Helter Culture
Mix and match, shock and awe, divide and conquer. Health care and the practice of clinical medicine in the U.S. today has become a hodge-podge and jigsaw puzzle of non sequiturs, influenced more and more by national origins and less by pathophysiologic principles. The tapestry and cultural framework of our nation has changed significantly, and with it, our view of pain, suffering, disease, medications, and the almighty caregiver in white. As illegal immigration continues to remain unchecked and uncontrolled, we must first come to the startling realization “they” are here to stay. Only then, can we turn our gaze to how U.S. medical interests are best served. The days of house calls and little black bags are gone. Norman Rockwell is turning in his grave. Yet all is not lost. We can still save a wheezing U.S. medical infrastructure, if we can just understand the needs of the cultural minorities it serves. It is that segment of the population that is uninsured for the most part. It is that segment of the population that congregates around the low end of the socioeconomic totem pole. Finally, it is that segment of the population that equates preventive medicine with Cadillac, Dom Pérignon, and excesses of luxury that only the white folks can afford.
Black, Hispanic, and Native Americans have lived in and on this land for hundreds of years. They are our neighbors, our friends, the men and women we date, and our colleagues at work. Yet they are as unprepared to take their place in the social and medical fabric of this nation as the hundreds of thousands, if not millions, of Africans, Arabs, Chinese, Columbians, Cubans, Dominicans, Eastern Europeans, Indians, Koreans, Mexicans, Pakistanis, Puerto Ricans, Russians, and Vietnamese, to name a few, that pour into this country each year. We must no longer tend only to the health care concerns of “our own,” but also to the legions of our future and potential citizens, whether they drive taxicabs or the lasers that repair our hearts. So, lets take a look at some cultural mores, in the hopes that they will help us understand whether health in the U.S. is chugging along nicely, or on a sidetrack to hell.
While asthma, coronary artery disease, diabetes mellitus, and hypertension take their collective financial toll on the nation’s coffers and our individual pocketbooks, imagine the devastation and havoc they wreak on the hearts, minds, and family resources of cultural minorities, older age groups, and homeless veterans now patrolling jungles of concrete and steel. Young, educationally deprived, pregnant, minority women, and their unborn fetuses, are also at risk, as prenatal care initiated in the first trimester requires education, information, money, transportation, and the ability to understand what they are up against. Even if these requirements could be satisfactorily met, there would still be significant problems, as young, pregnant, Hispanic women might forgo first-trimester prenatal care due embarrassment with the physical examination, lack of time spent in the physician-patient encounter, and long waiting times in the clinics. Pregnant Korean American women might complain of some of these very same issues. Culture is not important, you say!
Let’s take a look at cancer now. Depending on which side of the fence you’re on, it can have a very different affective meaning. African American women view breast cancer with fatalistic resignation. Hispanic women, on the other hand, are not only less likely to perceive themselves as targets of breast cancer, but when they are, indeed, stricken by the malady, perceive a smaller chance of cure.
And we are not immune to tribal superstition either. Native American women, for example, become reticent, when it comes to discussing cervical cancer. They do not like to discuss questions of health openly, nor do they trust their physicians or their recommendations. I guess you don’t have to be a Native American to be a Doubting Tom or Thelma, as I, too, often mistrust the advice of my own sawbones. So ingrained, however, is Native American mistrust of professional medical advice, that lay health educators, called project guides, are hired specifically to present screening education programs to local Native American women. Tell that to the Lone Ranger!
And if that were not enough, the changing American physician workforce, with most U.S. family physicians being foreign and only 31 percent actual Americans, makes for interesting conversation and cultural exchanges in the examining room, that is, after one has groomed those standing hairs on head.
Where do we go from here? We can continue to lament the downward spiral of U.S. health care, or we can “cowboy up” to conjure up a solution to our multifaceted, multicultural dilemma. Bankrupt and sick is no way to go through life, either for the once mightiest nation in the world, or for the millions of its culturally emarginated inhabitants without adequate health care.
© 2008, Albert M. Balesh, M.D. All rights reserved.
Black, Hispanic, and Native Americans have lived in and on this land for hundreds of years. They are our neighbors, our friends, the men and women we date, and our colleagues at work. Yet they are as unprepared to take their place in the social and medical fabric of this nation as the hundreds of thousands, if not millions, of Africans, Arabs, Chinese, Columbians, Cubans, Dominicans, Eastern Europeans, Indians, Koreans, Mexicans, Pakistanis, Puerto Ricans, Russians, and Vietnamese, to name a few, that pour into this country each year. We must no longer tend only to the health care concerns of “our own,” but also to the legions of our future and potential citizens, whether they drive taxicabs or the lasers that repair our hearts. So, lets take a look at some cultural mores, in the hopes that they will help us understand whether health in the U.S. is chugging along nicely, or on a sidetrack to hell.
While asthma, coronary artery disease, diabetes mellitus, and hypertension take their collective financial toll on the nation’s coffers and our individual pocketbooks, imagine the devastation and havoc they wreak on the hearts, minds, and family resources of cultural minorities, older age groups, and homeless veterans now patrolling jungles of concrete and steel. Young, educationally deprived, pregnant, minority women, and their unborn fetuses, are also at risk, as prenatal care initiated in the first trimester requires education, information, money, transportation, and the ability to understand what they are up against. Even if these requirements could be satisfactorily met, there would still be significant problems, as young, pregnant, Hispanic women might forgo first-trimester prenatal care due embarrassment with the physical examination, lack of time spent in the physician-patient encounter, and long waiting times in the clinics. Pregnant Korean American women might complain of some of these very same issues. Culture is not important, you say!
Let’s take a look at cancer now. Depending on which side of the fence you’re on, it can have a very different affective meaning. African American women view breast cancer with fatalistic resignation. Hispanic women, on the other hand, are not only less likely to perceive themselves as targets of breast cancer, but when they are, indeed, stricken by the malady, perceive a smaller chance of cure.
And we are not immune to tribal superstition either. Native American women, for example, become reticent, when it comes to discussing cervical cancer. They do not like to discuss questions of health openly, nor do they trust their physicians or their recommendations. I guess you don’t have to be a Native American to be a Doubting Tom or Thelma, as I, too, often mistrust the advice of my own sawbones. So ingrained, however, is Native American mistrust of professional medical advice, that lay health educators, called project guides, are hired specifically to present screening education programs to local Native American women. Tell that to the Lone Ranger!
And if that were not enough, the changing American physician workforce, with most U.S. family physicians being foreign and only 31 percent actual Americans, makes for interesting conversation and cultural exchanges in the examining room, that is, after one has groomed those standing hairs on head.
Where do we go from here? We can continue to lament the downward spiral of U.S. health care, or we can “cowboy up” to conjure up a solution to our multifaceted, multicultural dilemma. Bankrupt and sick is no way to go through life, either for the once mightiest nation in the world, or for the millions of its culturally emarginated inhabitants without adequate health care.
© 2008, Albert M. Balesh, M.D. All rights reserved.
posted by Dr. Al at
1/27/2008 06:55:00 PM
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