《混凝土结构工程施工质量验收规范.ppt

RespectfulCommunicationCertaintopicsaretabooinsomecultures.E.g.,askinganolderLatina/Hispanicunmarriedwomanaboutsexbehaviorcanbeconsideredoffensive.Youmaywanttotellthepatientthatyourealizethatsomethingsarenotnormallydiscussed,butthatitisnecessarysothatthebestcarecanbeplannedAlternative&ComplementaryHealingSystems/TechniquesLatino/Hispanicalternativeandcomplementaryhealingsystemsortechniquesinclude:Curanderismo,Espiritismo,andSanteria.Healersinclude:Curanderos(generalpractitionersofMexicanfolkhealing)Alternative&ComplementaryHealingSystems/TechniquesEspiritistas(PuertoRicanfaithhealers)Santeros(Cubanfaithhealers)Yerbistas(herbalists)Sobadores(massagetherapists)Folkhealersoftentreatchildrenforconditionssuchas:Alternative&ComplementaryHealingSystems/TechniquesColico(colic)Empacho(lockedbowels)Susto(fright)Maldeojo(evileye)Caidadelamollera(fallenfontanel)Alternative&ComplementaryHealingSystems/TechniquesHealersalsoperformspiritualcleansing(barridasorlimpias).InsufficientdataexistsregardingtheextenttowhichalternativeandcomplementaryhealersandsystemsareusedbyHispanicsVilla,M.L.,Cuellar,J.,Gamel,N.,&Yeo,G.(1993).AgingandHealth:HispanicAmericanElders(2ndedition),SGECWorkingPaperSeries,Number5,EthnogeriatricReviews,StanfordGeriatricEducationCenter.LatinoHealthCareGapsComparedwithnonLatinowhites,Latinosarethreetimesaslikelytobeuninsured.Manyhavenoregularsourceofprimarycare,receivefewercheck-ups,cancerscreeningsandotherpreventiveservices.Theyrelyheavilyonsporadicandemergencyroomcare.Asaresultoflatediagnosis,breastcanceristheleadingcauseofcancerdeathamongLatinas.NationalCancerInstitute,CancerNet,BreastCancerFacts,1999Hispanic/Latinos“Doubleburden”DotyandIveshaveextensivelydocumentedLatinos“Doubleburden”1)LimitedEnglishproficiency(LEP)2)LackofhealthinsuranceTogether,the“doubleburden”canbeadeathsentenceDoty,M.andIves,B.“QualityofHealthCareforHispanicPopulations:FindingsfromtheCommonwealthFund2001HealthCareQualitySurvey.”CommonwealthFund(March2002),Pub#526.English-onlyHealthcareProvidersIntheUS,providerstendtobemonolingual-Englishonly.And/orhaveinsufficientknowledgeofSpanishandlackawarenessofmedicallyrelevantaspectsofcultureLatinopatientandAngloproviderhavecommunicationgap,anddifferentworldviewsEvaluatingEffectiveCommunicationProvidersshouldevaluatewhetherquestionsorinstructionsgiventoLEPpatientshavebeenunderstoodTobepolite,someHispanic/Latinopatientswillnod“yes”butnotreallycomprehend.NonverbalCommunicationMuchofcommunicationbetweenpeopleisnonverbal.OnemustlearnittobeabletotrulycommunicateHowever,NonverbalCommunicationisrarelyapartofForeignLanguagetraininginthehighereducationsystemNonverbalcommunicationNonverbalcommunicationisthesumofnon-linguisticmessagesthatareencodedanddecodedthroughGesturesFacialexpressionsEyecontactToneofvoicePauses,silencesCommunicationgapsCultural,linguistic,andnonlinguisticgapscanleadtomiscommunicationandmistrust.HealthcarepersonnelmustbetrainedincrossculturalassessmentandinboththeverbalandnonverbalaspectsofcommunicationTwo-waycommunication:ethicalimperativeTopreventpoorhealthoutcomesforHispanic/Latinosandtolightentheir“doubleburden”EffortstoimprovethequalityofAnglo-Latinocommunicationinhealthcaresettingsareethicalimperatives.Translationvs.CulturalAdaptationHealthmessagesandpatienteducationdocumentsshouldbenotonlylinguisticallytranslatedbutalsoculturally adapted.StraighttranslationintoSpanishhasmanylimitations.Culturaladaptationisamoreeffectivemethodtoachievehealthpromotion.Conceptual equivalenceIntranslation,conceptualequivalenceismoreimportantthanlinguisticequivalenceHealthbehaviormodificationapproachesmustbeculturallyappropriatetobeeffectiveLatinos in Columbus:Health gapsUninsuredLatinosinColumbusreportjob-relatedinjuries,trauma,diabetes,hypertension,allergies,needforbirthcontrol,skinrashandotherconditionsOftentheycannotaffordtotaketimeawayfromworktogotoadoctorduringthedaySource:StateofLaClinicaLatina:AFirstYearReport”RaquelDiaz-Sprague,PharmDMSMLHR,January29,2002Latinos in Columbus:Health Care GapsAsLatinosaretheleastpaidworkers,andtheleastinsured,theycannotaffordthecostofaprimarycaremedicalconsultationortobuytheprescriptionstheyneedtocontrolchronicdiseasesorconditionssuchasallergies,asthma,diabetes,andhypertensionLatinos in Columbus:Health gapsTraumaticinjuriessometimesareleftunattendedresultinginirreparablelosses.E.g.,Marcos,a48yearoldMexicanconstructionworkerwasopeningadoorbyhammeringonaconcretewallonaTuesdayafternoonLatinos in Columbus:Health gapsApieceofconcreteflewintohisrighteye.Hefeltlikehewasbleedingbutnobloodwascomingfromtheeye.Thepainwasacute.Hisforeman“examined”him,toldhim“itsnothing”gavehimTylenolandtoldhimtokeepworkingorhellbefiredLatinos in Columbus:Health gapsMarcoskepttakingTylenolandkeptworkingwitheyepainfor5days.TheforemanfinallytookhimtoanemergencyroomonSundayeveningHehadanemergencyoperationtoremoveametalpiecefromtheeye.Latinos in Columbus:Health gapsTheoperationcost$2000.Hegavethehospitalallhehad,$400.Theforemanrefusedtohelppay.Thehospitalrefusedtodofollowupcare.Heneedsanoperationtocorrecttheeyemuscles.Hecantbescheduledforlackofresourcesforpayment.Hehaslost95%visioninthateye.MistakenIdentities&FearFactorSomeLatinosareputtingoffgoingtoadoctorbecauseoffeartheywillbeaskedtoshow“papers.”Theymayormaynothavelegalpapers.Theymaybeusingsomeoneelsespaperswithadifferentnameandadifferentdateofbirth.BridgingtheGapsIn2000HHSpublishedguidelinesCulturalandLinguisticallyAppropriateServices(CLAS)urgingprovidersto:Providequalifiedinterpreters.ProvidewrittenmaterialsinthepatientslanguageNearly45MillionUninsuredNearly45millionAmericans15.6%oftheU.S.populationdidnothavehealthinsuranceduringatypicalmonthin2003.Thisrepresentsanincreaseof5millionpeopleandmorethan1percentofthepopulationsince1990Source:ProtectingtheProtectingtheUninsured”KennethE.Thorpe,Ph.D.NewEnglandJournalofMedicineOctober6,2004Volume351October7,2004Number15Health care-a human rightLackofaccesstocarefortheworkingpoorandthe45millionuninsuredintheUS-therichestnationonearth-isanethicalissuerequiringactionresponse.Lackofaccesstohealthcareputspeopleatriskforsevereconditionsthatcouldhavebeeneffectivelymanagedwhendiagnosedandtreatedatanearlystage.HelpingLatinosinColumbusManynewHispanic/Latinoimmigrantshaveunmetprimaryhealthcareneeds.Mostareuninsured,havelittlefinancialresourcesandrelyonepisodicoremergencycare.From1999-2002,IledagroupofvolunteersasChairofLatinoHealthAllianceandFoundingDirectorofLaClinicaLatina.Thecliniccurrentlyoperatesforabout3hours2or3nightsamonth.ItisfundedbytheOSUMedicalCenter.Thestaffisallvolunteer.La Clinica LatinaMission of La Clinica LatinaTo educate Latinos in Columbus on health care issues and provide free primary care in a bilingual and bicultural atmosphere.La Clinica Latina(cont.)TheclinicopenedonDecember19,2000.An8-montholdboypresentingalegburnwasthefirstpatient.Theburnwascausedbyachemicalgelleakingfromacheapdiaper.Hewastreatedandrecoveredquickly.Wefellinlovewithhim.Hisparentsweresoverygrateful.LaClinicaprovided727patientvisitsto320patientsin2001.Source:StateofLaClinicaLatina:AFirstYearReport”RaquelDiaz-Sprague,PharmDMSMLHR,January29,2002LaClinicaLatina:ReceptionArea(snapshot taken in 2002snapshot taken in 2002)Educating Health Providers:Medical Communication with Latinos(AMP 641)AMP641evolvedfromaminimoduleintheMedicalHumanitiesProgramforMEDIandMEDII.CourseofferedSpringQuarteropentostudentsinanycollege.AMP641isincludedintheLatino/aStudiescurriculumoftheCollegeofHumanities,DivisionofComparativeEthnicStudies.MedicalCommunicationwithLatinos(AMP641)Thecourseprovidesinstructiononmedicalterminology,culturaladaptationintranslation,medicallyrelevantaspectsofHispanic/Latinoculture,servicelearningPermissionofInstructorisrequired.Instructor:RaquelDiaz-Sprague,PharmDContactThoughtsandReflectionAlmostonein6peopleintheUSlackshealthinsurance.Thenumberofuninsuredisgrowingascostsescalate.Thenationmustendthishealthinjustice.Creativesolutionstoprovideaccesstohealthcareforallareneeded.Itisanethicalimperative.ThoughtsandReflectionCharitable“freeclinics”whileprovidingawonderfulandnobleservicecandolittletoalleviatetheUShealthcareaccesscrisis.Expandinganetworkoffreeorlow-costclinics,isatbesta“bandage”overadeep,festeringwound.UniversalcoverageisneededFinalThoughtandReflectionTheinhumanityofslaveryintheUScouldnothavebeenendedbyexpanding emancipation,butbyabolishingtheinstitutionofslavery!Somustthisnationabolish,foralltimetocome,theinhumanityof“lack of health care coverage”builtintheUShealthcaresystem.Willwejointhecivilizedworld?Source:“Intercultural Understanding and Communication Can Help Bridge Health Gaps for Latinos”PresentationbyRaquelDiaz-Sprague,AmericanAssociationforPracticalandProfessionalEthics,13thAnnualMeeting.,February27,20040C4F7JaMdPhSkVnZq$u*x-A2D5G8KbNfQiTlXo#r%v(y0B3E6I9LcOgRjVmYp!t&w)z1C4G7JaMePhSo#r%u(y+B3E6H9LcOfRjUmYp!s&w)z0C4F7JaMdPhSkVnZq$u*x-A2D5G8KbNfQiTlXo#r%v(y0B3E6I9LcOgRjVmYp!t&w)z1C4G7JaMePhSkWnZq$u*x+A2D5H8KbNfQiUlXo#s%v(y0B3F6I9LdOgRjVmYq!t&w-z1C4G7JbMePhTkWnZr$u(x+A2E5H8KcNfRiUlXp#s%v)y0B3F6IaLdOgSjVmYq!t*w-z1D4G7JbMeQhTkWoZr$u(x+B2E5H9KcNfRiUmXp#s&v)y0C3F7IaLdPgSjVnYq$t*w-A1D4G8JbNeQhTlWoZr%u(x+B2E6H9KcOfRiUmXp!s&v)z0C3F7IaMdPgSkVnYq$t*x-A1D5G8JbNeQiTlWo#r%u(y+B3E6H9LcOfRjUmYp!s&w)z0C4F7IaMdPhSkVnZq$t*x-A2D5G8KbNeQiTlXo#r%v(y+B3E6I9LcOgRjUmYp!t&w)z1C4F7JaMePhSkWnZq$u*x+A2D5H8KbNfQiTlXo#s%v(y0B3E6I9LdOgRjVmYp!t&w-z1C4G7JaMePhTkWnZr$u*x+A2E5H8KcNfQiUlXp#s%v)y0B3F6IaLdOgSjVmYq!t*w-z1D4G7JbMePhTkWoZr$u(x+A2E5H9KcNfRiUlXp#s&v)y0C3F6IaLdPgSjVnYq!t*w-A1D4G8JbMeQhTlWoZr%u(x+B2E6H9KcOfRiUmXp#s&v)z0C3F7IaLdPgSkVnYq$t*w-A1D5G8JbNeQhTlWo#r%u(y+B2E6H9LcOfRjUmXp!s&w)z0C4F7IaMdPhSkVnZq$t*x-A2D5cOfRiUmXp#s&v)z0C3F7IaLdPgSkVnYq$t*w-A1D5G8JbNeQhTlWo#r%u(y+B2E6H9LcOfRjUmXp!s&w)z0C4F7IaMdPgSkVnZq$t*x-A1D5G8KbNeQiTlWo#r%v(y+B3E6H9LcOgRjUmYp!s&w)z1C4F7JaMdPhSkWnZq$u*x-A2D5H8KbNfQiTlXo#r%v(y0B3E6I9LcOgRjVmYp!t&w)z1C4G7JaMePhSkWnZr$u*x+A2D5H8KcNfQiUlXo#s%v)y0B3F6I9LdOgSjVmYq!t&w-z1D4G7JbMePhTkWnZr$u(x+A2E5H8KcNfRiUlXp#s%v)y0C3F6IaLdOgSjVnYq!t*w-z1D4G8JbMeQhTkWoZr%u(x+B2E5H9KcOfRiUmXp#s&v)y0C3F7IaLdPgSjVnYq$t*w-A1D4G8JbNeQhTlWoZr%u(y+B2E6H9KcOfRjUmXp!s&v)z0C4F7IaMdPgSkVnZq$t*x-A1D5G8KbNeQiTlWo#r%u(y+B3E6H9LcOfRjUmYp!s&w)z0C4F7JaMdPhSkVnZq$u*x-A2D5G8KbNfQiTlXo#r%v(y0B3E6I9LcOgRjVmYp!t&w)z1C4F7JaMePhSkWnZq$u*x+A2D5H8KbNfQiUlXo#s%v(y0B3F6I9LdOgRjVmYq!t&w-z1C4G7JbMePhTkWnZr$u(x+A2E5H8KcNfQiUlXp#s%v)y0B3F6IaLdOgSjVmYq!t*w-z1D4G7JbMeQhTkWoZr$u(x+B2E5H9KcNfRiUmXp#s&v)y0C3F7IaLdPgSjVnYq$t*w-A1D4G8JbMeQhTlWoZr%u(x+B2E6H9KcOfRiUmXp!s&v)z0C3F7IaMdPgSkVnYq$t*x-A1D5G8JbNeQiTlWo#r%u(y+B3E6H9LcOfRjUmXp!s&w)z0C4JbMeQhTlWoZr%u(x+B2E6H9KcOfRiUmXp!s&v)z0C3F7IaMdPgSkVnYq$t*x-A1D5G8JbNeQiTlWo#r%u(y+B2E6H9LcOfRjUmXp!s&w)z0C4F7IaMdPhSkVnZq$t*x-A2D5G8KbNeQiTlXo#r%v(y+B3E6I9LcOgRjUmYp!t&w)z1C4F7JaMdPhSkWnZq$u*x-A2D5H8KbNfQiTlXo#s%v(y0B3E6I9LdOgRjVmYp!t&w-z1C4G7JaMePhTkWnZr$u*x+A2E5H8KcNfQiUlXo#s%v)y0B3F6I9LdOgSjVmYq!t&w-z1D4G7JbMePhTkWoZr$u(x+A2E5H9KcNfRiUlXp#s&v)y0C3F6IaLdPgSjVnYq!t*w-A1D4G8JbMeQhTkWoZr%u(x+B2E5H9KcOfRiUmXp#s&v)z0C3F7IaLdPgSkVnYq$t*w-A1D5G8JbNeQhTlWo#r%u(y+B2E6H9LcOfRjUmXp!s&v)z0C4F7IaMdPgSkVnZq$t*x-A1D5G8KbNeQiTlWo#r%v(y+B3E6H9LcOgRjUmYp!s&w)z1C4F7JaMdPhSkWnZq$u*x-A2D5H8KbNfQiTlXo#r%v(y0B3E6I9LcOgRjVmYp!t&w)z1C4G7JaMePhSkWnZr$u*x+A2D5H8KcNfQiUlXo#s%v)y0B3F6MdPhSkVnZq$u*x-A2D5G8KbNfQiTlXo#r%v(y0B3E6I9LcOgRjVmYp!t&w)z1C4G7JaMePhSkWnZr$u*x+A2D5H8KcNfQiUlXo#s%v(y0B3F6I9LdOgRjVmYq!t&w-z1C4G7JbMePhTkWnZr$u(x+A2E5H8KcNfRiUlXp#s%v)y0C3F6IaLdOgSjVnYq!t*w-z1D4G8JbMeQhTkWoZr$u(x+B2E5H9KcNfRiUmXp#s&v)y0C3F7IaLdPgSjVnYq$t*w-A1D4G8JbNeQhTlWoZr%u(y+B2E6H9KcOfRjUmXp!s&v)z0C3F7IaMdPgSkVnYq$t*x-A1D5G8JbNeQiTlWo#r%u(y+B3E6H9LcOfRjUmYp!s&w)z0C4F7JaMdPhSkVnZq$u*x-A2D5G8KbNfQiTlXo#r%v(y+B3E6I9LcOgRjUmYp!t&w)z1C4F7JaMePhSkWnZq$u*x+A2D5H8KbNfQiUlXo#s%v(y0B3F6I9LdOgRjVmYq!t&w-z1C4G7JaMePhTkWnZr$u*x+A2E5H8KcNfQiUlXp#s%v)y0B3F6IaLdOgSjVmYq!t*w-z1D4G7JbMeQhTkWoZr$u(x+B2E5H9KcNfRiUlXp#s&v)y0C3F6IaLdPgSjVnu*x+A2E5H8KcNfQiUlXp#s%v)y0B3F6IaLdOgSjVmYq!t*w-z1D4G7JbMeQhTkWoZr$u(x+A2E5H9KcNfRiUlXp#s&v)y0C3F6IaLdPgSjVnYq!t*w-A1D4G8JbMeQhTlWoZr%u(x+B2E6H9KcOfRiUmXp!s&v)z0C3F7IaLdPgSkVnYq$t*w-A1D5G8JbNeQhTlWo#r%u(y+B2E6H9LcOfRjUmXp!s&w)z0C4F7IaMdPhSkVnZq$t*x-A2D5G8KbNeQiTlXo#r%v(y+B3E6H9LcOgRjUmYp!s&w)z1C4F7JaMdPhSkWnZq$u*x-A2D5H8KbNfQiTlXo#s%v(y0B3E6I9LdOgRjVmYp!t&w-z1C4G7JaMePhSkWnZr$u*x+A2D5H8KcNfQiUlXo#s%v)y0B3F6I9LdOgSjVmYq!t&w-z1D4G7JbMePhTkWoZr(y0B3E6I9LdOgRjVmYp!t&w)z1C4G7JaMePhSkWnZr$u*x+A2D5H8KcNfQiUlXo#s%v)y0B3F6I9LdOgSjVmYq!t&w-z1D4G7JbMePhTkWoZr$u(x+A2E5H8KcNfRiUlXp#s%v)y0C3F6IaLdOgSjVnYq!t*w-z1D4G8JbMeQhTkWoZr%u(x+B2E5H9KcOfRiUmXp#s&v)z0C3F7IaLdPgSjVnYq$t*w-A1D4G8JbNeQhTlWoZr%u(y+B2E6H9KcOfRjUmXp!s&v)z0C4F7IaMdPgSkVnZq$t*x-A1D5G8KbNeQiTlWo#r%v(y+B3E6H9LcOfRjUmYp!s&w)z0C4F7JaMdPhSkVnZq$u*x-A2D5G8KbNfQiTlXo#r%v(y0B3E6I9LcOgRjVmYp!t&w)z1C4G7JaMePhSkWnZq$u*x+A2D5H8KbNfQiUlXo#s%v(y0B3F6I9LdOgRjV$u*x-A2D5G8KbNfQiTlXo#r%v(y0B3E6I9LcOgRjVmYp!t&w)z1C4F7JaMePhSkWnZq$u*x+A2D5H8KbNfQiUlXo#s%v(y0B3F6I9LdOgRjVmYq!t&w-z1C4G7JbMePhTkWnZr$u(x+A2E5H8KcNfQiUlXp#s%v)y0B3F6IaLdOgSjVmYq!t*w-z1D4G7JbMeQhTkWoZr$u(x+B2E5H9KcNfRiUmXp#s&v)y0C3F7IaLdPgSjVnYq!t*w-A1D4G8JbMeQhTlWoZr%u(x+B2E6H9KcOfRiUmXp!s&v)z0C3F7IaMdPgSkVnYq$t*x-A1D5G8JbNeQiTlWo#r%u(y+B3E6H9LcOfRjUmXp!s&w)z0C4F7IaMdPhSkVnZq$t*x-A2D5G8KbNeQiTlXo#r%v(y+B3E6I9LcOgRjUmYp!t&w)z1C4F7JaMePhSkWnZq$u*x-A2D5H8KbNfQiTlXo#s%v(C4F7IaMdPhSkVnZq$t*x-A2D5G8KbNeQiTlXo#r%v(y+B3E6I9LcOgRjUmYp!t&w)z1C4F7JaMdPhSkWnZq$u*x-A2D5H8KbNfQiTlXo#s%v(y0B3E6I9LdOgRjVmYp!t&w-z1C4G7JaMePhTkWnZr$u*x+A2E5H8KcNfQiUlXo#s%v)y0B3F6I9LdOgSjVmYq!t&w-z1D4G7JbMePhTkWoZr$u(x+A2E5H9KcNfRiUlXp#s&v)y0C3F6IaLdPgSjVnYq!t*w-z1D4G8JbMeQhTkWoZr%u(x+B2E5H9KcOfRiUmXp#s&v)z0C3F7IaLdPgSkVnYq$t*w-A1D5G8JbNeQhTlWo#r%u(y+B2E6H9LcOfRjUmXp!s&v)z0C4F7IaMdPgS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