Demographic And Health Analysis: Country Report & Analysis Overview
spiderman2017
InformedEngagementinInternationalHealthWorkLectures.pdf
Informed Engagement in International Health Work: Cultural Competence
Caitlin Kennedy, PhD Johns Hopkins University
Outline
What is culture?
What is competence?
When and where is cultural competence needed?
How do you do cultural competence in public health?
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The material in this video is subject to the copyright of the owners of the material and is being provided for educational purposes under rules of fair use for registered students in this course only. No additional copies of the copyrighted work may be made or distributed.
Section A
What Is Cultural Competence?
Do You Have Any Pets at Home?
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What Is Culture?
Culture refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups
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What Is Culture?
Culture refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups
Patterns of behavior are … Not always 100% shared or consistent across individuals within a cultural group Not static over time
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Outline
What is culture?
What is competence?
When and where is cultural competence needed?
How do you do cultural competence in public health?
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What Is Competence?
Competence implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by households, patients, and communities
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What Training Have You Had in Cultural Competence?
Examples: Clinical training Peace Corps training Diversity training Other?
What was the content of that training?
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Outline
What is culture?
What is competence?
When and where is cultural competence needed?
How do you do cultural competence in public health?
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When and Where Is Cultural Competence Needed?
Source: Sachdev, N. (September 5, 2012). Ebola disease terror in Congo | French Tribune. Available at: http://frenchtribune.com/teneur/1213233-ebola-disease-terror-congo. Accessed December 11, 2014. 11
Case Example: Ebola
"We have been unable to control the spread due to continued denials, cultural burying practices, disregard for the advice of health workers and disrespect for the warnings by the government.”
—Liberian President Ellen Johnson Sirleaf,
national address, August 19, 2014
Source: Zavis, A. (August 20, 2014). Clashes erupt as Liberia seals off slum to prevent spread of Ebola. Los Angeles Times. Available at: http://www.latimes.com/world/africa/la-fg-africa-liberia-ebola-quarantine-curfew-20140820-story.html. Accessed December 15, 2014. 12
Case Example: Ebola
Source: Sun, L. H., Dennis, B., Bernstein, L., Achenbach, J. (October 4, 2014). How Ebola sped out of control. Washington Post. Available at: http://www.washingtonpost.com/sf/national/2014/10/04/how-ebola-sped-out-of-control/. Accessed December 11, 2014. 13
When and Where Is Cultural Competence Needed?
Communicating with patients
Communicating with communities
Communicating with other public health practitioners Ministries of Health NGOs/CBOs And other fields and disciplines
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Communicating With Other Public Health Professionals
Understanding of: Cultural background of professionals Culture of training institutions Culture of current professional organizations
Like “community members,” culture is shaped by myriad structural, economic, and social factors
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The material in this video is subject to the copyright of the owners of the material and is being provided for educational purposes under rules of fair use for registered students in this course only. No additional copies of the copyrighted work may be made or distributed.
Section B
How Do You Do Cultural Competence in Public Health?
Question 1
In which dimensions of cultural competence do you feel healthcare providers in the United States do best (are most competent)? a. Providing services in the language of the patients b. Taking into account different local understandings of health and illness c. Recognizing how their own cultural perspectives shape the clinical encounter
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Question 2
In which dimensions of cultural competence do you feel the projects funded by global health organizations and development agencies do best (are most competent)? a. Providing programs and services in the language of the clients b. Taking into account different local understandings of health and illness c. Recognizing how their own cultural perspectives shape programmatic encounters
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Anthropology in the Clinic (Kleinman and Benson, 2006)
4 Source: Kleinman, A., & Benson, P. (2006). Anthropology in the clinic: the problem of cultural competency and how to fix it. PLoS Med, 3(10), e294.
Explanatory Models Approach
Also called “Cultural Formulation”
Clinical interview technique that “tries to understand how the social world affects and is affected by illness” Ethnographic approach Steps for how to “do” cultural competence in clinical medicine
Source: Kleinman, A., & Benson, P. (2006). Anthropology in the clinic: the problem of cultural competency and how to fix it. PLoS Med, 3(10), e294. 5
Steps in Cultural Formulation
1. Ethnic identity
2. What is at stake?
3. The illness narrative
4. Psychosocial stresses
5. Influence of culture on clinical relationships
6. The problems of a cultural competency approach
Source: Kleinman, A., & Benson, P. (2006). Anthropology in the clinic: the problem of cultural competency and how to fix it. PLoS Med, 3(10), e294. 6
Case Example: Ebola
The Democratic Republic of Congo (DRC) has experienced seven Ebola epidemics Initial outbreak occurred in 1976 Through August 2014 outbreak, there
were a total of 1,034 infections and 794 deaths (76.7% mortality)
All but one of the outbreaks (Kikwit, 1995) have been in rural, isolated communities
Source: Wild, F., & Pettypiece, S. (August 25, 2014). Ebola Kills 13 in Congo Outbreak Separate From W. Africa. Bloomberg. Available at: http://www.bloomberg.com/news/2014-08-24/ebola-kills-13-in-congo-outbreak-separate-from-w-africa.html. Accessed December 11, 2014. 7
Case Example: Ebola
Source: Wild, F., & Pettypiece, S. (August 25, 2014). Ebola Kills 13 in Congo Outbreak Separate From W. Africa. Bloomberg. Available at: http://www.bloomberg.com/news/2014-08- 24/ebola-kills-13-in-congo-outbreak-separate-from- w-africa.html. Accessed December 11, 2014. 8
Case Example: Ebola
Background: DRC has significant experience developing and implementing clinical and
community-based interventions to prevent and respond to Ebola outbreaks
Task: Synthesize the Congolese experience and expertise into a framework and practical
approach to effectively respond to the West African epidemic
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Steps in Cultural Formulation / Explanatory Models Approach for Public Health
1. Ethnic identity
2. What is at stake?
3. The illness narrative
4. Psychosocial stresses
5. Influence of culture on clinical relationships
6. The problems of a cultural competency approach
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In Summary
Cultural issues are central to understanding health and health care
Culture is dynamic and relevant in different ways to different problems
Cultural competence is crucial for effective public health work: With communities and patients With organizations that draw upon people from different cultures
Cultural competence is the start of a conversation best approached through an ethnographic approach, not as a technical skill to be mastered
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Lecture Evaluation
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