According to Health Resources Services Administration, sixty-five to seventy-five percent of all patients seen in a non-profit healthcare clinic live below the poverty level. Providing effective health care to low income families requires an understanding of the potential cultural barriers, which may be faced. These barriers include social, language, religion, and technological issues. The majority of our patients from foreign cultures are Hispanic or Asian. Due to this fact, we will discuss the barriers of dealing with those from Hispanic and Asian Cultures, and offer possible solutions to overcome these obstacles effectively.
The number of immigrants entering the United States has been rapidly increasing over the last few years. For instance, the number of Asians in the United States has grown to more than 9 million in 1996. In 1996, there were over 28 million Hispanics in the United States, and the numbers are only increasing. The rapid growth of these two cultures in United States has made overcoming cultural barriers crucial in managing a non-profit healthcare clinic. A predominate social barrier in dealing with those from the Asian culture is their reluctance to disclose personal information to anyone outside of their family.
Due to this, they may not be honest and forth coming in giving physicians or other medical staff personal or critical information needed for their treatment. When it comes to healthcare for Asian women, they do not seek out medical care for Gynecological exams because they feel it is an invasion of their body and considered improper and very humiliating for the women. Differences between Asian culture and the American culture are the majority of health issues of Asians are not often addressed in the American health care system. However, the Asian culture is not the only culture that is facing social and economic barriers to healthcare.
With the numbers of immigrants increasing, what can we do to ensure that our clinic will be able to address the social and economic issues of all patients? First, we will need to hire someone to act as a cultural liaison, who not only has knowledge about the differing cultures, but can also speak the language. Second, we will need to address these issues and barriers with our clients to successfully seek out ways to eliminate any future barriers we may face. Our educational programs will address issues that range from preventing sexual diseases, use of birth control, and understanding your body all the way to addressing the needs of children.
We plan to make our clinic accessible to all low-income families by assuring our potential clients that we are not interested in their legal status, but in the health of their families. We believe by making the clinic’s fees based on a schedule of one’s income, that we are making healthcare affordable for everyone. The 1996 Personal Responsibility and Work Opportunity Reconciliation Act ("1996 Welfare Act”) was the major overhaul of the welfare system that many Americans were looking for to decrease the many who are taking advantage of their hard earned money.
One of the main points in the welfare reform legislation deters non- citizens from applying for public assistance. Even if they are eligible, they may fear that receiving public benefits will make them inadmissible or deportable. The many health problems that are prevalent in the Hispanic population are due to lack of adequate health care programs available to non-citizens. Due to that lack of citizenship, they are ineligible for federal health assistance programs such as Medicaid, even if their incomes are low enough to qualify.
The lack of availability of health care in the Hispanic population is mainly due to their citizenship status; even with low incomes, Hispanics are ineligible for health care programs such as Medicaid. Non-profit health care clinics do not fall under the Public Charge Law, they are exempt from having to verify immigration status, even if they provide a federal, state, or local public service, and they may not be penalized for not verifying immigration status. State and local governments may not impose verification requirements on such organizations.
To be exempt, an organization must be both nonprofit and charitable. With over 600 community and non-profit health centers around the United States, the undocumented populations are assured good quality care without having to worry about being turned into the INS. One of the first types of health center being excluded from the Public Charge Law were Federally Qualified Health Centers (FQHC) with the average number of undocumented aliens served a month being 4,316, at the cost of only $3,258 for all (Bureau of Primary Health Care). Another common barrier between cultures is the difference in language.
According to the 1990 United States Census Bureau, almost 2,300 people in Oklahoma over the age of 18 do not speak any English. Over 48,000 of Oklahomans are Spanish speaking. One problem language barriers create is the inability of the patients to communicate with the physician. Often, the physician is unable to clearly understand the symptoms the patient is describing. According to Charles Warren, an anesthesia technician at Mercy Health Center, only 8% of the doctors in the hospitals are multilingual. The breakdown in communication between the doctor and patient can multiply the possibilities of a misdiagnosis.
This can cause harm to the patient and make doctors vulnerable to malpractice lawsuits. Another danger, associated with a language barrier, is the possibility of the patients misunderstanding the doctor’s instructions for the medication. A solution for this would be to provide an interpreter to assist the doctor while treating this patient. Many healthcare facilities, such has Mercy Hospital, have a variety of employees who are multilingual, so they may be called upon to provide translation between and doctor and a patient. The hospital’s MIS (Medical Information System) tracks these employees.
One option currently available is known as a translator box. It is a service available where the attending physician calls an 800 number and is connected with the interpreter company, the physician informs the company what language he/she needs, and within minutes an interpreter for that particular language is online and ready to assist the physician as needed. Another problem is if the patient cannot read or speak English, they cannot understand the forms they must fill out in order to receive financial assistance for healthcare.
The government or insurance agencies that require these forms should distribute these forms in needed languages to all health care facilities, or make them available on a website where the language needed can be chosen and then the forms can be printed. A non-profit health center must have a strategy for dealing with religious barriers. For instance, the Mexican cultural mainly practices Catholicism and attends mass regularly. Catholic doctrine states, “Direct action to prevent the possibility of human life is impermissible in all circumstances, both when a person is living, dying, or yet to be conceived.
Thus contraception may not be used because it is direct action against the possibility of life”. Catholicism even goes so far as to publish an online directory called “Ethics and Meds”. In “Ethics and Meds”, they offer books that can be purchased like “Ethical Principle In Catholic Health Care” which adds the point that the Catholic Church wants its congregation to follow guidelines set by the Church. The physician who is legally and morally bound to follow a set standard in providing health care will provide the patient with the needed information regarding birth control.
The responsibility should rest, however, on the patient to inform the physician about their religious beliefs regarding birth control Society usually looks towards a licensed doctor to get advice and heal us. When dealing with the Asian person who practices Buddhism, they must take into account that some strands of this religion have a potential for incorporating religion into their beliefs of healing and restoration of health, for example; healing of the soul, and Acupuncture and Bowen Therapy may be two of those ways to heal the soul.
Using acupuncture releases the energy channels by putting pressure on a diseased area. Doctors or a therapist uses a needle to prick the skin regulate and correct the flow of energy in the body. The second one is Bowen Therapy, a subtle muscle/nerve/ connective tissue technique. Unlike massage and other manipulations that try to force a change, Bowen simply resets the body to heal itself. The results are profound and lasting, and usually apparent within two or three sessions. A clinic may want to incorporate these different services for its Buddhist patients.
When dealing with these two different religions a non-profit health care clinic must find different ways of helping the patient. The patient needs to be forthright in mentioning how they need to be treated. For instance, a practicing Catholic needs to mention to the doctor that they will not need any information on birth control or family planning. A practicing Buddhist should mention they use holistic medicine. The doctor needs to take the initiative to learn about the religious issues so that he/she can practice, or employ a licensed alternative practitioner to provide these services.
Today’s medical technology, if available and used properly, can be a huge benefit in operating and managing a low-income healthcare center. Doctor’s skills, along with the latest medical technology have accounted for saving many lives. Many of the Latino counties are considered third world countries and the people there often do not have access to the latest advances in medical technology. Most are not aware they exist. Many times a person of the Latino culture will not seek medical assistance due to the fact they believe there is nothing the doctors can do for them.
Many low-income Latinos suffer for a long time with ailments that can result in permanent effects and even death. Not being aware of the latest advances in medical technology, many feel they are better off attempting to treat themselves with a homemade remedy. These remedies are often ineffective and can even make matters worse. Medical education programs that inform people of advances in medical technology need to be more readily available for patients. These programs inform the patients of the benefits of today’s medical technology, and educate them on the numerous ways the doctors can treat the patients effectively.
In doing this, patients from less advanced cultures are often willing to seek medical attention promptly. Often a doctor who went to medical school in a third world country is not instructed in the latest in medical technology. In extenuating circumstances, these doctors are allowed visas to the United States as long as the doctor works in an area, which is designated as a HPSA (health physician shortage area). These doctors, not being aware of the technology available to them in the United States, often rely on older and less effective methods of treating patients.
In conclusion, we have addressed the social, language, religion, and technological barriers facing a non-profit health care center that affect the Hispanic and Asian cultures. We have also provided solutions to overcome those barriers in providing health care. If non-profit health care centers will incorporate the resolutions, they would be able to effectively provide quality health care to the Asian and Hispanic population.
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