Promises, Promises: Indian Healthcare Needs Unmet - page 2
on the net: indian health service: u.s. department of health and human services department's office of minority health: national congress of american indians' health care issues: senate... Read More
Jun 16, '09Specialty: 2 year(s) of experience in Med Surg, Home Health ; Joined: Oct '08; Posts: 198; Likes: 242Hope3546, you are absolutely right that this population has a lot of health issues due partially to alcoholism and lack of self-care. I think you're right in what you present. I also see that as one part of the picture, instead of the whole picture.
My husband is Aboriginal, has not touched alcohol since he was 19, and has never done drugs. His one bad habit is unhealthy food. He relates very well, most of the time, to people with all cultures. In fact, one of the exceptional sides of his personality is his ability to instantly make almost anyone feel at home and happy to be in his company. Usually he's content being the one entertaining, comforting, and welcoming, since he enjoys this, but when he's stressed out, he needs to be made to feel comfortable. His health situation is very stressful for him, and one thing I've seen is the failure, over and over, of docs and nurses to understand what he needs as a Native person to help him feel comfortable.
The differences between Native communication and a lot of White communication are subtle yet profound. The interrogative, rapid-fire taking of a medical history, for example, is at a much faster pace than many Native people feel comfortable giving the full picture of information about anything. Pace is a really big issue. My husband once went in to have his wisdom teeth taken out. The dentist saw he had an easily triggered gag reflex and so wanted to put him under to do the procedure, so proceeded to try to sell my husband on this in rapid-fire got-other-patients-to-see fashion. My husband, usually very calm and unflappable, got totally flustered by this technique. Now, if the dentist had presented his reasons and desires more personally and calmly, then given my husband a minute or few of presence and silence to think it over, my husband, in my experience, would have handled the whole situation much more calmly and comfortably. I don't think my husband went back to that dentist again.
Another issue: some of the basic tenets of Western Med currently clash with Native spiritual beliefs about health. It would be very helpful to many Nations if body samples such as blood, skin, bone, shaved hair, or teeth could be either returned to them or disposed of with proper (to their Nation and preference) ceremony.
Also: medical practitioners may need to learn some local and national Native history to understand why their patients don't seem to fully trust them. In my husband's community, Native women were still receiving forced hysterectomies in his mother's generation, and that's just the tip of the iceberg.
In other words, in my experience, good medical care according to most Native preferences might probably utilize a gradual, listening based communication style, a willingness to work within spiritual traditions whenever possible, and an awareness of the local and societal history of Native/medical interactions. Also, even trying to learn and speak Native languages where spoken couldn't hurt. (Does anyone else have any perspectives on this they'd like to share?)
I'm not going to pretend that fitting cross-cultural health care into the medical system everyone struggles to make work already is going to be easy....but some parts of fitting it in might be easier, and pay off more in the long run, than mostly imagined.
Some great books on transcultural medical care:
The Spirit Catches You and You Fall Down by Anne Fadiman
Trancultural Health Care: A Culturally Competent Approach - Larry D. Purnell
And about Native/European communication styles:
Dancing with a ghost: Rupert Ross
Disclaimer: I'm a pre-nursing student, although one with half of a graduate in conflict resolution majoring in transcultural conflict resolution, so I'm coming more from the idealistic, best-theory side of things than from experience as a health care practitioner. So....grain of salt, and feel free to check it past your reality...lol
Jun 16, '09Occupation: ED Charge Specialty: 32 year(s) of experience in NICU, Peds, ICU/CCU, Cathlb,ER, Flight ; Joined: Apr '08; Posts: 35; Likes: 37Sadly, here in Oregon a 14 yr. old girl had gone to the community health clinic, & to the IHS clinic twice . 3 visits in a month. When she came into ER I was doing triage. Her mother spoke very little English & this young woman said to me, "I know you think I'm making this up but I have something in my belly."
I assured her that I believed her & that we would figure it out.
In the 3 previous visits to the clinics, no abdominal films were ever done, much less blood work. (They did do a pregnancy test 3 times.) She rated her abdominal pain 10/10.
We found that she had a lg. abdominal tumor, probably CA.
She was flown to a city hospital for immediate OR/chemo.
Her mother came into the ED with her 3 older brothers to give me a beaded belt bag 2 wks ago & to tell me that her dtr had passed through the west gate.
I still cry when I think of this...
Jun 16, '09Joined: May '09; Posts: 24; Likes: 21Wonderful posts Cinquefoil & Pennyfave! Keep them coming.
Jun 17, '09Joined: Jul '06; Posts: 1,813; Likes: 1,629Quote from Vito AndoliniYou can't sue the Federal government for medical malpractice. This also applies to people who got substandard care through the military.I pray for the family of this child to find peace in traditional ways and in a big, fat lawsuit. It won't bring her back but it is necessary to let them know that they gave sub-standard care and that someone died unnecessarily and probably in a whole lot of pain.
Jun 17, '09Specialty: Med/Surg; School Nurse ; Joined: Nov '05; Posts: 19; Likes: 7I work on the Navajo Nation reservation and one of the problems I see with IHS is the loan forgiveness program for healthcare providers. Some (definitely NOT ALL) providers think that they will come here for an easy 2 years, work of their loans and then set up private practice some place far more lucrative than the reservation. As a consequence many patients do not receive continuity of care and wind up seeing a new provider every time they walk into the facility.
It is challenging to work with patients and families here as many do not have modern services in there homes like running water, electricity, indoor plumbing. Patients are sometimes admitted to the hospital for a minor diagnosis that could be treated at home not because there's abuse or neglect going on, but because there's no place to plug in a nebulizer or keep an antibiotic cold. Patient education/teaching is HUGE! While many access IHS for services, they don't always understand the whys and what fors of a treatment planObesity and diabetes are rampant in this community-too much white man food and lifestyle.
I totally agree with Cinquefoil about the differences in communication, pacing and spiritual beliefs between Native cultures and Western medicine. What happened to this little girl is a tragedy for sure but what's even more tragic is that it won't be the last time something like this happens again.
Jun 17, '09Occupation: Public Health LPN Specialty: LPN, Peds, Public Health ; Joined: May '08; Posts: 399; Likes: 298I work in a Native American clinic that is run by IHS.
I think we give great care here.
Im also in Oklahoma where we have a large American Indian population.
Some things are more difficult under our guidelines but typically you get the care you need. I am also Native American myself and use the services, but I also have private insurance so I can go outside but a lot of the others dont.
I guess maybe from where I am I dont understand the problem ? We dont have reservations here maybe that is part of it?
Jun 17, '09Occupation: Licensed Practical Nurse Specialty: Community Health, Med-Surg, Home Health ; From: US ; Joined: Sep '05; Posts: 9,297; Likes: 8,221My heart breaks for this poor little girl and my mind is enlightened and blown at the sort of care that the Native Americans are getting. Thank God for this article, or I would have never considered this. What a horrible situation!
Jun 17, '09Occupation: CRNA Specialty: 45 year(s) of experience ; From: MI, US ; Joined: Nov '03; Posts: 1,681; Likes: 2,187Very few educated Americans want to live in these extremely rural areas. Would any of these posters who think the care sucks want to pack up themselves and their families and move to a reservation? I don't have any answers except to move the reservations closer to Starbucks!
I do have a doctor friend who retired from her NYC practice to live on and serve a reservation in Az. and loves it, but this is an unusual story. For decent care, I think the providers have to come from the native American community - you need a not of educational infrastructure to get it done. Maybe boarding school for the talented native students who can be exposed to educational standards good enough to get them into medical fields. I don't think enough kids can make it spending their youth on the reservations. I have come to believe (from long life) that poverty can be cured only one student at a time. These schools could be comprised of entirely native students - there's a lot of them out there.
Jun 17, '09Specialty: 2 year(s) of experience in Med Surg, Home Health ; Joined: Oct '08; Posts: 198; Likes: 242Here's one of those subtle intercultural moments: Native people have had such bad experience with boarding schools designed by others for their children that even the greatest, most culturally respectful boarding school in the world would have an uphill battle for attendance. (Because historically us non-Natives have not been the best about being culturally respectful, and as a result have stripped culture from the Nations instead of encouraging biculturally fluent professionals.)
I think this idea would have to come from within the community, be decided by the community, and be mostly run by the community to achieve the benefits you envision.
Some reservations can be rife with factors that discourage children from the daunting task of braving the mostly white colleges. However, there's also a lot of great work being done in terms of grassroots movements towards sobriety and healthier (usually more traditional) living. These efforts don't necessarily get as much airtime as the other images and statistics, but as health professionals we can seek out these efforts to encourage and learn from them.
Jun 18, '09Joined: Jan '99; Posts: 735; Likes: 216It's a shame more native american indians just aren't "mainstreamed" and allowed to live where ever they want. Hopefully they are NOT limited to just certain reservations. They should still get all of the "perks" no matter where they live if they can prove their heritage.
Jun 18, '09Occupation: Public Health LPN Specialty: LPN, Peds, Public Health ; Joined: May '08; Posts: 399; Likes: 298Quote from lee1Wow, Im kind of curious as to where all this is taking place?It's a shame more native american indians just aren't "mainstreamed" and allowed to live where ever they want. Hopefully they are NOT limited to just certain reservations. They should still get all of the "perks" no matter where they live if they can prove their heritage.
Call me ignorant, but here Native Americans are mainstream, we are everywhere. We live wherever we want, work wherever we want, shop wherever we want...plus we still get tribal benefits.
Am I missing something?? Seriously, this isnt the first time I have heard these things so I am really curious, I guess things are just totally different depending on where you go in the country?? Someone please fill me in.
Jun 19, '09Occupation: Med Surg RN Specialty: Med/Surg, ICU, educator ; From: US ; Joined: Nov '04; Posts: 1,051; Likes: 958I just think its a shame that anyone, regardless of heritage, could be treated like this. Unfortunately, we hear the stories everyday....
Jun 21, '09Joined: Jun '08; Posts: 1,489; Likes: 1,704Quote from rph3664Well it bet a good lawyer could sue them. Find something, like violation of their civil rights or something like that.You can't sue the Federal government for medical malpractice. This also applies to people who got substandard care through the military.