《混凝土结构工程施工质量验收规范.ppt

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1、RespectfulCommunicationCertaintopicsaretabooinsomecultures.E.g.,askinganolderLatina/Hispanicunmarriedwomanaboutsexbehaviorcanbeconsideredoffensive.Youmaywanttotellthepatientthatyourealizethatsomethingsarenotnormallydiscussed,butthatitisnecessarysothatthebestcarecanbeplannedAlternative&ComplementaryH

2、ealingSystems/TechniquesLatino/Hispanicalternativeandcomplementaryhealingsystemsortechniquesinclude:Curanderismo,Espiritismo,andSanteria.Healersinclude:Curanderos(generalpractitionersofMexicanfolkhealing)Alternative&ComplementaryHealingSystems/TechniquesEspiritistas(PuertoRicanfaithhealers)Santeros(

3、Cubanfaithhealers)Yerbistas(herbalists)Sobadores(massagetherapists)Folkhealersoftentreatchildrenforconditionssuchas:Alternative&ComplementaryHealingSystems/TechniquesColico(colic)Empacho(lockedbowels)Susto(fright)Maldeojo(evileye)Caidadelamollera(fallenfontanel)Alternative&ComplementaryHealingSystem

4、s/TechniquesHealersalsoperformspiritualcleansing(barridasorlimpias).InsufficientdataexistsregardingtheextenttowhichalternativeandcomplementaryhealersandsystemsareusedbyHispanicsVilla,M.L.,Cuellar,J.,Gamel,N.,&Yeo,G.(1993).AgingandHealth:HispanicAmericanElders(2ndedition),SGECWorkingPaperSeries,Numbe

5、r5,EthnogeriatricReviews,StanfordGeriatricEducationCenter.LatinoHealthCareGapsComparedwithnonLatinowhites,Latinosarethreetimesaslikelytobeuninsured.Manyhavenoregularsourceofprimarycare,receivefewercheck-ups,cancerscreeningsandotherpreventiveservices.Theyrelyheavilyonsporadicandemergencyroomcare.Asar

6、esultoflatediagnosis,breastcanceristheleadingcauseofcancerdeathamongLatinas.NationalCancerInstitute,CancerNet,BreastCancerFacts,1999Hispanic/Latinos“Doubleburden”DotyandIveshaveextensivelydocumentedLatinos“Doubleburden”1)LimitedEnglishproficiency(LEP)2)LackofhealthinsuranceTogether,the“doubleburden”

7、canbeadeathsentenceDoty,M.andIves,B.“QualityofHealthCareforHispanicPopulations:FindingsfromtheCommonwealthFund2001HealthCareQualitySurvey.”CommonwealthFund(March2002),Pub#526.English-onlyHealthcareProvidersIntheUS,providerstendtobemonolingual-Englishonly.And/orhaveinsufficientknowledgeofSpanishandla

8、ckawarenessofmedicallyrelevantaspectsofcultureLatinopatientandAngloproviderhavecommunicationgap,anddifferentworldviewsEvaluatingEffectiveCommunicationProvidersshouldevaluatewhetherquestionsorinstructionsgiventoLEPpatientshavebeenunderstoodTobepolite,someHispanic/Latinopatientswillnod“yes”butnotreall

9、ycomprehend.NonverbalCommunicationMuchofcommunicationbetweenpeopleisnonverbal.OnemustlearnittobeabletotrulycommunicateHowever,NonverbalCommunicationisrarelyapartofForeignLanguagetraininginthehighereducationsystemNonverbalcommunicationNonverbalcommunicationisthesumofnon-linguisticmessagesthatareencod

10、edanddecodedthroughGesturesFacialexpressionsEyecontactToneofvoicePauses,silencesCommunicationgapsCultural,linguistic,andnonlinguisticgapscanleadtomiscommunicationandmistrust.HealthcarepersonnelmustbetrainedincrossculturalassessmentandinboththeverbalandnonverbalaspectsofcommunicationTwo-waycommunicat

11、ion:ethicalimperativeTopreventpoorhealthoutcomesforHispanic/Latinosandtolightentheir“doubleburden”EffortstoimprovethequalityofAnglo-Latinocommunicationinhealthcaresettingsareethicalimperatives.Translationvs.CulturalAdaptationHealthmessagesandpatienteducationdocumentsshouldbenotonlylinguisticallytran

12、slatedbutalsoculturally adapted.StraighttranslationintoSpanishhasmanylimitations.Culturaladaptationisamoreeffectivemethodtoachievehealthpromotion.Conceptual equivalenceIntranslation,conceptualequivalenceismoreimportantthanlinguisticequivalenceHealthbehaviormodificationapproachesmustbeculturallyappro

13、priatetobeeffectiveLatinos in Columbus:Health gapsUninsuredLatinosinColumbusreportjob-relatedinjuries,trauma,diabetes,hypertension,allergies,needforbirthcontrol,skinrashandotherconditionsOftentheycannotaffordtotaketimeawayfromworktogotoadoctorduringthedaySource:StateofLaClinicaLatina:AFirstYearRepor

14、t”RaquelDiaz-Sprague,PharmDMSMLHR,January29,2002Latinos in Columbus:Health Care GapsAsLatinosaretheleastpaidworkers,andtheleastinsured,theycannotaffordthecostofaprimarycaremedicalconsultationortobuytheprescriptionstheyneedtocontrolchronicdiseasesorconditionssuchasallergies,asthma,diabetes,andhyperte

15、nsionLatinos in Columbus:Health gapsTraumaticinjuriessometimesareleftunattendedresultinginirreparablelosses.E.g.,Marcos,a48yearoldMexicanconstructionworkerwasopeningadoorbyhammeringonaconcretewallonaTuesdayafternoonLatinos in Columbus:Health gapsApieceofconcreteflewintohisrighteye.Hefeltlikehewasble

16、edingbutnobloodwascomingfromtheeye.Thepainwasacute.Hisforeman“examined”him,toldhim“itsnothing”gavehimTylenolandtoldhimtokeepworkingorhellbefiredLatinos in Columbus:Health gapsMarcoskepttakingTylenolandkeptworkingwitheyepainfor5days.TheforemanfinallytookhimtoanemergencyroomonSundayeveningHehadanemerg

17、encyoperationtoremoveametalpiecefromtheeye.Latinos in Columbus:Health gapsTheoperationcost$2000.Hegavethehospitalallhehad,$400.Theforemanrefusedtohelppay.Thehospitalrefusedtodofollowupcare.Heneedsanoperationtocorrecttheeyemuscles.Hecantbescheduledforlackofresourcesforpayment.Hehaslost95%visioninthat

18、eye.MistakenIdentities&FearFactorSomeLatinosareputtingoffgoingtoadoctorbecauseoffeartheywillbeaskedtoshow“papers.”Theymayormaynothavelegalpapers.Theymaybeusingsomeoneelsespaperswithadifferentnameandadifferentdateofbirth.BridgingtheGapsIn2000HHSpublishedguidelinesCulturalandLinguisticallyAppropriateS

19、ervices(CLAS)urgingprovidersto:Providequalifiedinterpreters.ProvidewrittenmaterialsinthepatientslanguageNearly45MillionUninsuredNearly45millionAmericans15.6%oftheU.S.populationdidnothavehealthinsuranceduringatypicalmonthin2003.Thisrepresentsanincreaseof5millionpeopleandmorethan1percentofthepopulatio

20、nsince1990Source:ProtectingtheProtectingtheUninsured”KennethE.Thorpe,Ph.D.NewEnglandJournalofMedicineOctober6,2004Volume351October7,2004Number15Health care-a human rightLackofaccesstocarefortheworkingpoorandthe45millionuninsuredintheUS-therichestnationonearth-isanethicalissuerequiringactionresponse.

21、Lackofaccesstohealthcareputspeopleatriskforsevereconditionsthatcouldhavebeeneffectivelymanagedwhendiagnosedandtreatedatanearlystage.HelpingLatinosinColumbusManynewHispanic/Latinoimmigrantshaveunmetprimaryhealthcareneeds.Mostareuninsured,havelittlefinancialresourcesandrelyonepisodicoremergencycare.Fr

22、om1999-2002,IledagroupofvolunteersasChairofLatinoHealthAllianceandFoundingDirectorofLaClinicaLatina.Thecliniccurrentlyoperatesforabout3hours2or3nightsamonth.ItisfundedbytheOSUMedicalCenter.Thestaffisallvolunteer.La Clinica LatinaMission of La Clinica LatinaTo educate Latinos in Columbus on health ca

23、re issues and provide free primary care in a bilingual and bicultural atmosphere.La Clinica Latina(cont.)TheclinicopenedonDecember19,2000.An8-montholdboypresentingalegburnwasthefirstpatient.Theburnwascausedbyachemicalgelleakingfromacheapdiaper.Hewastreatedandrecoveredquickly.Wefellinlovewithhim.Hisp

24、arentsweresoverygrateful.LaClinicaprovided727patientvisitsto320patientsin2001.Source:StateofLaClinicaLatina:AFirstYearReport”RaquelDiaz-Sprague,PharmDMSMLHR,January29,2002LaClinicaLatina:ReceptionArea(snapshot taken in 2002snapshot taken in 2002)Educating Health Providers:Medical Communication with

25、Latinos(AMP 641)AMP641evolvedfromaminimoduleintheMedicalHumanitiesProgramforMEDIandMEDII.CourseofferedSpringQuarteropentostudentsinanycollege.AMP641isincludedintheLatino/aStudiescurriculumoftheCollegeofHumanities,DivisionofComparativeEthnicStudies.MedicalCommunicationwithLatinos(AMP641)Thecourseprov

26、idesinstructiononmedicalterminology,culturaladaptationintranslation,medicallyrelevantaspectsofHispanic/Latinoculture,servicelearningPermissionofInstructorisrequired.Instructor:RaquelDiaz-Sprague,PharmDContactThoughtsandReflectionAlmostonein6peopleintheUSlackshealthinsurance.Thenumberofuninsuredisgro

27、wingascostsescalate.Thenationmustendthishealthinjustice.Creativesolutionstoprovideaccesstohealthcareforallareneeded.Itisanethicalimperative.ThoughtsandReflectionCharitable“freeclinics”whileprovidingawonderfulandnobleservicecandolittletoalleviatetheUShealthcareaccesscrisis.Expandinganetworkoffreeorlo

28、w-costclinics,isatbesta“bandage”overadeep,festeringwound.UniversalcoverageisneededFinalThoughtandReflectionTheinhumanityofslaveryintheUScouldnothavebeenendedbyexpanding emancipation,butbyabolishingtheinstitutionofslavery!Somustthisnationabolish,foralltimetocome,theinhumanityof“lack of health care co

29、verage”builtintheUShealthcaresystem.Willwejointhecivilizedworld?Source:“Intercultural Understanding and Communication Can Help Bridge Health Gaps for Latinos”PresentationbyRaquelDiaz-Sprague,AmericanAssociationforPracticalandProfessionalEthics,13thAnnualMeeting.,February27,20040C4F7JaMdPhSkVnZq$u*x-

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