From Rural Zimbabwe to Native Reservations: Similarities in Attitudes and Cultural Practices’ Influence on Health by Justice Mbizo, Dr. PH, Assistant Professor, University of West Florida Co-Presenters: Ann Bullock, MD and Terry Friend, CNM, MSN, AAHIVS IHS Clinical Rounds October 10 th , 2012 hosted by Susan Karol, MD IHS Chief Medical Officer
Objectives: 1. Describe similarities in international social conditions that give rise to disease and premature mortality. 2. Describe the role of cultural competency in improving health interventions, and overall health outcomes in general. 3. Identify gaps in cultural training needs in their work-teams and work to develop a strategy to improve to better serve the AI/AN population. 4. Apply cultural competency skills in addressing issues related to HIV and diabetes in AI/AN communities.
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Upcoming Clinical Rounds IHS TBHCE Training Calendar • November 8 th – PHN Presentation • December 13 th – ABC’s of Diabetic Foot & Wound Care, Shoe Program & Vascular Interventions
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Meet the Presenter: Justice Mbizo, Dr. PH Dr. Justice Mbizo, Dr. PH is Assistant Professor of Epidemiology and Public Health in the Master of Public Health Program at the University of West Florida. He also serves as the Program Coordinator and Academic Advisor for the MPH Program. Dr. Mbizo was born in Zimbabwe and grew up in the villages of rural Matabeleland, bordering Botswana. Completing his BA and MS with distinction in the U.S., he went on to earn his Doctor of Public Health (Dr.PH) degree from Morgan State University. Research interests include social determinants of health, including the role of culture concerning chronic and infectious diseases in vulnerable and/or underserved populations. Co-presenters: • Anne K. Bullock, MD (IHS) • Terry Friend, CNM, MSN, AAHIVS (IHS)
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Role of Culture in Health Cultur e and language may influe nc e he a lth, he a ling , a nd we llne ss b e lie f syste ms; o ho w illne ss, dise a se , a nd the ir c a use s a re pe rc e ive d; b o th b y the o pa tie nt/ c o nsume r a nd the b e ha vio rs o f pa tie nts/ c o nsume rs who a re se e king he a lth c a re a nd the ir o a ttitude s to wa rd he a lth c a re pro vide rs; a s we ll a s the de live ry o f se rvic e s b y the pro vide r who lo o ks a t the wo rld o thro ug h his o r he r o wn limite d se t o f va lue s, whic h c a n c o mpro mise a c c e ss fo r pa tie nts fro m o the r c ulture s. (Offic e of Minority He a lth, DHHS)
Facts about Zimbabwe • 2012 E stima te d po pula tio n 12,619,600 • De a th ra te 12.38 de a ths/ 1,000 po pula tio n (July 2012 e st.)
Some Statistics about Zimbabwe • I nfa nt mo rta lity ra te to ta l: 28.23 de a ths/ 1,000 live b irths • AI DS a dult pre va le nc e ra te 14.3% (2009 e st.) At the he ig ht o f the e pide mic a s muc h a s 25% o o f the po pula tio n wa s Operation Murambatsvina • Physic ia n de nsity 0.16 “Drive out the Filth” physic ia ns/ 1,000 po pula tio n (2004)
Subcultures HIV/AIDS • T he c ustom of ‘kugar a naka ’ or ‘ kugar wa naka ’ also known as ‘ ukunge na ’ ‘ ukunge nwa ’* or * T he pra c tic e o f wife inhe rita nc e
Poverty • Aro und 564 fe de ra lly re c o g nize d, Ame ric a n I ndia n a nd Ala ska Na tive trib e s a nd a ho st o f sta te - re c o g nize d trib e s. • A g re a t ma ny o fte n ha ve lo w so c io e c o no mic sta tus. Picture by Aaron Huey, 2010. Pine Ridge Reservation, South Dakota
HIV/AIDS in Native Americans T he ra te (pe r 100,000 pe rso ns) o f o HI V/ AI DS dia g no sis fo r Ame ric a n I ndia ns a nd Ala ska Na tive s wa s 10.4, c o mpa re d with 71.3 fo r b la c ks, 27.8 fo r Hispa nic s, 8.8 fo r white s, a nd 7.4 fo r Asia ns a nd Pa c ific I sla nde rs, a s o f 2005
Subcultures within a Culture • Be mindful o f sub - c ulture s tha t ma y e xist Alc o ho l a nd drug use o MSM o
The Case of Diabetes • Nurses all over the world have an important role in fighting the diabetic pandemic by health promotion aimed to keep people healthy as long as possible (hjelm, mufunda, nambozi & kemp, 2003 ) • Diabetes affects American Indians/Alaska Natives (AI/ANs) disproportionately compared with other racial/ethnic populations (CDC, 2002; NHIS, 2010) • Risk factors o Dietary practices o Physical inactivity Picture by Aaron Huey, 2010. Pine Ridge o Obesity Reservation, South Dakota o Genetic predisposition
Diabetes in Zimbabwe • Body image, • Risk factors o Dietary practices Joyce Banda, o Physical inactivity President of Malawi o Obesity o Genetic predisposition Joyce, Vice President
Diabetes in Zimbabwe (continued) • Ma in unde rlying c a use s o f the dise a se a re g e ne tic a nd e nviro nme nta l fa c to rs, suc h a s ur banizatio n and ializatio n , a s we ll a s industr inc re a se d lo ng e vity a nd c ha ng e s in life style fro m a tra ditio na l he a lthy a nd a c tive life to a mo de rn, se de nta ry, stre ssful life a nd o ve r- c o nsumptio n o f e ne rg y-de nse fo o ds
Why Cultural Competence is Important • ma in ing re die nts in c lo sing the dispa ritie s g a p in he a lth c a re • I t’ s the wa y pa tie nts a nd do c to rs c a n c o me to g e the r a nd ta lk a b o ut he a lth c o nc e rns witho ut c ultura l diffe re nc e s hinde ring the c o nve rsa tio n, b ut e nha nc ing it • he a lth c a re se rvic e s tha t a re r e spe c tful o f and e spo nsive to the he a lth b e lie fs, pra c tic e s a nd r c ultura l a nd ling uistic ne e ds o f dive rse pa tie nts c a n he lp b ring a b o ut po sitive he a lth o utc o me s Offic e o f Mino rity He a lth, Co mmo nwe a lth F und
Designing Culturally Competent Public Health Interventions • Showing respect for the priority population • Identifying key leaders, both formal and informal to help you navigate the terrain • Involving the priority population in identifying the causes of the problem • Explain in way that shows respect for the culture and the values of the priority population • Involve the target population in developing the interventions let them tell you what they want to address and how to fit the problem o • Examine the composition of your professional team Include people who belong to the culture or subculture of the priority o population • Never assume anything about the culture, or population
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