Health Heritage and Practices of the Appalachian and Arab People
The health heritage of the Appalachian and Arab people as well as their cultural beliefs have an influence on the delivery of health care especially, as concerns community care. Definitively, the Appalachian people are those found in the Appalachia which is the cultural area along the Appalachian Mountains in the eastern part of the United States (Purnell, 2014). The area runs from western New York State to Mississippi and Alabama including regions such as New York, Ohio, Kentucky and Pennsylvania among others within the defined area (Ibid, 2014). They are basically Germans, Scots-Irish, French, Welsh and English people who settled these regions between the 17th and 19th centuries. A key characteristic of the Appalachian people is that typically, they are white, blue collar workers and often rural folk. Heritage of the Appalachian and Arab People Assignment
Outstanding cultural traits that have influenced communal health care, are their distrust for outsiders which manifests as trust issues. They also have distinct dialects and styles of communication and additionally, the social hierarchy is based on kinship and loyalty is particularly valued within the community (Ibid2, 2014). In terms of communal health, there are difficulties arising from their distrust especially as regards counselling interventions. Therapists who fail to recognize these distinctiveness of culture as compared to the mainstream population, often fail in delivery of such care and thus they must be aware of the differences and utilize acceptable theories and techniques for intervention.
On the other hand, Arabs are identified as people from any of the 22 Arab countries stretching from North Africa to the Arabian Gulf including Libya, Morocco, Syria, Egypt, Iraq, and Yemen among others (Hajaj, 2015). However, contrary to common belief, Turkey and Iran are not Arab countries. Essentially, Arabs are diverse in terms of religion, political standing as well as ethnicity but they have a commonality of understanding the classical Arabic language as formally spoken and printed (Ibid, 2015). In the United States of America, Arabs have substantial numbers in Los Angeles, Detroit, New York and Washington D.C. cities.
In terms of their acculturation, Arabs view discrimination as the greatest barrier with many believing that they are more of a nation in exile than they are immigrants or citizen of America. For this reason, they have often divided loyalties between their home countries and the United States with a common dilemma being the decision as whether to accept or reject assimilation into Western culture and way of life.
In the Arabic culture, mental health is held as most stigmatizing and in particular women fare worse than their male counterparts in that regard (Ibid2, 2015). In general, this group has negative notions and views regarding mental health especially concerning psychiatric and psychological interventions.
A key health practices of the Appalachian people is managing illness by individuals with no medical training and the problem is that effective interventions are hindered. For instance, 70 – 90% of the population are averse to making positive health behavior change such as quitting smoking (Purnell, 2014). For the Arabs, there are misconceptions regarding the causes of illnesses due to the religious and cultural beliefs that view fate as their master rather than being masters of their own fates as Westerners typically do (Hajaj, 2015). As a result, many fail to visit healthcare facilities and when they do there is preference for gender healthcare givers and providers especially among the women. Conclusively, these are both detrimental health practices arising from the cultural aspects of both the Appalachian and Arabic peoples. Heritage of the Appalachian and Arab People Assignment
References
Hajaj, H. (2015).Working with Arab American Clients: A culturally relevant, sensitive, and competent approach. Retrieved from<http://www.smchealth.org/sites/main/files/file-attachments/arabamericanpresentationjan2015.pdf>
Purnell, L. (2014). Guide to Culturally Competent Health Care. F.A. Davis.
Appalachians
Larry Purnell, PhD, RN, FAAN
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview
- Heritage from England, Wales, Scotland, Ireland, France, and Germany
- Came to the United States for religious freedom and better economic opportunities
- Purposely isolated themselves in the mountains to live and practice their religions as they chose
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview Continued
- Appalachia includes 410 counties in 13 states and extends from southern New York to northern Mississippi.
- Continuous migration from the country to the city and vice versa
- High proportion of aging in Appalachia
- Farming, mining, textiles, service industries, etc.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview Continued
- High poverty and unemployment rates
- Originally most educated group in America, now some of the least educated due to isolation
- Area still lacks infrastructure
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communications
- Carry over from Elizabethan English
- Spellin for spelling
- Warsh for wash
- Badder for bad
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Ethic of Neutrality
- Avoid aggression and assertiveness
- Do not interfere with others’ lives
- Avoid dominance over others
- Avoid arguments and seek agreement
- Accept without judging—use few adjectives and adverbs, resulting in less precise description of emotions and thoughts
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communications
- Sensitive about direct questions and personal issues
- Sensitive to hints of criticism. A suggestion may be seen as criticism.
- Cordiality precedes information sharing so “sit a spell” and chat before doing business, which is necessary for developing trust
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication Continued
- A few may avoid direct eye contact because it can be perceived as aggression, hostility, or impoliteness
- More being than doing oriented, more relaxed culture and being in tune with body rhythms
- Be formal with name format until told to do otherwise. Heritage of the Appalachian and Arab People Assignment
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication Continued
- Healthcare provider must be flexible and adaptable
- Come early or late for an appointment and still expect to be seen
- Family lineage is important
- Formality with respect—Miz Florence or Mr. John
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family
- Varied decision-making patterns but the more traditional Appalachian family is still primarily patriarchal
- Women make decisions about health care and usually carry out the herbal treatments and folk remedies
- Women marry at a young age and have larger families than the other white ethnic groups
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Continued
- Children are accepted regardless of what they do
- Hands-on physical punishment is common
- Motherhood increases the status of the woman in the eyes of the community
- Take great pride in being independent and doing things for oneself
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Continued
- Family rather than the individual is the treatment unit
- Having a job is more important than having a prestigious position
- Consistent with the ethic of neutrality, alternative lifestyles are accepted, they are just not talked about
- Extended family is the norm
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Biocultural Ecology
- High incidence of respiratory conditions due to occupations
- Increase of parasitic infections due to lack of modern utilities in some areas
- High incidence of cancer, otitis media, anemia, obesity, cardiovascular disease, suicide, accidents, SIDS, and mental illness
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
High-Risk Behaviors
- Tobacco is a main farming crop in some areas of Appalachia
- Smoke at a young age
- Alcohol use at a young age—binge drinking
- Believe in the mind, body, spirit connection
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Ten Steps in Seeking Health Care
- Use self-care practices learned from mother or grandmother
- Call mother or grandmother if available
- Then trusted female family member, neighbor, or a nurse
- Then go to OTCs they saw on TV
- Then use a neighbor’s prescription medicine
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Ten Steps in Seeking Health Care Continued
- Pharmacist or nurse for advice
- Physician or Advanced Practice Nurse
- Then to a specialist
- Then to the closest tertiary medical center
- DO NOT BE JUDGMENTAL, if you want to keep them in the system
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Nutrition
- Food may be synonymous with wealth
- Wide variety of meats, do not trim the fat—low-fat wild game is also eaten
- Organ meats are common
- Bones and bone marrow used for making sauces
- Preserve with salt
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Nutrition Continued
- Lots of frying (using lard or bacon grease) and pickling
- Anytime is the time to celebrate with food, especially in the rural areas
- Many teens have particularly poor health
- Status symbol to have instant coffee and snack foods for some
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Nutrition Continued
- Early introduction of solid foods
- May feed babies teaspoons of grease to make them healthy and strong
- Diet is frequently deficient in Vitamin A, iron, and calcium
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Childbearing Family
- Must eat well to have a healthy baby
- Do not reach over your head when pregnant to prevent the cord from wrapping around the neck of the fetus
- Being frightened by a snake or eating strawberries or citrus can cause the baby to be marked
- Use bands around the belly and asafetida bags
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Death Rituals
- Must stay with the dying person
- Family should not be left alone
- Funerals with personal objects at the viewing and buried in their best clothes
- May take the deceased for viewing at home
- After the funeral there is more food and singing and for some a “wake” to celebrate life
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Death Rituals Continued
- Flowers are more important than donations to charity
- Particularly good at working through the grieving process
- Funeral directors are commonly used for bereavement
- Cremation is acceptable and ashes may be saved or dispersed on the “land”
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Spirituality
- Baptist, Pentecostal, Episcopalian, Jehovah’s Witness, Methodist, Presbyterian
- Each church adapts to the community
- Most are highly religious even though they do not attend church
- Common to attend Sunday and other days
- Preacher has a calling to “preach”
- Ministers are trained
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Spirituality Continued
- Meaning in life comes from the family and “living right with God,” which varies by the specific religious sect
- Nature is in control—fatalism
- Religion and faith is important in a hostile environment
- I will be there if the “creek does not rise” or if “God is willing”—fatalism
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Healthcare Practices
- Good health is due to God’s Will
- Self-reliance fosters self-care practices
- Family important for health care
- May be very ill before a decision is made to see a professional resulting in a more compromised health condition
- Direct approaches are frowned upon
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Healthcare Practices Continued
- Herbal medicines, poultices, and teas are common
- See Table 8–1 in the textbook; these practices are still alive and well
- Folk medicines used in conjunction with biomedical treatments
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Barriers
- Fatalism
- Self-reliance
- Lack of infrastructure
- Health profession shortages
- Culture of “being”
- Poverty and unemployment
- Care not acceptable from outsiders
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Responses to Health and Illness
- Take care of our own and accept the person as whole individual
- Not mentally ill, the person has “bad nerves” or are “odd turned”
- Having a disability with aging is natural and inevitable—if you live long enough
- Must establish rapport and trust
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Responses to Health and Illness Continued
- Pain is something that is to be endured
- Some may be stoical
- Pain legitimizes not working or fulfilling one’s responsibilities
- Withdraw into self when ill
- Culture of being works against rehabilitation
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Healthcare Practitioners
- Lay and trained nurses and midwives still provide much of the care in some parts of Appalachia
- Breckenridge Frontier Nursing Service
- Prefer people known to the family and community —the insider versus outsider concept
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Healthcare Practitioners Continued
- Culture of “being” says the healthcare provider should not give the perception of being rushed
- Physicians may not be trusted due to outsided-ness, not to being foreign
- Must ask the clients what they think is wrong