Cultural Paper
Yeshua E. Villalobos Garcia
Ivy Tech Community College
April 29, 2018
As our community grows, we all should stay competent on how to better serve our community whether that be in our practices as well as how to communicate with our new neighbors. Among one of the fast growing population here in the Fort Wayne area are the people from Burma who are migrating from Myanmar. Myanmar is a country that is experiencing turmoil in its government and military. Many of the people relocating are refugees fleeing from their violence stricken hometowns in hope of a better life. Myanmar is located in between China, India and Thailand by the Bay of Bengal.
Some of the major infectious diseases that stricken people in Burma that are in refugee camps are Bacterial and protozoal diarrhea, Hepatitis A and typhoid fever. They are also affected by dengue fever, polio, scabies and tuberculosis. Due to some lack of running water a major infectious disease is leptospirosis which can affect kidney function, meningitis and can cause liver failure and even death (CIA, 2016). Burma or Myanmar has the highest human immunodeficiency virus, or more commonly known as HIV, and malaria rates in Southeast Asia. Malaria screens and treatment is not available for most people because the country lack resources and most people have poor living conditions (Refugees from Burma)
Health Beliefs
Due to the the living conditions in Burma or Myanmar their health beliefs depend on their ethnicity and where they lived whether that would be in rural or more urban areas. Some beliefs are religiously linked like meditation and yoga. Also because of the lack of resources they also turn to herbal medicines and traditional healers. Even when some illnesses are not explained they still turn to healers because that is something they know and feel comfortable with.
Spiritual religious beliefs and practices The majority of people from Burma are Buddhist followed by Christians and Muslims. There are some Animists who believe in spirits in nature like trees, rivers, mountains and rocks. Buddhists believe faithfully in "karma" which is the idea that ones actions can persuade ones fate and future events. Some may believe that some illnesses are caused because of prior actions that were distasteful and we have to be considerate of those beliefs.
Time orientation
According to an article from the Business Insider in America our concept of time is seen as money since we live in a for profit society time is seen as precious and a commodity. The Anglo-Saxon world has a what is called a "linear vision" of time and action. Linear activities are referred to as "those who plan, schedule, organize, pursue action chains, do one thing at a time" (Business Insider 2014). Time orientation for Asian cultures are of those of cyclic time where Asians "do not see time as racing away in a linear future, but coming around again in a circle, where the same opportunities, risks and dangers will re- present themselves when people are much wiser" (Business Insider 2014)
Interpersonal relationships
In healthcare we see some health disparities due to language barriers. It is best to have an interpreter if one does not speak the language fluently in order to better communicate with our patients to eliminate any potential errors or mistakes one may make as a health professional. Burmese are less direct when communicating and not as expressive beside the language barrier this may impede from communicating thoroughly with health providers making there be miscommunication. Some things that should be noted is some taboos in their customs. While in American culture we may see it harmless and even warm and caring, in Burmese culture some may not be okay with touching or close contact of the opposite sex, pointing at others with fingers, hands or feet (CDC, 2016).
Family is the core of Myanmar's social structure. They sometimes consider their extended family immediate family and could state that they have 40 or more people in their family. The strongest bonds are considered mother and daughter at which remain close throughout life (Families in Myanmar 2013). Families share responsibilities and are expected to pitch in. Some elders may take care multiple children, some even not their own, without any compensation expected however it is expected that the family take care of elders when they get older. Children and young adults rarely have freedom of expression and should obey older siblings and parents at all times. There really is not a division of labor between genders. Both put their part in cooking and taking care of children. Women are allowed to work to supplement any income that may be needed in the household. However, women are expected to help with the chores around the house and take care of aging grandparents more than the men (Families in Myanmar 2013).
Communication, Actual/potential health care problems (cultural, physical psychological, social, financial, developmental)
We have to be ready and able to treat these new neighbors of ours with respect and dignity. According to research made by the Great Brook Valley Health Center in Worcester Massachusetts in their presentation Refugees from Burma (Myanmar) we must acknowledge what those refugees and new immigrants have gone through to better understand some of their illnesses. Some of the refugees need to be educated in knowing where they can go if they are sick and they also need to be educated about the concept of a primary care physician. One as a health provider must also assess their emotional health as it is not rare that they may have experienced hardships like experience traumatic experiences, loss of loved ones, torture, forced labor and rape. They could be undiagnosed with post traumatic stress disorder which could be causing more problems in the health of their family . They may also be suffering from malnourishment due to the lack of resources in refugee camps and the basic food rations that they were given with no running water.
Even though we may think that we are doing a good when we ask for a Burmese translator, we don't always take the time to assure that the translator speaks the same dialect as our patients. There have been numerous times where our patients are left in the position where there are language barriers even when translators are called. We also need to considerate during assessments. In their culture it is seen as "polite" to be asked or begged in our culture and for them to refuse several times before them actually accepting the proposal or answering a question. They may see it as very polite and modest so we have to acknowledge that we have to take our time during assessments to be able to make accurate decisions regarding their complaints or diagnoses. Another big education point is dental hygiene. Many people from Burma chew on betel nut which turn may stain the teeth and turn them a reddish and even black color. Betel nut chewing has been linked to having a higher risk of mouth, stomach, liver, lung, prostate and cervix cancers. It not only can stain the teeth but the lips and excrement. It is said that it can be addictive and can even cause intoxication if used in large quantities. It has a similar effect as chewing tobacco as some do add tobacco to the chewing paste. We may even need to consider that because Burma is currently the world's leading supplier of opiates and poppies, some drug addictions and dependencies on some narcotics.
There are financial challenges that they may encounter once placed in their new home. Although they may be eager to start working and to start their new lives they may not fully understand the application and interview processes that are common here in the U.S. They may also not fully understand laws in their new country. They may not fully understand some laws that we abide by like smoking, domestic violence, drinking while driving and even underage drinking. They may not understand the public space laws that are instituted here and are not used to. Some may even be scared of law enforcement because of past trauma that they went through in their native land (Refugees from Burma).
People of Burma may have also have some educational or developmental problems. The schools systems are relatively different from what they are used to in Myanmar. It is said in Refugees from Burma that there is a difference in teacher's roles "in respect to discipline". This may cause a clash between what is expected to be able to successful in the classroom. They may also have the need for ESL or English as a Second Language classes to be able to learn read, write and speak the new language that is spoken in their new home.
While giving treatment one must remember their diet. Their dishes regularly contain rice. They also typically to eat very spicy foods and curry. They may also include green tea after meals. As a healthcare provider we should be considerate of any type of food that may interfere with any treatment. We should be careful and patient when asking history or what their usual diet is to be able to prevent any issues or educated when necessary.
Customs and potential therapeutic interventions
Potential therapeutic interventions for the client and promotion of wellness which demonstrate respect for the client’s culture, rights, beliefs, values and life experiences: Some cultural practice that we have to keep in mind are how to address them in a respectful manner as we should any other patient, there for we must take into considerations some things that is not so common in our American culture. For example they see it as disrespectful if we step over someone or if we pass anything above someones head. We should not refer to them as "Burmese" but instead as "people from Burma" or by their ethnicity. Although here in the U.S. one may think that by having ones arms crossed is a sign of being closed off or a sign of being angry, it is quite the opposite for people of Burma. To them having ones arms crossed while talking is a sign of respect. One should never sit higher than an elder and one should never point your feet at them because it is seen as very disrespectful. Eye contact may also be considered extremely rude and is avoided when speaking to one another with respect. Other practices we will have to take into consideration are their garments and things they may wear. Usually in the U.S. it is not accustomed to see men wearing "skirts" but both men and women wear what is called a longyis (pronounced lon-jee) which are ankle length skirts that are tied at the waist. Some may wear Thanakha, which is made from ground up tree bark and wear it on their face as makeup or as a type of sunscreen.
Community resources available
There are several resources that I was able to get from Parkview's shared employee page. I had found a list of some of Fort Wayne's programs who serve refugee which included links to ESL classess, Medical resource directory of low cost services, and services to immigrants and refugee families that experienced violence, crime, mental health, abuse or neglect. The list includes:
List of Fort Wayne Programs who serve Refugees
The Reclamation Project
ESL/ENL classes and teacher training
Circle of Friends – pairing refugees with Americans for support and friendship * www.thereclamationproject.org
St. Joseph Community Health Foundation
Grantmaking for health related activities that serve low income and vulnerable populations
Project Connect – medical interpretation & health navigation for Burmese
Medical Resource Directory of quality low cost services – sign up for email alerts on health events and submit your events to share
www.sjchf.org
Crime Victim Care
Services to immigrants and refugee families who experience brokenness due to violence, crime, mental health, addictions, abuse and neglect
www.cvcin.org
Neighborhood Christian Legal Clinic
Offering pro bono legal representation and preventive law education to low income families, including immigrant families
www.nclegalclinic.org/ftwayne
Catherine Kasper Place
Provides programs, services and opportunities that advance the integration of immigrants, refugees and political asylees into the community of northeast Indiana
www.catherinekasperplace.org
Park Center Multi Cultural Health Initiative
Working collaboratively with community agencies to provide quality neighborhood-based mental health services to the minority and immigrant/refugee members of the Fort Wayne community
www.parkcenter.org/multicultural.htm
American Red Cross MIX Program
Provide free translation, interpretation, referral and tracing services to non-native English speakers in the community and cultural competency workshops to help local organizations effectively communicate with different cultural groups
www.redcrossofnei.org/transservices.html
International House
Several programs that serve Internationals and refugees
www.ihouse.cc
Burmese Advocacy Center
Serve to coordinate local efforts for improving the accessibility of services and to provide the education necessary for the successful acclimation of the Burmese community
www.bacindiana.org
Catholic Charities Resettlement Program & Refugee Services
Services include pre-arrival processing, arrival services, assistance with housing, referrals for medical care, acculturation, referrals for ESL (English-as-a-second-language) classes, school enrollment for the children, and other educational services as needed
www.ccfwsb.org/our-services/refugee-resettlement/