brokering is becoming not exclusive to HCO but also human and social community-based organizations trying to reach their consumers.

Here are a few definitions of a cultural broker and a community health worker:

The goal of the Cultural Broker Project is in keeping with the NCCC’s overall mission to “increase the capacity of health care and mental health programs to design, implement and evaluate culturally and linguistically competent service delivery systems.” Cultural and linguistic competence have emerged as fundamental approaches to the goal of eliminating racial and ethnic disparities in health. A major principle of cultural competence involves working in conjunction with natural, informal supports and helping networks within diverse communities (Cross et al., 1989).

A Promotor(a) or Community Health Worker is a person who provides cultural mediation between their communities and health and human service systems. They are a bi-lingual/cultural liaison between patients and healthcare providers through activities that include assisting in case conferences, providing linguistically and culturally appropriate health education, informal counseling, and social support; advocates for individual and community needs; assures people get the services they need; builds individual and community capacity; and provides referral and follow-up services (Colorado 

Institute of Public Policy, 2007).

Cultural Brokers (CB) are navigators and bridge the cultural gap between communities and the formal healthcare system. CB, like Community Health Workers, are drawn from the community they serve though their backgrounds are highly variable. Some CBs are immigrant children who live in two cultures daily. Some are leaders of advocacy organizations. Training may be extensive or non-existent. The need for CBs is only increasing as the U.S. population is diversifying and health disparities persist. A Cultural Broker fulfills a variety of roles. They serve as

·     Liaisons between (1) the family/community’s health values, beliefs and practices and (2) the healthcare system.

·     Cultural guides who understand the strengths and needs of a community but also know about the structures and functions of the healthcare setting.

·     Mediators who help establish and maintain trust with communities and build relationships between the patient and medical provider.

·     Advocates for change of the healthcare system by virtue of the work they do for communities and with the medical community (National Health Service Corps, 2004).

References

1.     Cultural Responsiveness: Social-Emotional Health of Young Children, Birth – 5 Years of Age: Research, Policy and Financing

Link: www.denverearlychildhood.org/.../D%205%20DECC%20Report%20Chapter%202%2011.18.09.pdf

2.     National Center for Cultural Competence: Bridging the Cultural Divide in Health Care Settings

Link: http://www.culturalbroker.info/appendix_A/3_appendixA.html

For more information contact Helen Dao, MHA at Helen@daoconsultingservices.com

Why Should Health Care Organizations Accommodate for Sign Language?

 The Federal Law for Interpreter services states as follow:

·     All health care providers have a legal obligation under the Americans with Disability Act to provide effective communication to people who have a hearing loss. Health care providers may use a variety of auxiliary aids and services, but the result must be communication that is as effective as communication with other individuals without hearing loss. In most circumstances, this means a qualified interpreter is necessary.

·     All health care providers have a legal obligation under the Americans with Disability Act to provide effective communication to people who have a hearing loss. Health care providers may use a variety of auxiliary aids and services, but the result must be communication that is as effective as communication with other individuals without hearing loss. In most circumstances, this means a qualified interpreter is necessary.

 Many of the malpractice claims are related to the lack of appropriate communication between doctor-patients.  “The ability to communicate well with patients has been shown to be effective in reducing the likelihood of malpractice claims.

A 1994 study appearing in the journal of the American Medical Association indicates that the patients of physicians who are frequently sued had the most complaints about communication. Physicians who had never been sued were likely to be described as concerned, accessible and willing to communicate. When physicians treat patients with respect, listen to them, give them information and keep communication lines open, therapeutic relationships are enhanced and medical personnel reduce their risk of being sued for malpractice.” 

From a technical point of view, we could say that health care organizations can provide sign language interpreters to individual with hearing loss, why should there be any differences from individuals with LEP?  The point is that sign language interpreters are harder to find, there is a special certification that they must complete in order to perform their job (The competency and quality of sign language interpreters is assessed and documented through the Registry of Interpreters for the Deaf (RID), which administers a national certification system for sign language interpreters).  Cost may be higher for health care organizations.  Perhaps some of the strategies may be the training of in-house staff, which re willing to go through the training and serve as interpreters.  I see it as an investment because health care organizations will increase their patient satisfaction as some of the above examples.

Another strategy is for health care organizations to create an interpreter initiative, where management, staff, and patient champions can work together by creating a framework that identifies gaps, needs, internal resources, external resources, cost, eliminating waste to produce productivity.

REFERENCE

1.     Minnesota Department of Health - www.health.state.mn.us/divs/pqc/hci/ISWGreport08.pdf

For more information contact Helen Dao at helen@daoconsultingservices.com

 

Technology and CLAS Standard 12 recommendations

Standard 12. Health care organizations should develop participatory, collaborative 

partnerships with communities and utilize a variety of formal and informal mechanisms 

to facilitate community and patient/consumer involvement in designing and implementing 

CLAS-related activities.

The description of standard 12 boils down creativity, innovation, and improvising in order to develop and maintain ongoing doctor-patient communication.  I believe that technology provides many advantages yet, some challenges as well.  I have broken down my answer in four different sub-topics:

Cost of technology:  Many health care organizations are concerned about the cost involved in adopting and implementing CLAS.  This is an issue that many organizations may want to take on or others may not have the financial capacity to do it all.  Another problem related to this may be that even if the organization purchases the technology, patients may not be willing to utilize it.  If the technology is welcomed and utilize properly it can have tremendous positive impact on the care for patients and the doctor-patient communication.  Technology can go either way, cost reduction or high cost for an organization.

Communicating with rural and urban communities through technology: Technology becomes very valuable and a necessary when serving rural communities. Rural communities have other challenges such as transportation and shortage in general practitioners and specialists.  However, here are some of the must innovative and creative initiatives with telemedicine, videoconference, and tele-translators.  The way I see it is that health care organizations are applying Standard 12 in a creative way in order to design and implement CLAS-related activities.  Through technology health care organizations are promoting participation, collaboration with communities and utilizing a variety of formal and informal mechanisms to facilitate doctor-patient communication.

Considering cultural Taboos:  The Hmong community in the USA (An Asian ethnic group from the mountainous regions of China, Vietnam, Laos, and Thailand) do not allow pictures or video because it is believe that their souls will be stolen as are indigenous from Guatemala.  Other cultures may not see technology as a way of seeking and receiving medical care.  So the challenge here is educating people and doctors about technology and how it can help improve their quality of life by receiving information that they would not have access to any other way (specially people living in rural areas).

Education: As many things that we do, people need and want to be informed about things.  Educating the public and health care organizations about the necessary of technology in medicine is very important.  But also educating/informing them about the challenges such as utilization, technical training required, and limitations must take place before the technology is introduced.

To summarize, technology like anything else has it limitations, it can never substitute in-person encounters between doctors and patients.  I want to give a few examples of how technology and in-person encounters have helped some health care organizations reduced cost and improve patient’s satisfaction.

Substantial reductions in outsourced language interpretation services and subsequent savings in related costs. Many health care organizations that address the threshold issue of language services have found very efficient ways to make better use of their own bilingual staff or volunteers, thereby reducing substantial costs of outsourcing interpretation services.

•Contra Costa Health Services was able to reduce its per minute interpretation costs from $1.69 per minute for contracted services to $.75 per minute through a project with remote video interpretation.

•L.A. Care created an alternative approach to interpretation services through which providers and patients access language services via telephonic dual headsets or handsets. The project reduced L.A. Care’s reliance on expensive contract interpretation services, reduced the reliance on friends and family members for interpretation, as well as decreasing the use of gesturing and other ineffective communication methods.

• Holy Cross Hospital uses 175 employee volunteers who speak 60 different languages to provide interpretation services for patients, families, physicians and staff employees. The program achieved significant cost savings by avoiding additional costs for contract interpretation services ranging from $320,000 to $190,000 depending on the circumstances.

References

1.  MAKING THE BUSINESS CASE FOR CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES IN HEALTH CARE: CASE STUDIES FROM THE FIELD Alliance of Community Health Plans Foundation 2007 Support

2.     The Office of Minority Health - http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15

3. Communication Current – National Communication Association, August 2010. http://www.natcom.org/CommCurrentsArticle.aspx?id=1348

NATIONAL STANDARDS FOR CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES (CLAS) IN HEALTH CARE

June is here and our new theme for the month too!  Cultural and Linguistic Competence will be our topic for the month of June!  We at DAO are very excited to bringing you endless information on the paradigm shift of quality improvement through cultural and linguistic competence!

 

In December 22, 2000 the final CLAS report was published by the Office of Minority Health (OMH), highlighting three major themes Culturally Competent Care (Standards 1-3), Language Access Services (Standards 4-7), and Organizational Supports for Cultural Competence (Standards 8-14). 

 

Withing this framework there are three types of standards of varying stringency: mandates, guidelines, and recommendations as follows: 

 

CLAS mandates are current Federal requirements for all recipients of Federal funds (Standards 4, 5, 6, and 7). 

CLAS guidelines are activities recommended by OMH for adoption as mandates by Federal, State, and national accrediting agencies (Standards 1, 2, 3, 8, 9, 10, 11, 12, and 13). 

CLAS recommendations are suggested by OMH for voluntary adoption by health care organizations (Standard 14).

Below are all the 14 standards, DAO's June blog will be driven by each of the standards.  Cultural and linguistic competence does not only have a positive impact on the improved communication among individuals ,but also a positive impact on the bottom line and cost reduction.

 

NATIONAL STANDARDS FOR

CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES (CLAS) IN HEALTH CARE

Culturally Competent Care (Standards 1-3)

Standard 1. Health care organizations should ensure that patients/consumers receive from all staff members’ effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language.

Standard 2. Health care organizations should implement strategies to recruit, retain, and promote at all levels of the organization a diverse staff and leadership that are representative of the demographic characteristics of the service area.

Standard 3. Health care organizations should ensure that staff at all levels and across all disciplines receive ongoing education and training in culturally and linguistically appropriate service delivery.

Language Access Services (Standards 4-7)

Standard 4. Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.

Standard 5. Health care organizations must provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services.

Standard 6. Health care organizations must assure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingual staff. Family and friends should not be used to provide interpretation services (except on request by the patient/consumer).

Standard 7. Health care organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area.

Organizational Supports for Cultural Competence (Standards 8-14)

Standard 8. Health care organizations should develop, implement, and promote a written strategic plan that outlines clear goals, policies, operational plans, and management accountability/oversight mechanisms to provide culturally and linguistically appropriate services.

Standard 9. Health care organizations should conduct initial and ongoing organizational self-assessments of CLAS-related activities and are encouraged to integrate cultural and linguistic competence-related measures into their internal audits, performance improvement programs, patient satisfaction assessments, and outcomes-based evaluations.

Standard 10. Health care organizations should ensure that data on the individual patient’s/consumer’s race, ethnicity, and spoken and written language are collected in health records, integrated into the organization’s management information systems, and periodically updated.

Standard 11. Health care organizations should maintain a current demographic, cultural, and epidemiological profile of the community as well as a needs assessment to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area.

Standard 12. Health care organizations should develop participatory, collaborative partnerships with communities and utilize a variety of formal and informal mechanisms to facilitate community and patient/consumer involvement in designing and implementing CLAS-related activities.

Standard 13. Health care organizations should ensure that conflict and grievance resolution processes are culturally and linguistically sensitive and capable of identifying, preventing, and resolving cross-cultural conflicts or complaints by patients/consumers.

Standard 14. Health care organizations are encouraged to regularly make available to the public information about their progress and successful innovations in implementing the CLAS standards and to provide public notice in their communities about the availability of this information. 

For more information contact Helen Dao at helen@daoconsultingservices.com or at 1-800-905-1208.