Johnny Suzuki
Community and Culture
During rounds, you tell Dr. I about your community windshield assessment and your discovery that housing and transportation are factors in Johnny’s ability to manage his diabetes. You also know that some health services are available the community, and he could have obtained insulin and testing supplies from the Social Services clinic.
Dr. I asks if you considered culture as another factor. You are unsure about this…she suggests you meet with an outreach worker from Ke Ola Mamo. She says they are the experts at Native Hawaiian culture, and how cultural misunderstandings can affect how Johnny may respond to care.
The next day, you arrange to meet Kalani, a community health worker at Ke Ola Mamo. Kalani suggests you accompany him on an outreach, and describe what you learned from the community windshield assessment.
After explaining Johnny’s situation and problems obtaining help and insulin, Kalani reviews basic concepts in Native Hawaiian culture.
Traditional Native Hawaiian culture places emphasis on the
unity of the individual with their environment.
To understand the connectiveness of the Native Hawaiian to health and
the environment, several key concepts are important:
Mana (spirituality)
Native Hawaiians believe that all things, animate and
inanimate, are interrelated by a creative force that is the divine power of the
gods. A Hawaiian’s oneness with spirits
and gods might be viewed as a part of the natural consciousness for the
Hawaiian, a second sense that encompasses every phase of sensory and mental
conscious.
Lokahi (harmony)
Native Hawaiians believe in harmony and unity. Lokahi is described as living in unity and
peace with oneself, the family, the gods, and the environment.
Ohana (extended family)
The family at-large, which may include extended family and
others who are regarded with affection.
A predominate social characteristic of a Native Hawaiian is a tendency
to see oneself in relationship with others as a contributing member of the
group, not as an individual.
Kokua (mutual help)
Mutual help and cooperation that contributes to group unity
by fostering cooperation, interdependence, and reciprocity (Braun, 1995).
Affiliation, or reliance on informal networks of family,
friends, and peers are important coping mechanisms when health problems
arise. Native Hawaiians are not
comfortable with bureaucratically organized services relying on defined lines
of authority (Hughs, Tsark, Mokuau, 1996). Unfortunately, the western
healthcare approach focuses on treatment for the individual, without context
for the family or community involvement.
This is in direct conflict with Native Hawaiian culture, as the
individual seeks to restore health by the kokua of informal networks and
traditional healing practices.
Health seeking behaviors are directly related to cultural
acceptability. Many Native Hawaiians
seek out traditional healers who use laau lapaau (use of herbs) and laau
kahea (use of prayer). These
traditional practices incorporate the unity of one with family and the
environment, which is consistent with the Native Hawaiian culture. However, because western medical practices are not culturally
sensitive, care is not sought out until non-western approaches fail. This becomes problematic as the patient
enters treatment at a latter stage of the disease process.
Health issues
Native Hawaiian culture is a source of pride for the State
of
Risk factors commonly associated with heart disease are
prevalent among Native Hawaiians (Aluli, 1991).
Hawaiians also suffer from higher rates of cancer when compared with
other minority groups. A 1985 Task Force
report by the Secretary of the Health and Human Services revealed that
Hawaiians have the highest rates of cancer of the female breast, endometrium,
stomach, and female lung (U.S. DHHS, 1985).
Mortality rates for all causes of death continued to be
highest for full-Native Hawaiians and part-Native Hawaiians when compared with
other minorities. The 1990 mortality
rates for Native Hawaiians increased from 1980, while other minorities
decreased their mortality rates (Braun, 1995).
The high levels of heart disease and associated risk factors
among Hawaiians may reflect limited awareness of, and limited participation in
prevention and treatment services. Low participation in health care services
does not necessarily suggest that Hawaiians do not care about their health. Rather, it likely suggests that the health
care system has failed to provide services in ways that are accessible and meet
the need of this population ( Mokuau, Hughs, & Tsark, 1995).
Accessibility and acceptability are important factors that either encourage or impede use of health care services. If health care is inaccessible and not culturally acceptable, people will not interact with the system unless they are in need of acute care.
You tell Kalani about the ecological and systems theory model
learned from Dr. Derauf, and begin to see a connection to understanding Native
Hawaiian culture. Unity with oneself,
family, and community; both view illness
as affecting the individual and environment.
Assessment of illness is based on the person’s individual coping
strengths, family and community involvement.
Treatment looks to restore unity by incorporating the family and
community to compensate for deficits due to illness.
An ecological approach was consistent with Native Hawaiian
values. The assessment consisted of
identifying sources of discord and strengths, while specifying the required
services (Pals, 1981). Assessment and
intervention (Pardeck, 1988) consisted of the following:
Entering the system
Meeting with Ke Ola Mamo and touring the community help you to understand the strength of Native Hawaiian culture and threat to its continuance by poor health rates.