Refelction on The Immortal Life of Henrietta Lacks

In a perfect world, race, ethnicity and culture would have no negative effect on the medical care we receive. The effect is due to historical heritage more than skin color.

This statement is saying that so many more things that result in poor access to healthcare, not just skin color.  In the book "The Immortal Life of Henrietta Lacks", skin color played a big part in Henrietta's availability of healthcare, but there were a lot of other things that I think played an even bigger role.  
Henrietta and her family did experience health disparities.  During the lifetime of Henrietta colored people may have still been looked down on and had limited treatment, having to travel all the way to Hopkin. Henrietta may have had to travel further to seek treatment, but she had no lack of people willing to take her there for appointments.  However, her lack of any type of medical knowledge hindered her greatly.  Health literacy itself was not a priority for a majority of people. That lack wasn't completely because she was colored.  There was a lack because she was female, a lack because she was poor, a lack because she was from the south, a lack because she didn't finish school, etc.  So many things lead to her not understanding what was going on. 

 In that time, no matter what your skin color was, doctors knew best and you didn't question them. There were no Informed Consent laws like there are now, so even though Henrietta consented to treatment, she had know idea what the outcome would be.

Ethically, there were no laws or about taking cells and using them, or even using biomedical waste how you wanted as a doctor and researcher.  Because of that many felt there was no need to inform patients of what was going on, or what they were doing.   

Going through the book here are just a few of the times there were health literacy issues, consent issues, etc:

Page 47- "Toward the end of her treatments, Henrietta asked her doctor when she'd be better so she could have another child.  Until that moment, Henrietta didn't know that the treatments had left her infertile."

Page 184- "When Henrietta died, Day had agreed to let her doctors do an autopsy because they'd told him it might help his children someday.  They must have been telling the truth, Day thought."

Page 29- "Like many doctors of his era, TeLinde often used patients from the public wards for research, usually without their knowledge."

Page 167- "In 1969, a Hopkins researcher used blood samples from more than 7,000 neighborhood children-most of them from poor black families-to look for a genetic predisposition to criminal behavior.  The researcher didn't get consent."

Page 192- "It was so clear they hadn't been treated well, Rogers told me.  They truly had no idea what was going on, and they really wanted to understand.  But doctors just took blood samples without explaining anything and left the family worrying."

Page 16- "It was no surprise that she hadn't come back all those times for follow-up.  For Henrietta, walking into Hopkins was like entering a foreign country where she didn't speak the language."

Page 128- "He told them he was testing their immune systems; he said nothing about injecting them with someone else's malignant cells."

Page 130- "Southam wrote, he didn't tell patients they cells were cancerous because he didn't want to cause any unnecessary fear."

The we get to all the pages where Deborah read things about her mother. "Scientists do all kinds of experiments and you never know what they doin. I still wonder how many people they got in London walkin around look just like my mother."   Her lack of health literacy, leads her to believe that actually cloned her mother, not just her cells.  Deborah grew up in a time where colored people could go to school, could attend college, etc.  The family's lack of money and education is what lead to her and her family's lack of health literacy, not their skin color.

A study done by Dubay and Lebrun has come to this exact conclusion.  Regardless of race, the low income of the Lacks family had a bigger effect on their healthcare and that problem still exists today.

"While important, the race/ethnicity disparities among adults of similar incomes identified in this article were dwarfed by the magnitude of the disparities identified between high- and low-income groups for those of the same race. For each outcome examined, except overweight and obesity, high-income adults were found to be in better health, to engage in healthier behaviors, to have greater use of general health and dental services, and to receive more timely screening for cancer and other health conditions, compared to low-income adults of the same race/ethnicity."2

 "As long as societal factors result in minorities disproportionately having low incomes, an exclusive focus on reducing race disparities will be ineffective. The economic, environmental, and social factors that put low-income populations at much greater risk for poor health outcomes than their higher-income counterparts, regardless of race, must be addressed to eliminate both race-based and income-based disparities in population health."2


References
1. Skloot R. The immortal life of Henrietta lacks. New York: Crown Publishing Group (NY); February 2, 2010.

2. Dubay LC, Lebrun LA. Heath, Behavior, and Health Care Disparities: Disentangling the Effects of Income and Race in the United States. International Journal of Health Services. 42(4):607-25.  October 2012.  http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.817.5720&rep=rep1&type=pdf. Accessed Nov 5, 2017.

Interdisciplinary Cultural Competence

1. What changes in attitudes, knowledge, and skills does diversity/cross-cultural training bring about? 

There are many changes that are brought about from cross-cultural training.  People that go through diversity training learn to turn their negative images of a culture into positive ones.  Before going through this type of training many people have single stories attached to a culture or race. They have a difficult time relating to or understanding what a different does and why.  Through diversity training people can learn to be open and accepting of others in situations they normally wouldn't have been.  Healthcare providers will be better skilled to attend to all their patients needs. It is important to note that cross-cultural training isn't done when you complete a course.  It should continue on your whole life because there is always something new to learn or understand.

2. Is there a common definition of cultural competence that is useful in broad range of fields? 

Cultural Competence- "the ability to understand, appreciate and interact with people from cultures or belief systems different from one's own"1

I found this definition one that could be very useful in a broad range of fields.  But when considering the health field I like this definition much better:

 "Cultural competence is more than just being aware of differences; it refers to demonstrating attitudes and an approach that allows you to work effectively cross-culturally. It implies valuing and adapting to diversity; being aware of your own identity and cultural biases; and being able to manage the dynamics of treating people who are different."2

Reflect on progress toward your learning outcomes identified in post #3.

Looking back at my three original learning goals, I feel like I have made some changes.

Goal 1:I want to look for ways to improve on how I perceive patients. I thought if I was conscientious about it, I could avoid or get rid of my negative thoughts or assumptions about people. After taking this quiz I found that you actually can't just get rid of those feelings by thinking about it or being "conscientious" about it. Everyone has some form of prejudices about different people and they are a part of life. There are ways to work around those prejudices and remove them by learning, but you can't just think them away.

I have since taken this class, learned about diversity in non-verbal communication with the presentation I had to create and also gone though some diversity training at work.  All of these are helping me learn to break away from my prejudices I had.

Goal 2: When working with someone that has different cultural beliefs on medicine explaining why they are wrong is not the way to go. Even if you do it gently. I would like to work on some tactics that will help me work WITH a patient that has different beliefs, so they still get the treatment they need to get healthy.

Goal 3: I learned that even though someone has a belief in traditional medicine and treatment, that doesn't mean they aren't willing to try "Western" medicine. I would like to learn ways to interact with someone that normally uses traditional medicine, but could benefit from "Western" or "Conventional" treatments.

Goal 2 and 3 I wanted to tackle together since they are similar. Besides the basics that I have learned though this class I haven't had much of a chance to tackle these goals.  I did however learn through this class how important it is to work WITH the patients beliefs, instead of against them.  When working against them neither you nor the patient will get the best results.  When you take the time to learn and work together it will result in a better outcome.  I am attending an event on diversity in 2 days with a Native American keynote speaker, so I look forward to learning even more there.

References:

1. DeAngelis T. In search of cultural competence. American Psychological Association. 2015; 46(3):64. http://www.apa.org/monitor/2015/03/cultural-competence.aspx. Accessed Nov 5, 2017.

2. UOttowa. From Cultural Awareness to Cultural Competency. https://www.med.uottawa.ca/sim/data/Serv_Culture_e.htm#definitions. Updated Aug 1, 2017. Accessed Nov 5, 2017.

Refelctions on Cultural Training Programs

I was asked what my thoughts were on the following statement. "Many “culture-specific” training programs use an inventory of cultural characteristics of minority groups to help trainees understand and interact appropriately. Does this technique run the risk of perpetuating stereotypes and offending ethnic groups?"

While I think that culture-specific training programs are very helpful, especially when someone knows absolutely nothing about a cultural group, there is a danger in it also.  It goes back to the single story video we watched.  In order to help trainees understand and interact appropriate you need to give them something like a set of rules so they know when to act which way.  If you come in and teach them that Japanese people don't like handshakes and only bow, that may be true (or not) for a majority of people raised in Japan. However,  if their patient was born in america, ethnically Japanese, yet didn't grow up that way, and they come in and bow to them, the patient may find it strange or even take it as you are stereotyping them and get angry.  

If your patient is Greek ethnically, yet was born or raised in America, then using techniques you may have been taught in a Greece Cultural training like nodding your head for no and shaking it for yes would be even more confusing than it already is.  They would most likely assume you have no idea what you are talking about.  

"Becoming aware of another culture’s beliefs and practices is essential for fostering strong, open communication with people from that culture. Many cultural awareness programs, however, present cultural differences in terms of “we act like this, and they act like that.”"1

"Cultural awareness training has been criticized for increasing stereotyping and reinforcing essentialist racial identities"2

We need to treat everyone like an individual.  Yes, having a basic idea of cultural characteristics may be helpful, but the world is a melting pot now.  So many people now days come from multiple cultures or multiple races, so to generalize them into something you learned in a cultural training class is doing them and yourself a disservice.



1. Bromberg and Associates.Cultural Awareness Training: Dodging the Stereotype Trap. http://brombergtranslations.com/2017/06/01/cultural-awareness-stereotype-trap/. Accessed Nov 5, 2017.

2. Truong M, Paradies Y, Priest N. Interventions to improve cultural competency in healthcare: a systematic review of reviews. BMC Health Services Research. 2014;14:99. doi:10.1186/1472-6963-14-99.

CLAS Standards vs ASRT Standards in Radiology

I have found some things that are similar and some that are different between the ASRT Radiology standards and the CLAS standards. I found the CLAS standards listed in the currated content and I found the Radiology standards on ASRT's website in PDF form.  ASRT is the American Society of Radiology Technologists.

A few standards for Radiology Technologist are:

1. Delivers patient care and service free from bias or discrimination.

2. Know personal and professional strengths. 

3. Act as a patient advocate.

4. Respect the patient's right to privacy and confidentiality.

5. Accept accountability for decisions made and actions taken.

6. Provide health care services with consideration for a diverse patient.

A few standards from the CLAS are:

1. Provide effective, equitable, understandable and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy and other communication needs.

2. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.

3. Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them

4. Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing.

5. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided.

The ASRT and CLAS standards  are similar when it comes to dealing with diverse patients. The ASRT standards mention that services should be provided with consideration for diverse patients.  This means that different patients need different things and we, as radiology technologist, have a duty to provide that for them. The CLAS also stated that health care professional should provide effective, equitable, understandable and respecting care to all people, with consideration of their health beliefs and practices, preferred languages, and any other needs.  

Both standards also believe that the care provider has a duty to continue educating themselves further in the ways of cultural awareness.  

 CLAS and ASRT standards do have one difference though.  CLAS talks more about what the hospital should provide to/for the diverse patients, while ASRT refers more towards how the Radiology Technologist should act and behave while working with diverse patients. 

 CLAS STANDARDS

 ASRT STANDARDS

How do my beliefs affect my work?

I was posed this question during my class. "To what extent do my beliefs, prejudices or biases influence my thinking in terms of providing service in my profession?"   This is a hard question to answer, because no one wants to believe they have prejudices or biases.   

I'm really trying to come up with something, and am forced to think if I treat any of my patients differently....

We treat all sorts of patients where I work.  All different ages groups, poverty levels, body types, etc, but for the most part they are white (not because we don't accept others here, we will treat anyone that comes in happily!).  I work in a small town of just over 5,000 people with other hospitals less than 30 mintues away, so many people don't even stop in to see us.  

I've found myself being leery when i see a  patient sitting in the room talking to a police officer, but I shouldn't be because the officers come in for so many different reasons.  They sit and talk to Domestic Abusers, traffic law breakers, victims of accidents, the abused etc.  My personal experience with an ex may be what makes me leery towards those with the officers. He was one of the abusers and though i got out, it wasn't unscathed.  Seeing the police, my brain sometimes jumps to "be careful" or "watch out" especially when the patient is a male sitting talking to that officer.  That is something I am personally working on to fix.

Now according to the population statistics I've looked up for another class, only about 1-2% of our towns population is not white. That limits my experience medically with anyone else ethnically, so I can't speak to that, but I do have experience with drug seekers.

I believe I have (and many of the doctors and nurses all around the world) made assumptions about certain people that come in only looking for pain medicine.  I get many of them that come to my department for xrays on areas that hurt (yet when someone isn't looking they are magically able to use that part with no pain).  I do find myself having less patience with those patients.  I sometimes take a look at someone that makes a lot of visits,is disheveled looking, moaning in pain, etc and roll my eyes before taking them over to the department.  

   I should watch that because some day a "regular" may come in with an actual injury.  Everyone deserves to be treated well, because you never know if they are really in pain, or injured.  I will work harder not to become impatient with patients.

Danger of a Single Story

I just watched a video called The Danger of a Single Story. I think everyone experiences this even when they try not to.  It is very hard for anyone to avoid, unless you actively think about it.  It so much easier to just take the single story and role with it.  To attempt to counteract this type of thinking, one must try to learn all sides, whether listening to news, reading a book, or even talking to friends.  When you hear something about a race, religion, place, or situation, don't make the assumption that it is true, instead do your research.  Learn more about the situation from different sources.  Read books, talk to people, look up information.  These are all things you can do to avoid the single story situation.  Now that I know better, when someone tells me something, especially with current events, I do my research on it, before assuming it is the truth.  I try not to make assumptions about people or places either.

When thinking about Stereotypes and generalizations most of us are taught that stereotypes are harmful and generalizations are helpful, but in the case of the single story they both make assumptions about people or a situation.  While it may be true that stereotypes lock people into a catagory, and generalizations adjust as we learn more, they are both incomplete stories.   

I've had many experiences with the single story.  We see single stories on the news every day.  Politically each side is giving a single story, internationally countries give single stories everyday.  We hear things about countries all the time, but unless we have been there or know people from there or have done our research, then we are all guilty of making assumptions and stereotypes.  Growing up in the US, when you hear about Australia, you hear about surfing, shrimp on the barbie, and surfer dudes.   As I've gotten older, I've met and talked to many Australians.  Not a single ones surfs, or runs around shirtless in surfer shorts with long blonde hair.  The single story i heard thanks to television growing up, turned out to be completely untrue. 

Quality and Culture

Looking back at my results on the quiz for Quality and Culture I found I do have some areas I can improve on. So I've decided to set some goals for myself.


MY LEARNING OUTCOMES

 1. I want to look for ways to improve on how I perceive patients. I thought if I was conscientious about it, I could avoid or get rid of my negative thoughts or assumptions about people. After taking this quiz I found that you actually can't just get rid of those feelings by thinking about it or being "conscientious" about it. Everyone has some form of prejudices about different people and they are a part of life. There are ways to work around those prejudices and remove them by learning, but you can't just think them away.

 2. When working with someone that has different cultural beliefs on medicine explaining why they are wrong is not the way to go. Even if you do it gently. I would like to work on some tactics that will help me work WITH a patient that has different beliefs, so they still get the treatment they need to get healthy.

 3. I learned that even though someone has a belief in traditional medicine and treatment, that doesn't mean they aren't willing to try "Western" medicine. I would like to learn ways to interact with someone that normally uses traditional medicine, but could benefit from "Western" or "Conventional" treatments.

These are 3 learning goals I will be working on during the span of this class and even after.