WEBVTT

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The issue of diversity

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is an amazingly complex and interesting
one. We live in an amazing time

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and what we see is that this
is a time characterized

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by incredible demographic change in U.S.

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You look and see at the beginning of the
20th century, minorities account for

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about 13% of the population. But
by the end of the 20th century,

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minorities account for about 25% of,
of the total population. And there is

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more change yet to come. The demographers
project that by the year 2010

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minorities will account for about one third of
the total population. That\'s an extraordinary

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demographic transformation
of a society and it

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poses uh… some important umm…
challenges and opportunities

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really for all of us, through
all the professions. Umm…

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and in medicine perhaps in particular.

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When they go to the provider,

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they go to a clinic or a hospital, they
know they don\'t speak the language.

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They already feel umm… insecure, they

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feel uh… they feel, they feel so bad already
because they can\'t communicate with people.

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Cancer for my community is death.

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(inaudible) also, they
will work with a lot of

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herbal medicine and for any sickness that we get,
the science that we have, the traditional medicine,

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we also put the herbal medicine into place.

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Patients have come into my
office with the fear of death

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because if you have a diagnosis of cancer,
obviously meant death where they came from before

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because it wasn\'t uh… a treatable disorder given
the limited healthcare resources in their country.

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Some people don\'t have,

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they don\'t know where their next meal is gonna come. So
if they don\'t know where the next meal is gonna come,

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they cannot get into a cab and
go to right to the hospital.

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We\'re talking about sexuality, we are talking
about incontinence. We\'re talking about…

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These are the issues that historically
are not gonna talk about.

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If you\'re talking about
breast exams for women

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umm… maybe middle, middle east women, if you\'re talking
about, it\'s not a very well known concept to them.

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I always say the most important challenge
is to make two worlds connect.

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There are, they have different beliefs, different
systems and sometimes when I\'m interpreting

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perfectly well, I\'m saying, everything
is being said. They don\'t connect.

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There is something that\'s missing
and which is the cultural part.

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[sil.]

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Cancer, the word provokes all
kinds of feelings and ideas

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umm… thoughts about uh… why me?
How did it start?

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What\'s the cause of it? What should I do about
it? This is also a really important area

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because there are incredible
differences in risk

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and outcomes for all kinds of cancers.

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There are important disparities in the
incidence, in the outcomes umm… that

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uh… break a lot of racial and ethnic lines.

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It\'s also important because
many of these illnesses

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that we call cancer are preventable
that a person\'s risk is shaped

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in so many ways by a person\'s social position,
the person\'s exposure, environments

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and these are shaped by, by
cultures and by social forces.

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In working with my very culturally
diverse group of patients,

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I\'ve had an opportunity to really

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appreciate for example how
cancer is perceived by them

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in terms of their own culture uh… whether or not it
is viewed as treatable whether or not it\'s viewed

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fatalistically or whether or
not it is viewed as something

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that simply is integrated into their life.
So I really do believe that

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come into understand the meanings attributed
to one disease such as cancer and lessons,

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we can learn about how to better
help patients understand prevention,

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screening, treatment, transfer,
transfer quite readily to

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every situation we face in healthcare.
How we\'re gonna understand

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what it is we need to understand in order to
do at work to drive better health outcomes

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among the people we serve? Well, we have to pay
attention to all of the voices that matter.

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We have to hear all of the players to
connect with community health workers.

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Hear those voices with social
workers, with nurses, with doctors,

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with all kinds of community members
who make a difference in terms of

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uh… serving the people we want to serve.

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[music]

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[music]

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A patient\'s uh… satisfaction
umm… experience of the illness

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umm… outcomes of illness,
the doctor\'s risk of

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uh… malpractice, all of these things have

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important robust connections to the quality of
communication that happens in the encounter.

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When they go to the provider,

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they go to a clinic or a hospital, they
know they don\'t speak the language.

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They already feel umm… insecure, they feel

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uh… they feel, they feel so bad already
because they can\'t communicate with people.

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Sometimes like in emergency
room, I\'ve helped another

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person that the daughter was
interpreting for the mother

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and it took me a while, a little bit to go to the
emergency room. When I got there, the story that

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the provider got for me or in other
words, from the patient was different

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than the doctor was saying.
So details, medication,

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how often do you take this medication,
things like that get lost sometimes.

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It happens really, really often in my
community. Men speak, speaking for their wives

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but it\'s not really good. It\'s not
a good thing. I always try to

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umm… to recommend that they get an
interpreter instead of using the husband

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because most of, it\'s, it\'s but
in both voice. Move the time,

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he would miss out, he would,
he would miss out like umm…

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the interpretation words, what the
doctor is saying to the woman

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and sometimes he would lie too.
I think providers need to know

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how to work with an interpreter. For example,
providers need to address the patient

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in the first person saying,
uh… how can I help you

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instead of turning to the interpreter and
saying, ask him, how can I help him?

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See the patient is yours, don\'t see the patient as something
as a third party that you\'re talking through the interpreter.

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A lot of the clients come
to me and complain that

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when they go to the doctor and they talk to
the doctor, the doctor doesn\'t look at them.

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The doctor looks at the
interpreter and when the doctor

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respond to their question, again he looks
at the interpreter not look at them.

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They are telling me we never even
had an eye contact with our doctor

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and the doctor doesn\'t explain
a lot of the concepts.

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Doctors, I can see and they only give a fair
piece of paper and saying, you need a mammogram

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and you have to have a mammogram once a
year. But the science that what he said

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and why he said, you have to have a mammogram,
they have nothing explaining to them.

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One of the little things that I do before
they have a mammogram is bring these ladies

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into the room and ask them to come and be
near to the machine so that they get familiar

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and sometimes I, I do it myself. I volunteer
myself. I say this is what\'s gonna happen to you.

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You\'re just gonna put your breast in this and you\'ll look to this direction and the
tech will come and she will squeeze it two times very quickly. It\'s not painful.

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Doctors in this country use a very

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high level medical terminology.
Doctors in our country

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know how to deal with their own communities
and they use basic simple definitions.

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Translating material into
creole is a good step

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but it\'s not as simple as that.
Because umm… as

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I mentioned the words, people have to know

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to be attuned to the language and to
the culture to be able to translate.

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Just thinking somebody would speak Creole
to translate a material is not gonna do it.

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And uh… besides many people
who need the information

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may not be literate to read even
the Creole. So I do read Creole

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but many people, let\'s say my father\'s
generation, they do not read Creole.

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Reading it is an extra step that they have to take. For
these people to reach them, French is the best way.

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Part of being reluctant here
of going to the doctor is that

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this is a complain I hear a lot that

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they treat us as though we are no one
and we don\'t understand anything

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and even though we go with an interpreter,

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they don\'t bother to explain
to us what is happening.

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Maybe we\'re asking a question for two minutes.
Maybe we\'re getting one word in response.

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If the primary care provider that they have

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don\'t understand their culture or
don\'t understand their language

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umm… sometimes they\'ll
brush away with okay uh…

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take this and come in two days. It\'s not
the language that you really speak.

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It\'s how you are to deal with the person.
You really have to have a way

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to be, to be open and you know to really
try to make the connect with other people

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and when you make that connect with a
person, things are easy to be done.

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I would say the most important challenge
is to make two worlds connect.

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There are, they have different beliefs, different systems
and sometimes when I\'m interpreting perfectly well.

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I\'m saying, everything that\'s being said.
They don\'t connect.

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There is something that\'s missing. And which
is the cultural part or the expectation,

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the expectations that provider or
patient have. When someone goes to

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a provider, let\'s say to a doctor.

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Umm… most likely this person will
not go to the story directly.

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They would come with a story about
uh… they would not come with

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what is ailing them at the moment.
There would be a story attached to it

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and as far as the provider is concerned,
he or she wants to get exactly

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what are you here for. How
do we tackle the problem?

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Do we teach the provider to listen to the
problem, to the stories, so they can get the,

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the problem out of it or
do we teach our people

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in the community to come to the point
and give what exactly they are feeling.

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Many things when translated,
they don\'t translate

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word for word and uh… one example is

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uh… when somebody says my stomach hurts

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and my stomach hurts in, in
Creole may not be the stomach

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is because you can\'t really feel pain
from your stomach in that sense but

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when you say (inaudible)it
might be the chest.

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Okay whereas if you translate it in
English, you say my stomach hurts,

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you might think it\'s, it more has to do with the GI
tract but it may not be when uh… taken literally.

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Everything that\'s wrong with them, that
has to do with gas. It doesn\'t matter

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no where in the body. I mean sometimes where gas, you know,
you can\'t even find gas but now they\'ll tell you, it\'s a gas.

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But that\'s a way of
saying, it\'s a pain umm…

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I have a pain, yes, I have a gas. I mean, you know,
you might as well make the equation, gas, okay,

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when I hear gas, I know, it\'s pain. Numbers is
something that my community wouldn\'t understand.

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You can say a 100%, 20% of this population and they
don\'t get it. Unless you\'re well educated people.

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When a provider asks a patient

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to rate uh… umm… his or her
pain on a scale of one to ten

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and not too many people
can relate to, to that.

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They have, they don\'t have a clue so what
the doctor is talking about, so I try to

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uh… use some thing they can relate to.
For example, I will say, well say,

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when the pain first started, it was at $50
and as you views, you know, some of it

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and some of it has now gone away. Now how
much of it is left? I had a recent situation

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where uh… I explained to the medical
interpreter that the purpose of my visit

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with this recently immigrated
Somali gentleman was to understand

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how it was that his diabetes was so
out of control and for us together

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to try to understand how to
help him control his diabetes.

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She, at some point during the visit relate her
concern that she knew that he was Muslim,

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she knew he was about to fast for
Ramadan and was quite concerned that

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it could be injurious to his health. It
really illustrated how important it is

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to work with a medical interpreter as, as a
team in terms of furthering our understanding.

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Just the look and also the look in people\'s
faces when they waited for the interpreter

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and I get in, you know come into the room and
they\'re just like, the patient just goes

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oh my God, thank God, you\'re here.

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[sil.]

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Every culture, every group

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has explanatory models.

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Uh… ideas about the cause and the uh…

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onset of symptoms. The path
of physiology at work.

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The course of the illness,

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what treatments are appropriate. People have all kinds
of explanatory models and it\'s really important

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to undersand them. That\'s your baseline.
That\'s your foundation.

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That\'s what you work from. In our
country, we have a lot of beliefs.

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Umm… we believe in the moon that the moon
have influence especially on ladies.

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[non-English narration]

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A lot of Haitian, they will not say, all Haitians but a
lot of Haitians now would do, try to find out exactly

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umm… who is, who but a hex on me.

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When something hurts enough, they usually
attribute that to some supernatural causes.

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[sil.]

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A lot of women feel that people who get
cancer do something wrong in life.

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Maybe umm… you\'re on drugs or
maybe you stole someone\'s husband

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or you messed with someone else. Something
in their personality, in their behavior,

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they have made a connection that if you do something
wrong, something wrong can happen to you.

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Most of the population
that I work with is Latino

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and African American women. This woman

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umm… most of the time believed that,
that causes for cancer is sun.

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Umm… maybe hereditary uh…
smoking and things like that

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but also they think that
cancer can be contagious.

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A lot of women have told me
that umm… people think that

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since cancer can be deadly because
you can die from it at some point,

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that a disease or an illness that strong and that potent
must be something that you can pass to other people.

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They basically think that
if you eat can food,

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if you eat preservative, that will give
you cancer. You have to eat fresh foods,

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fresh vegetables, stuff like that
for yourself. A lot of women

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when we encourage them
to get their mammogram

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umm… say to me, well Hope I don\'t feel sick. You
know, I\'m not in any pain. I don\'t feel tired.

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Umm… you know, I\'m eating well. I
do what I normally do everyday.

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So I can\'t possibly have breast cancer.
I had a woman who actually,

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I called to get uh… her yearly
mammogram and she told me

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that she\'s been having pain since she, she
had her last mammogram. So she\'s not going.

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For the people who actually have a
low level education, it\'s like,

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it\'s a big deal. They can\'t have mammogram.
It\'s painful. It can give them cancer.

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It\'s scary. The machine is scary for them.

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We have to really make sure you make them
understand why they\'re having the mammograms done.

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So it\'s, it\'s something really,
really difficult for us.

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Cancer is the sort of evil thing.

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Scary and, and it\'s sort of the issue
that you don\'t want to talk about.

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Uh… people usually refer to it is as the bad thing,
you know, like if somebody wants to say that

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if a certain person has cancer, they will say, she
has that bad thing without even saying the word.

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My parents\' generation talked about it but they
didn\'t talked about it outside the family.

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It was something you kept at home. You didn\'t
talk about it. You didn\'t talk about it downtown.

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You didn\'t talk about it at school.
You whispered it.

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When I was told that I might have cancer in
my liver or uterus, I was really scared.

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I thought, \"Physicians are not held
accountable when they say this to a patient.\"

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In fact, they should check carefully
before making a diagnosis.

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If I\'m incorrectly told that I have
cancer, that can be very harmful.

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Whenever people here the word pre-cancer,

00:24:25.000 --> 00:24:29.999
it\'s very hard uh… to undo
the effect of the word

00:24:30.000 --> 00:24:34.999
which is fear and say, oh my God, I have cancer. So uh… it takes me
a lot of work to say, no, no, no you know, then we have to explain.

00:24:35.000 --> 00:24:39.999
I asked the doctor if he

00:24:40.000 --> 00:24:44.999
can make another test just to make sure
because I know once we just mention

00:24:45.000 --> 00:24:50.000
the word, it will be, it
may not even come back.

00:24:55.000 --> 00:24:59.999
[sil.]

00:25:00.000 --> 00:25:04.999
In the latino community umm…
we\'re a little bit fatalistic.

00:25:05.000 --> 00:25:09.999
So uh… the worst is gonna happen.
If something is not wrong,

00:25:10.000 --> 00:25:14.999
let\'s not touch it and let it be. And
if I have cancer and I let them go in,

00:25:15.000 --> 00:25:20.000
inside umm… and operate and
take it out, it\'s gonna spread.

00:25:30.000 --> 00:25:34.999
One they perceive that cancer
cannot be treat, then they won\'t

00:25:35.000 --> 00:25:39.999
even bother to see the screening.
In Appalachian,

00:25:40.000 --> 00:25:44.999
the religious, more religious
conservative communities,

00:25:45.000 --> 00:25:49.999
especially the more isolated communities. You get
cancer because God is, it\'s part of God\'s plan.

00:25:50.000 --> 00:25:54.999
It\'s God\'s punishment for you. I would say
the older people, the older generation

00:25:55.000 --> 00:25:59.999
usually thinks that uh… it\'s God\'s will and that\'s
how it works. If you\'re destined to have cancer,

00:26:00.000 --> 00:26:04.999
that\'s your destiny, there is
nothing, you can do about it.

00:26:05.000 --> 00:26:09.999
The younger people that I see which are more umm…
mostly Brazilians, they believe you can prevent.

00:26:10.000 --> 00:26:14.999
So they, they uh… will easily
do the prevention tests

00:26:15.000 --> 00:26:19.999
like Pap smears and mammograms
and things like that.

00:26:20.000 --> 00:26:24.999
I often find that patients don\'t understand and if
they don\'t understand why something is happening

00:26:25.000 --> 00:26:29.999
uh… they don\'t understand what we view as
the causation or the connection between

00:26:30.000 --> 00:26:34.999
cause and treatment uh… that they may not
follow through and without that understanding,

00:26:35.000 --> 00:26:39.999
it really isn\'t high quality care.

00:26:40.000 --> 00:26:45.000
[sil.]

00:27:05.000 --> 00:27:09.999
So often

00:27:10.000 --> 00:27:14.999
people don\'t understand that
what happens in the calendar

00:27:15.000 --> 00:27:19.999
is really a social act and
it\'s an act that\'s constructed

00:27:20.000 --> 00:27:24.999
by the culture of the patient
but also the culture

00:27:25.000 --> 00:27:29.999
of the provider. The culture of
the institution, the provider

00:27:30.000 --> 00:27:34.999
delivers his care within. I hear a
lot of complaints from patients

00:27:35.000 --> 00:27:39.999
that every time they come for the appointment,
they see different doctors. Every single time

00:27:40.000 --> 00:27:45.000
they come for the appointment, they will
have to tell the story over and over again.

00:29:00.000 --> 00:29:04.999
People from my community expect from
a doctor to provide a good medicine

00:29:05.000 --> 00:29:09.999
and to be cured. More of the people from
our community has been complaining,

00:29:10.000 --> 00:29:14.999
taking a day off from work,
going to the emergency room

00:29:15.000 --> 00:29:19.999
and be prescribed with a Tydenol. There
might not be possibility to get to

00:29:20.000 --> 00:29:24.999
where the services are. Especially somebody
who doesn\'t speak English would need somebody

00:29:25.000 --> 00:29:29.999
from a family member to go with them
and if it\'s between nine and five,

00:29:30.000 --> 00:29:34.999
they have to work. So that\'s
a difficulty that we find.

00:29:35.000 --> 00:29:39.999
Time is very important in our communities.
Umm… most of our people just here to work

00:29:40.000 --> 00:29:44.999
no one job, two jobs and the
results of having a mammogram

00:29:45.000 --> 00:29:49.999
on a Tuesday is completely different
than having a mammogram on a Saturday.

00:29:50.000 --> 00:29:54.999
I will say that if we have 40 ladies
scheduled for a Saturday, 39 will show up

00:29:55.000 --> 00:29:59.999
and if we have those 40 on a
Tuesday, 25 will show up.

00:30:00.000 --> 00:30:04.999
So I will say that when you are making

00:30:05.000 --> 00:30:09.999
these appointments for these ladies for
a mammogram or whatever keep in mind

00:30:10.000 --> 00:30:15.000
their time not your time as a provider.

00:30:35.000 --> 00:30:39.999
A client of mine three days
after they arrived here,

00:30:40.000 --> 00:30:44.999
she fell down and broke her wrist and

00:30:45.000 --> 00:30:49.999
there, there has been a lot of
complications with this case and

00:30:50.000 --> 00:30:54.999
the doctor told him that okay, you have
chances 50-50 either we can do surgery

00:30:55.000 --> 00:30:59.999
or just leave it the way it is in a cast and
it might get better. And she came to me crying

00:31:00.000 --> 00:31:04.999
and said that this doctor, he
doesn\'t know what he\'s doing.

00:31:05.000 --> 00:31:09.999
If I were back home, I knew
of this person who would just

00:31:10.000 --> 00:31:15.000
fix my wrist like that and I\'ll be all set and I
didn\'t have to go through things that they\'re doing.

00:31:25.000 --> 00:31:29.999
What cross cultural uh…
research has shown us is that,

00:31:30.000 --> 00:31:34.999
that often traditional
healers, folk healers

00:31:35.000 --> 00:31:39.999
on manners of uh… of healing speak to

00:31:40.000 --> 00:31:44.999
what\'s at stake for people in really
important and compelling ways

00:31:45.000 --> 00:31:49.999
and often in ways that are,
are not captured or addressed

00:31:50.000 --> 00:31:55.000
by what goes on in the realm
of doctors and nurses.

00:32:25.000 --> 00:32:29.999
From my culture one of the
things that I see is umm…

00:32:30.000 --> 00:32:34.999
people that are umm…
mediums or the two sort of

00:32:35.000 --> 00:32:39.999
spiritual kind of treatments and they\'re
able to cure you with their hands

00:32:40.000 --> 00:32:44.999
without any intervention without cutting
any sorts of surgery or anything

00:32:45.000 --> 00:32:49.999
and usually if you, if you get very
bad news, that\'s what they\'ll do.

00:32:50.000 --> 00:32:54.999
You get the last resort will be
to go to one of those umm… people

00:32:55.000 --> 00:32:59.999
that pray and eats very expensive.
There are a lot of healers

00:33:00.000 --> 00:33:04.999
umm… besides (inaudible) here, Haitian.

00:33:05.000 --> 00:33:09.999
Umm… everybody knows somebody
like some people do massages.

00:33:10.000 --> 00:33:14.999
Some people do tea, so there is a lot of
leaves they drink. They drink for cancer,

00:33:15.000 --> 00:33:19.999
they drink for, for cold.
They drink for fever.

00:33:20.000 --> 00:33:24.999
My family comes from Puerto Rico.
I have been here for 20 years.

00:33:25.000 --> 00:33:29.999
But when I was growing up umm… my grandmother
used to get a lot of bad headaches.

00:33:30.000 --> 00:33:34.999
So they will take a
bottle of umm… Alcolado.

00:33:35.000 --> 00:33:39.999
It\'s an alcohol with a fragrance
to it and then they will put

00:33:40.000 --> 00:33:44.999
some other herbs in it or they will put

00:33:45.000 --> 00:33:49.999
umm… the leave from the
lemons and some Eucalyptus

00:33:50.000 --> 00:33:54.999
umm… and things and they mixed it and she
used to go and she used to tie her head

00:33:55.000 --> 00:33:59.999
in that and that will take
care of her headaches.

00:34:00.000 --> 00:34:04.999
Prevention in a sense as it\'s practiced
here is not the same as we do in Haiti

00:34:05.000 --> 00:34:09.999
or in the Haitian community because
uh… there are some teas that we use.

00:34:10.000 --> 00:34:14.999
If a child, that\'s if one
person in the house has a cold,

00:34:15.000 --> 00:34:19.999
most likely every child in the house
will get a tea, lemon tea or something.

00:34:20.000 --> 00:34:24.999
That\'s an intervention. Just keep in mind also
they will work with a lot of herbal medicine

00:34:25.000 --> 00:34:29.999
and for any sickness that we get, besides
that we have the prescription medicine,

00:34:30.000 --> 00:34:34.999
we also put the herbal medicine into place. So we\'re
working with, with two things at the same time.

00:34:35.000 --> 00:34:39.999
I\'ve had a wonderful opportunity to
work with uh… many different patients

00:34:40.000 --> 00:34:44.999
from a variety of countries and,
and learn very quickly working

00:34:45.000 --> 00:34:49.999
for example with uh… Chinese clients I had with
hypertension, how important it was for her to balance,

00:34:50.000 --> 00:34:54.999
if you will her understanding of her illness
between the two cultures in which she lived.

00:34:55.000 --> 00:34:59.999
She would spend a good deal of,
of her year in United States

00:35:00.000 --> 00:35:04.999
and then would return to China where
she would have to reimmerse herself

00:35:05.000 --> 00:35:09.999
in the Chinese cultural system and also to reimmerse
herself in the Chinese healthcare system.

00:35:10.000 --> 00:35:14.999
She would inevitably come back to me,
telling me that she has been offered her

00:35:15.000 --> 00:35:19.999
medications and had begun taking
a series of the Chinese Herbs

00:35:20.000 --> 00:35:24.999
uh… which she felt really maintained her in China.
It was a challenge for me not to pass judgment

00:35:25.000 --> 00:35:29.999
but to rather accept and understand
how important it was for her to,

00:35:30.000 --> 00:35:34.999
to try to integrate and for me to
be respectful and to start fresh

00:35:35.000 --> 00:35:39.999
rather than run the risk of alienating her by
rejecting the importance of her own cultural beliefs.

00:35:40.000 --> 00:35:45.000
[music]

00:36:10.000 --> 00:36:14.999
One of the real privileges
and exciting things

00:36:15.000 --> 00:36:19.999
about doing the work of, of caring

00:36:20.000 --> 00:36:24.999
for people who are ill is
that you learn from them.

00:36:25.000 --> 00:36:29.999
You learn from their stories.
I can remember

00:36:30.000 --> 00:36:34.999
the case of a kid, a Haitian boy,

00:36:35.000 --> 00:36:39.999
about six years old. He had
uh… the diagnosis of AIDS

00:36:40.000 --> 00:36:44.999
and his physicians were
really concerned about him.

00:36:45.000 --> 00:36:49.999
One of their greatest concerns
was that he wasn\'t getting

00:36:50.000 --> 00:36:54.999
the medicines that he needed.
What the providers had learnt was

00:36:55.000 --> 00:36:59.999
some sort of superficial, umm… concepts

00:37:00.000 --> 00:37:04.999
about what is Haitian culture and of course

00:37:05.000 --> 00:37:09.999
uh… the issue of sorcery and voodoo

00:37:10.000 --> 00:37:14.999
were involved in that regard.

00:37:15.000 --> 00:37:19.999
The providers were all too willing to
attribute the problem of non-compliance to

00:37:20.000 --> 00:37:24.999
uh… what they thought, what
they expected might be a,

00:37:25.000 --> 00:37:29.999
a mother\'s belief in sorcery or voodoo

00:37:30.000 --> 00:37:34.999
and what was really trued

00:37:35.000 --> 00:37:39.999
when you talked with the mom,
she had a very sophisticated

00:37:40.000 --> 00:37:44.999
uh… western biomedical understanding
of his illness. His mom worked

00:37:45.000 --> 00:37:49.999
as a nursing assistant uh… in a nursing
home and she made just over minimum wage.

00:37:50.000 --> 00:37:54.999
But those wages were not
enough to lift this family

00:37:55.000 --> 00:37:59.999
out of persistent poverty and
uh… intermittent homelessness.

00:38:00.000 --> 00:38:04.999
Now, it was clear from talking with the mom

00:38:05.000 --> 00:38:09.999
about her experience of this devastating
illness, incredible challenge

00:38:10.000 --> 00:38:14.999
was that the economic issues
were really incredibly important

00:38:15.000 --> 00:38:19.999
and they were really the key barrier to him

00:38:20.000 --> 00:38:24.999
getting all of the care that he needed.

00:38:25.000 --> 00:38:29.999
So how you\'re gonna sort all these out?
Is it economic issues,

00:38:30.000 --> 00:38:34.999
is it class issues? Is it cultural issues?
Issues of cultural or racial difference.

00:38:35.000 --> 00:38:39.999
Ethnic differences. One way
is to talk with people.

00:38:40.000 --> 00:38:44.999
To hear their voices. To hear the voices
where all the players are involved.

00:38:45.000 --> 00:38:49.999
In some cases, you know,
we have patients in denial

00:38:50.000 --> 00:38:54.999
as in the case of a 84 year old patient.
He is working here

00:38:55.000 --> 00:38:59.999
and he\'s supporting his family in Haiti

00:39:00.000 --> 00:39:04.999
uh… and he does have a prostate cancer
but he\'s in denial and said no,

00:39:05.000 --> 00:39:09.999
I cannot be sick because I still have
my family to take care of and he says,

00:39:10.000 --> 00:39:14.999
the day, I mean, he\'s trying to sponsor them here
and he said, the day after they arrived here,

00:39:15.000 --> 00:39:19.999
I\'ll quit working but until then, I
have to. Some people don\'t have,

00:39:20.000 --> 00:39:24.999
they don\'t know where their next meal, it\'s gonna come.
So they don\'t know where the next meal is gonna come.

00:39:25.000 --> 00:39:29.999
They cannot get into a cab and
go to right to the hospital.

00:39:30.000 --> 00:39:34.999
A lot of the women here are
in single parent homes.

00:39:35.000 --> 00:39:39.999
They are the head of their households. They might be
raising their children in addition to their grandchildren.

00:39:40.000 --> 00:39:44.999
Umm… they maybe the only one working
in the household. So they have a lot.

00:39:45.000 --> 00:39:49.999
They have a lot of stress. So for them to get
a mammogram, that\'s not priority for them.

00:39:50.000 --> 00:39:54.999
Some people don\'t have the money to pay
for it and even sometimes we offer them

00:39:55.000 --> 00:39:59.999
this program to come to have the mammogram and
we\'ll pay and they receive a bill anyway.

00:40:00.000 --> 00:40:04.999
So they don\'t believe sometimes they will,
they won\'t get the bill. I just remember

00:40:05.000 --> 00:40:09.999
umm… one of my women
going to an appointment.

00:40:10.000 --> 00:40:14.999
It took us some convincing to get her there but she did
decide to have a mammogram. She wanted to go by herself.

00:40:15.000 --> 00:40:19.999
She felt that she was making a big step.
So she went on her own

00:40:20.000 --> 00:40:24.999
and umm… I believe she waited for about an hour and 15
minutes in the waiting room before she was called upon.

00:40:25.000 --> 00:40:29.999
She had told me that, there were people
that came to the waiting room after her

00:40:30.000 --> 00:40:34.999
and went in to be seen before her.
So she was finally seen

00:40:35.000 --> 00:40:39.999
uh… she had her mammogram and she called
me and said that she wasn\'t going back.

00:40:40.000 --> 00:40:44.999
Uh… she felt other people umm… that should
have come after her went in before her.

00:40:45.000 --> 00:40:49.999
She said these people were not of color and she
just felt that she was put on the back burner

00:40:50.000 --> 00:40:54.999
and she feels that sometimes people of color, when
they don\'t have uh… expensive health insurance

00:40:55.000 --> 00:40:59.999
that they just kind of
are given the leftover.

00:41:00.000 --> 00:41:04.999
Once I was asked by a lady about
the construction of the breast

00:41:05.000 --> 00:41:09.999
and I didn\'t have no education
whatsoever about that issue either.

00:41:10.000 --> 00:41:14.999
And I don\'t think the community knows that there
is a possibility that they can have it done.

00:41:15.000 --> 00:41:19.999
In my experience, I don\'t think they
really tell people about the construction

00:41:20.000 --> 00:41:24.999
because umm… most of the free care programs
that I know of. They don\'t really cover

00:41:25.000 --> 00:41:29.999
the construction surgeries. So they, these
people don\'t really have too many option.

00:41:30.000 --> 00:41:34.999
When people are asked what kind
of health insurance they have,

00:41:35.000 --> 00:41:39.999
I want to say, everybody but many people
would think that, that would equate

00:41:40.000 --> 00:41:44.999
the type of care that they would get.
Because if it\'s free,

00:41:45.000 --> 00:41:49.999
then it might not be up to the same level
as somebody who is paying out of pocket.

00:41:50.000 --> 00:41:54.999
So umm… a lot of people would,

00:41:55.000 --> 00:41:59.999
would choose not to give that kind
of information. So that they in,

00:42:00.000 --> 00:42:04.999
in to not jeopardize the kind of care that
they would receive. There is a definite

00:42:05.000 --> 00:42:09.999
umm… historical link to umm… black people

00:42:10.000 --> 00:42:14.999
not trusting the health system.
Umm… as you know,

00:42:15.000 --> 00:42:19.999
with all of the (inaudible) studies and
there is a lot of past negative instances

00:42:20.000 --> 00:42:24.999
that was focused with black people.

00:42:25.000 --> 00:42:29.999
So I think there is hesitation. I think
that\'s uh… uh… a good hesitation

00:42:30.000 --> 00:42:34.999
because you\'re not just a guinea pig. You
just don\'t go in being totally oblivious

00:42:35.000 --> 00:42:39.999
to what\'s happening to you. Umm…
but I think just trying to do

00:42:40.000 --> 00:42:44.999
basic intervention, basic screening,
your pap once a year, your mammogram.

00:42:45.000 --> 00:42:49.999
I think there is more
hesitancy than needs to be.

00:42:50.000 --> 00:42:54.999
In the U.S. race matters. It
matters in really important ways

00:42:55.000 --> 00:42:59.999
in terms of health and illness.

00:43:00.000 --> 00:43:04.999
An important study in the
early 1990s showed that

00:43:05.000 --> 00:43:09.999
a black man in Harlem has a lower

00:43:10.000 --> 00:43:14.999
life expectancy than a man in
the Third World, in Bangladesh.

00:43:15.000 --> 00:43:19.999
That\'s an incredible outcome. How
is this produced? How do we achieve

00:43:20.000 --> 00:43:24.999
an outcome like this in the wealthiest
nation on the face of the earth.

00:43:25.000 --> 00:43:29.999
How is that possible? Well,
the answer is we start early

00:43:30.000 --> 00:43:34.999
and we really work hard at it.
A boy in Harlem,

00:43:35.000 --> 00:43:39.999
a 15 has only a 30%

00:43:40.000 --> 00:43:44.999
chance of surviving to age 65.
How do we account for this?

00:43:45.000 --> 00:43:49.999
What we know is that poor
kids have more illnesses,

00:43:50.000 --> 00:43:54.999
they\'re sicker longer and they
have worse health outcomes

00:43:55.000 --> 00:44:00.000
than their more privileged peers.
This is how it\'s achieved.

00:44:05.000 --> 00:44:09.999
Patients have come into my office with,

00:44:10.000 --> 00:44:14.999
if you will umm… wounds from past beatings
when they have left the country in violence.

00:44:15.000 --> 00:44:19.999
They\'ve come into my office
with a fear of death because

00:44:20.000 --> 00:44:24.999
if you were a diagnosis of cancer, obviously meant
death where they came from before because it wasn\'t

00:44:25.000 --> 00:44:29.999
uh… a treatable disorder given the limited
healthcare resources in their country.

00:44:30.000 --> 00:44:34.999
So stepping back, thinking about what
may have come before in their life,

00:44:35.000 --> 00:44:39.999
before they entered our office and being patient
with them umm… with what they tell you.

00:44:40.000 --> 00:44:44.999
A lot of latinos that are not
documented that they don\'t have

00:44:45.000 --> 00:44:49.999
a legal status in the United
States are afraid of going

00:44:50.000 --> 00:44:54.999
and seeking healthcare and the
reason is because they are

00:44:55.000 --> 00:44:59.999
very afraid of being sent back to their
country because bad things are happening.

00:45:00.000 --> 00:45:04.999
When you\'re in a war like the war

00:45:05.000 --> 00:45:09.999
between Iran and Iraq that
one million got killed

00:45:10.000 --> 00:45:14.999
and I don\'t know how many people
wounded and how many people missing

00:45:15.000 --> 00:45:19.999
then the doctors, the physicians, the
whole system of healthcare cannot

00:45:20.000 --> 00:45:25.000
focus on prevention at that point.

00:45:45.000 --> 00:45:49.999
Some of them come with a lot of physical
problems that they\'ve had for a long, long time

00:45:50.000 --> 00:45:54.999
and if they\'re coming from
refugee camps they really

00:45:55.000 --> 00:45:59.999
were not able to get any kind of care. Some of
them come with a lot of psychological trauma.

00:46:00.000 --> 00:46:04.999
So it depends really who we are talking
about. If you\'re talking about middle east

00:46:05.000 --> 00:46:09.999
or some of African countries, it\'s very
difficult to talk about sexual abuse

00:46:10.000 --> 00:46:14.999
but it is coming out and
we know that for a fact,

00:46:15.000 --> 00:46:19.999
a lot of that happen and a
lot of the women were raped

00:46:20.000 --> 00:46:24.999
or their daughters were kidnapped and
raped and maybe murdered after that.

00:46:25.000 --> 00:46:29.999
When some of the refugees will come
here if they have left families behind.

00:46:30.000 --> 00:46:34.999
They never think that
they\'re settled for good.

00:46:35.000 --> 00:46:39.999
So there is always a thought
of I\'m going back somehow,

00:46:40.000 --> 00:46:44.999
some day, I\'ll go back or the thought
of bringing the family members

00:46:45.000 --> 00:46:49.999
and rejoining the family here.
So uh… in that light,

00:46:50.000 --> 00:46:54.999
maybe the number one priority
wouldn\'t be to like going,

00:46:55.000 --> 00:47:00.000
get some kind of physical
or psychological care.

00:47:40.000 --> 00:47:44.999
I think it\'s very important to build a trust when
you\'re having a relationship with your physician

00:47:45.000 --> 00:47:49.999
and often that\'s missing, that\'s what
I\'ve seen with a lot of my client

00:47:50.000 --> 00:47:54.999
that it\'s just not there because
they didn\'t feel that warmth.

00:47:55.000 --> 00:47:59.999
They didn\'t feel that they
were received by the doctors

00:48:00.000 --> 00:48:04.999
and they didn\'t think that the doctor
respected them. These problem tend to create,

00:48:05.000 --> 00:48:09.999
you know, to uh… deter them from

00:48:10.000 --> 00:48:14.999
seeking medical care within the
United States because of the,

00:48:15.000 --> 00:48:19.999
the mistrust that they brought from home.

00:48:20.000 --> 00:48:24.999
They have come here because they needed
help. I really don\'t think anybody loves

00:48:25.000 --> 00:48:29.999
to leave their home. Leave their family
behind. Leave the life they have made

00:48:30.000 --> 00:48:34.999
behind and come to a new country
with absolutely no resources.

00:48:35.000 --> 00:48:39.999
And at least, we need to respect that

00:48:40.000 --> 00:48:44.999
and think where they have come from and what
they need to get, what they deserve to get here.

00:48:45.000 --> 00:48:49.999
[music]

00:48:50.000 --> 00:48:55.000
[sil.]

00:49:15.000 --> 00:49:19.999
[music]

00:49:20.000 --> 00:49:24.999
There are some important domains

00:49:25.000 --> 00:49:29.999
in which differences are made to matter.

00:49:30.000 --> 00:49:34.999
If you look at cross cultures,
there are clear differences

00:49:35.000 --> 00:49:39.999
in terms of the ways that people uh… look
at and deal with issues of authority.

00:49:40.000 --> 00:49:44.999
Umm… issues of uh…

00:49:45.000 --> 00:49:49.999
physical contact with issues
of gender and of sexuality,

00:49:50.000 --> 00:49:55.000
of religion and different
communication styles.

00:50:00.000 --> 00:50:04.999
Back home, you only have

00:50:05.000 --> 00:50:09.999
one decision from the doctor. He\'s the
one who decided for you. Not you.

00:50:10.000 --> 00:50:14.999
Once they get the three or four
options, they get confused.

00:50:15.000 --> 00:50:19.999
They don\'t, they don\'t know why the
doctor has to ask me to decide.

00:50:20.000 --> 00:50:24.999
I would say 90% of the times when that happens,
the patient says but you\'re the doctor.

00:50:25.000 --> 00:50:29.999
I didn\'t go to medical school like how can I decide about
my own health. You\'re the one that\'s supposed to tell me.

00:50:30.000 --> 00:50:34.999
So they actually take that as being incompetence
that the doctor doesn\'t know what he\'s doing.

00:50:35.000 --> 00:50:39.999
Most Latino women don\'t feel
comfortable talking to their doctor

00:50:40.000 --> 00:50:44.999
or questioning the doctor, the physician
or the primary care or the nurse

00:50:45.000 --> 00:50:49.999
that they talk to. Specially
because physicians,

00:50:50.000 --> 00:50:54.999
healthcare providers are held to a
very high standard next to God.

00:50:55.000 --> 00:50:59.999
The woman with a little bit more education
will question if the primary care physician,

00:51:00.000 --> 00:51:04.999
the nurse, the practicitioner, the
healthcare provider. The Latino community,

00:51:05.000 --> 00:51:09.999
the Appalachian community is focused
on home, family, neighborhood.

00:51:10.000 --> 00:51:14.999
They tend to be stressful
about authorities.

00:51:15.000 --> 00:51:19.999
They tend to be non-compliant
without questioning authority.

00:51:20.000 --> 00:51:24.999
Which is a very interesting combination
because they\'ll say, yes to the doctor,

00:51:25.000 --> 00:51:29.999
they\'ll nod their heads. They really don\'t understand what the doctor
is saying and then we go home and we sit around the kitchen table

00:51:30.000 --> 00:51:34.999
and we don\'t take our medicine the way we should be
taking it. In healthcare, we have this funny term,

00:51:35.000 --> 00:51:39.999
we call non-compliance and the
assumption behind non-compliance is that

00:51:40.000 --> 00:51:44.999
it is upto the patient to comply with
a plan that the healthcare provider

00:51:45.000 --> 00:51:49.999
has developed and that\'s a very loaded
notion because first of all, it assumes that

00:51:50.000 --> 00:51:54.999
we have the power to make decisions
and direct the care when in fact,

00:51:55.000 --> 00:51:59.999
I think we need to stop and look at the
fact that really is the patient\'s power

00:52:00.000 --> 00:52:04.999
to make decisions about what they want
to do and to look at that if you will

00:52:05.000 --> 00:52:09.999
as a process of integration overtime and rather
than a one time, here is the plan, accept it.

00:52:10.000 --> 00:52:15.000
If you don\'t accept it,
you\'re non-compliant.

00:52:20.000 --> 00:52:24.999
The men in the Latino
community are very reluctant

00:52:25.000 --> 00:52:29.999
to go and do physical exam
umm… for the prostate,

00:52:30.000 --> 00:52:34.999
for prostate cancer for example. Umm…

00:52:35.000 --> 00:52:39.999
because they\'re machismo. They think
by having a prostate exam done,

00:52:40.000 --> 00:52:44.999
they are not, their manhood is in question.

00:52:45.000 --> 00:52:49.999
I\'ve heard men say that if I do have
prostate cancer, I just want to continue

00:52:50.000 --> 00:52:54.999
to be sexually active as long as I can and
when the time comes, when that stops,

00:52:55.000 --> 00:52:59.999
then you know, I\'ll deal with it. So they
just kind of live in denial so to speak

00:53:00.000 --> 00:53:04.999
umm… but that possibility of being
impotent is enough for them to say,

00:53:05.000 --> 00:53:09.999
I don\'t want to be bothered. I just don\'t
want to know. This particular case involves a

00:53:10.000 --> 00:53:14.999
uh… umm… Muslim gentleman
uh… from the North Africa.

00:53:15.000 --> 00:53:19.999
Umm… he came for his regular check
up and the doctor wanted to

00:53:20.000 --> 00:53:24.999
uh… do a screening for testicular cancer

00:53:25.000 --> 00:53:29.999
and he just would not have anything.

00:53:30.000 --> 00:53:34.999
He just would not uh… submit to it because
it involves another doctor you know

00:53:35.000 --> 00:53:39.999
just touching you know his
uh… uh… genitals and he,

00:53:40.000 --> 00:53:44.999
he was extremely uncomfortable with the idea.
But the doctor did just showed him that

00:53:45.000 --> 00:53:49.999
I was not so, I was not trying
to force you to have the exam.

00:53:50.000 --> 00:53:54.999
So the doctor just sort of had that
detached attitude. That\'s fine.

00:53:55.000 --> 00:53:59.999
It\'s okay, if you don\'t want to have the exam but this is how you
do it yourself and I\'ll, I\'ll show you this is how you do it.

00:54:00.000 --> 00:54:04.999
And after a while, after waiting
for about a few minutes, he said,

00:54:05.000 --> 00:54:09.999
well doc, I think you know, that\'s
okay, you can do the exam now.

00:54:10.000 --> 00:54:14.999
We women know when we go for an annual exam, the first
thing, it\'s like, you take your clothes off and

00:54:15.000 --> 00:54:19.999
you lay down and you just
let it be all shown.

00:54:20.000 --> 00:54:24.999
Then it\'s uncomfortable. They\'re
gonna, you know, look at a stranger

00:54:25.000 --> 00:54:29.999
doing something like that with them.
It\'s like for them, it\'s not, normal.

00:54:30.000 --> 00:54:34.999
In my community, they prefer to have the same
gender especially women for any pelvic exam

00:54:35.000 --> 00:54:39.999
or any time when she has to take
off your clothes, to be checked,

00:54:40.000 --> 00:54:44.999
then she needs female doctor. This is,
I\'m talking about religious because

00:54:45.000 --> 00:54:49.999
most of them are Muslim and for
them to be seen by strange male

00:54:50.000 --> 00:54:54.999
it\'s prohibitive from their, from our
religion. If you\'re taking about

00:54:55.000 --> 00:54:59.999
breast exams for women umm… maybe
middle, middle east women,

00:55:00.000 --> 00:55:04.999
if you\'re talking about, it\'s not a very

00:55:05.000 --> 00:55:09.999
well known concept to them.
It\'s mainly, Muslim countries

00:55:10.000 --> 00:55:14.999
and in some of them there are very strict
rules about women covering themselves.

00:55:15.000 --> 00:55:19.999
So you\'re walking on the street, you
know, all you see, they\'re all covered.

00:55:20.000 --> 00:55:24.999
Everything covered in dark colors.
But you come here and

00:55:25.000 --> 00:55:29.999
you see something like a card
telling you how you need to

00:55:30.000 --> 00:55:34.999
examine yourself and how you immediate
to go for a test and to even see that

00:55:35.000 --> 00:55:39.999
image of a naked woman and you\'re
supposed to do this to yourself

00:55:40.000 --> 00:55:44.999
that would freak them out probably.
It would be very scary to them.

00:55:45.000 --> 00:55:49.999
They\'d be ashamed to even look at it.
So a woman feel that touching

00:55:50.000 --> 00:55:54.999
yourself is sinful. Umm… it\'s a form of
masturbation uh… the church will look down on them.

00:55:55.000 --> 00:55:59.999
So they cannot touch themselves.

00:56:00.000 --> 00:56:05.000
Some women umm… are just uncomfortable
with their bodies on the whole.

00:56:10.000 --> 00:56:14.999
This was a man that had uh…
lung cancer and he was in ICU

00:56:15.000 --> 00:56:19.999
uh… and the doctor

00:56:20.000 --> 00:56:24.999
talked to his wife. We went inside and we
uh… the doctor was trying to tell the wife

00:56:25.000 --> 00:56:29.999
what was wrong with the husband
and he had lung cancer

00:56:30.000 --> 00:56:34.999
and uh… umm… the wife
when she heard the news,

00:56:35.000 --> 00:56:39.999
she said, no, no, no, you cannot tell that to my husband. No
way, I\'m not gonna let you. And one of the beliefs is that

00:56:40.000 --> 00:56:44.999
if you tell that news to a patient, the
patient will umm… be so discouraged,

00:56:45.000 --> 00:56:49.999
you know, that he will get sicker and
sicker much faster. He has a right to know,

00:56:50.000 --> 00:56:54.999
right so how can we give him the
option of not knowing without

00:56:55.000 --> 00:56:59.999
giving him the idea that there is something
wrong with him, that might be cancer.

00:57:00.000 --> 00:57:04.999
So the idea, the solution we talked, the
three of us talked and what we came up was,

00:57:05.000 --> 00:57:09.999
you know, how much do you want to know. I have all these
things to tell you. I have a lot of things to explain to you.

00:57:10.000 --> 00:57:14.999
But how much do you want to know? Do you want to know the whole
thing, do you want me to just tell you what you need to do?

00:57:15.000 --> 00:57:19.999
How do you want to do this? And he
said, just tell me what I need to do?

00:57:20.000 --> 00:57:24.999
My father has been diagnosed with prostate cancer.
It\'s been a year and he\'s following treatment

00:57:25.000 --> 00:57:29.999
but as far as he\'s concerned,
he does not know exactly

00:57:30.000 --> 00:57:34.999
what his diagnosis is
because he\'s 82 years old

00:57:35.000 --> 00:57:39.999
and he\'s had many other medical
conditions that the, we feel

00:57:40.000 --> 00:57:44.999
that uh… is best that he does,
it\'s not that he doesn\'t know

00:57:45.000 --> 00:57:49.999
but he\'s not sure because he does go for his
shots every three months. Once in a while,

00:57:50.000 --> 00:57:54.999
he would ask my mother what is wrong with
him and at times, it\'s very emotional

00:57:55.000 --> 00:57:59.999
because he would start crying and
he goes to depression at times.

00:58:00.000 --> 00:58:04.999
So we feel that it\'s best that he is not

00:58:05.000 --> 00:58:09.999
that much aware of his condition at
this point. I have this young man

00:58:10.000 --> 00:58:14.999
making the decision of umm…
after a biopsy to have,

00:58:15.000 --> 00:58:19.999
he had a nodule under his
arm and it was melanoma

00:58:20.000 --> 00:58:24.999
and being melanoma and he
didn\'t want to have it,

00:58:25.000 --> 00:58:29.999
he had the lump removed but then they needed to go in and remove
all the other nodules and he didn\'t want to do any of that.

00:58:30.000 --> 00:58:34.999
He just wants to be left alone. He went to
church and he was praying a lot to be cured

00:58:35.000 --> 00:58:39.999
and umm… after being in
church when he went home,

00:58:40.000 --> 00:58:44.999
he, the wound drained. So he was convinced

00:58:45.000 --> 00:58:49.999
that it was a miracle that he was cured. So then
he simply refused to come back for more treatment.

00:58:50.000 --> 00:58:54.999
With him, I felt, his wife and his
mom were all sort of contributing

00:58:55.000 --> 00:58:59.999
and again the role of the family, they
were all supporting him in his decision

00:59:00.000 --> 00:59:05.000
of not getting treatment. And he,
this went on and on until he died.

00:59:10.000 --> 00:59:15.000
[sil.]

01:00:40.000 --> 01:00:44.999
The church community let\'s you feel comfortable
about whatever illness or disease, you may have

01:00:45.000 --> 01:00:49.999
and they feel that prayer is very powerful.

01:00:50.000 --> 01:00:54.999
So someone opens up and says, that they
have this illness, that they have cancer.

01:00:55.000 --> 01:00:59.999
Umm… what a lot of the ministers or
pastors do is pray over that person

01:01:00.000 --> 01:01:04.999
and what they also do is put oil. So
for a woman if it\'s breast cancer,

01:01:05.000 --> 01:01:09.999
they might put it over her breast or her chest. If it\'s
something with her stomach, they\'ll put it on her stomach area

01:01:10.000 --> 01:01:14.999
and pray for her and ask God to take the
illness away and ask God to help her heal.

01:01:15.000 --> 01:01:19.999
I\'m a Baha\'i and one of the

01:01:20.000 --> 01:01:24.999
major principles of the Baha\'i faith
is that uh… there should be harmony

01:01:25.000 --> 01:01:29.999
between science and religion.

01:01:30.000 --> 01:01:34.999
So if there is no harmony between them,

01:01:35.000 --> 01:01:39.999
this is not the way it should be. So in
light of that, going to a physician,

01:01:40.000 --> 01:01:44.999
seeking help, professional help is
always encouraged in my religion.

01:01:45.000 --> 01:01:49.999
When I\'ve encountered women that said, well Hope,
you know, this is God\'s will that I have cancer.

01:01:50.000 --> 01:01:54.999
God\'s gonna take care of me. I don\'t need
medication. I don\'t need intervention.

01:01:55.000 --> 01:01:59.999
I\'m just going to live my life day by day.
I don\'t like to just leave it at that

01:02:00.000 --> 01:02:04.999
but I don\'t like to ignore the fact
that God is part of this process

01:02:05.000 --> 01:02:09.999
because I believe in God and I can kind
of identify with him as I talk to them

01:02:10.000 --> 01:02:14.999
but I let them know that God just doesn\'t want
you to sit here and let the cancer spread

01:02:15.000 --> 01:02:19.999
and let your symptoms increase and ultimately,
you may die sooner than you have to.

01:02:20.000 --> 01:02:25.000
[music]

01:02:30.000 --> 01:02:34.999
[music]

01:02:35.000 --> 01:02:39.999
What are we, what are we trying to achieve?
What we\'re trying to achieve

01:02:40.000 --> 01:02:44.999
is the very best outcome that is possible.
The highest possible,

01:02:45.000 --> 01:02:49.999
attainable standard of health that can be
achieved for this person sitting before me

01:02:50.000 --> 01:02:54.999
and for the population that
the person belongs to.

01:02:55.000 --> 01:02:59.999
How are we gonna achieve that? We
have to be able to communicate

01:03:00.000 --> 01:03:04.999
with the person or with the group.
Every community must have a,

01:03:05.000 --> 01:03:09.999
a religious leader or a community leader

01:03:10.000 --> 01:03:14.999
or the gatekeeper, foreman. It\'s important

01:03:15.000 --> 01:03:19.999
that these healthcare provider work
very close with these leaders,

01:03:20.000 --> 01:03:24.999
trying to lead the community without
reaching these community leader,

01:03:25.000 --> 01:03:29.999
it\'s very tough. It\'s just like
a, you try to go into a house

01:03:30.000 --> 01:03:34.999
without opening the gate. In the Latino
culture, in the Appalachian culture,

01:03:35.000 --> 01:03:39.999
if you want to make a difference, if you want to
get out, you want to do good educational outreach.

01:03:40.000 --> 01:03:44.999
You need to have the ministers
stand up in church and say,

01:03:45.000 --> 01:03:49.999
you know, we\'re gonna have a prostate screening
and we need to have every man in this church

01:03:50.000 --> 01:03:54.999
come to this prostate screening
over the age of whatever.

01:03:55.000 --> 01:03:59.999
Sometimes you tell people things and they
may not uh… make it their own problem.

01:04:00.000 --> 01:04:04.999
They may not think that you know, their risk but if they
see that somebody is talking to them at their level,

01:04:05.000 --> 01:04:09.999
somebody from the community,
somebody they know

01:04:10.000 --> 01:04:14.999
that they may seen at work or they may have seen
at church, that makes it that much credible.

01:04:15.000 --> 01:04:19.999
Because coming from a provider is one thing
but coming from somebody who is actually,

01:04:20.000 --> 01:04:24.999
who has gone through the process of
getting screened, getting treatment

01:04:25.000 --> 01:04:29.999
and is doing okay, that to me
is, is more, is a lot credible.

01:04:30.000 --> 01:04:34.999
I would like to give advice to providers.

01:04:35.000 --> 01:04:39.999
One of them is to be open even though you can learn
about cultures, different cultures, different people,

01:04:40.000 --> 01:04:44.999
don\'t assume just ask the patient tell
me how do you do this in your country?

01:04:45.000 --> 01:04:49.999
Don\'t uh… think that what it\'s
been done in another country

01:04:50.000 --> 01:04:55.000
is inferior. Just respect
what\'s being done.

01:05:25.000 --> 01:05:29.999
A lot of women feel that they
are just looking at me as

01:05:30.000 --> 01:05:34.999
a body or a body part. They are not looking at me
as a person uh… because they\'re not respecting me

01:05:35.000 --> 01:05:39.999
by allowing me to say who I am or
even enquiring to me about who I am.

01:05:40.000 --> 01:05:44.999
So a lot of women have said
it will really go a long way

01:05:45.000 --> 01:05:49.999
for doctors just to acknowledge them, just a little
introductory and then proceed with umm… the examination.

01:05:50.000 --> 01:05:54.999
So just common respect, common respect

01:05:55.000 --> 01:05:59.999
umm… means a lot to women.
We need to be very sensitive

01:06:00.000 --> 01:06:04.999
and judge each case just based
on what they\'re telling you,

01:06:05.000 --> 01:06:09.999
where they\'re from and what
they have been through.

01:06:10.000 --> 01:06:14.999
It probably wouldn\'t take five minutes
to just log on to the internet

01:06:15.000 --> 01:06:19.999
ask for some cultural
background from that country.

01:06:20.000 --> 01:06:24.999
If you\'re serving a person from Afghanistan,
it\'s good to know that this country

01:06:25.000 --> 01:06:29.999
has been in the war for 22 years.

01:06:30.000 --> 01:06:34.999
So you know what kind of
people we\'re dealing with.

01:06:35.000 --> 01:06:39.999
Stepping back and taking the time to listen
to patients, to value what they have to say

01:06:40.000 --> 01:06:44.999
and to be willing to learn from them
about their cultures, their belief,

01:06:45.000 --> 01:06:49.999
their practices is for me
uh… very, very important.

01:06:50.000 --> 01:06:54.999
Really that\'s what works
best for our patients, to,

01:06:55.000 --> 01:06:59.999
to view us, ourself as facilitators for
help rather than directors of help.

01:07:00.000 --> 01:07:05.000
[music]

01:09:40.000 --> 01:09:45.000
[music]