HURT Final

• What do the terms "high blood" and "low blood" mean to US-born African Americans?

"High Blood" "High blood" refers to a condition associated with overly rich foods and reddish foods, such as beets, carrots, grape juice, red wine, red meat, and pork. Some African Americans believe a diet rich in these foods sends an oversupply of blood to the heart or brain, which is thought to raise pressure and clog them. Symptoms of "high blood" include "falling out (a sudden collapse in which the eyes usually remain open but the person cannot see), headaches, dizziness, and spots before the eyes. Natural remedies focus on lowering the pressure of "high blood" by opening the bowels to eliminate pressure and on thinning out the blood by opening the pores and sweating. Treatments include foods (many of them white in color), herbal teas, and laxatives. Remedies used in rural southern areas (where "high blood" may also be called "sweet blood") include "bitters," such as bullfrog urine mixed with garlic and onion. In urban areas, astringents such as vinegar, lemon juice, olive oil, pickle juice, garlic, and Epsom salts are common home remedies. "Low Blood" "Low blood" is associated with anemia; its symptoms are weakness, lassitude, and fatigue, and it is home-treated with iron pills and tonic. Some African Americans may confuse the folk terms "high blood" and "low blood" with the medical conditions of high and low blood pressure. Patients diagnosed with high or low blood pressure and given a long-term management plan may be reluctant to take medication indefinitely, fearing that too much medication for high blood pressure may thin the blood and cause "low blood" and vice versa. Caregivers must take pains to explain the condition of high or low blood pressure carefully, as well as the function of the prescribed medication. They might also reassure patients that long-term medication is necessary and will not result in the opposite condition.

• How would you characterize recent Russian immigrants with respect to age education, and language?

4ge-Distribution Effects A substantial number of immigrants from this region arrived in the United States when they were 65 years of age or older, and others, who had arrived at a younger age, are now in this age range. Recent immigrants from Russia, however, are younger and highly educated, and many know some English even before their arrival to the United States. These factors help them assimilate into American lifestyle more quickly than their elders. Though no statistics are currently available, this younger group will probably have a life expectancy similar to the majority population in the United States.

espiritismo

A Latin American and Caribbean belief that good and evil spirits can affect human life, such as one's health and luck

What part of Filipino culture is commonly demonstrated by both patients and Filipino healthcare workers?

A large number of Filipino immigrants work in the healthcare field. For example, 18 percent of Filipino immigrant women work as registered nurses, and 20 percent of all registered nurses in California are Filipinos (Rodis 2013). According to an article in Asian Week (Rodel 2013), Filipino women nurses migrated to the United States in three waves: (1) in the early years of the twentieth century, just after Philippine territory was transferred from Spain to the United States in the aftermath of the Spanish-American War of 1898 and the subsequent enactment of the Pensionado Act of 1903, (2) in the 1940s, shortly after World War II, and (3) in the latter half of the 1960s, when US immigration laws were relaxed. Many of these women were recruited because of a nursing shortage in the United States. More than any other immigrant group, Filipinos-men as well as women-are more likely to work in health care as practitioners, registered nurses, and in healthcare support positions (Stoney and Batalova 2013). Many Filipino healthcare professionals are fluent in English. Those who are not American citizens have obtained a qualifying score on the Test of English as a Foreign Language (TOEFL) exam prior to working in the United States. However, communication difficulties involving both non- Filipino staff and non- Filipino patients arise as a result of heavily accented English and cultural differences regarding respect for authority and passiveness in professional roles. Although Filipino healthcare professionals are trained in Western medicine, some traditional cultural beliefs may influence their responses to patients.

• Your Somali patient has been told to return to the office when their lab results come back. Why might this patient be upset?

A major issue in Somali health care is communication. One problem is that many Somalis do not speak English. A possibly greater problem is the difference in communication styles and expectations between Somali immigrants and US-born American healthcare workers. Because Somalis view health and illness holistically, a caregiver's question, "What brings you here today?" may involve a long story, starting from many years before, for which many efficient and hurried American physicians lack the time or patience to deal with effectively. Somali patients are accustomed to a healthcare provider who, after listening to their story, immediately prescribes a treatment. Somalis are impatient with and distrustful of American physicians who often designate many tests (some requiring a number of visits) before prescribing medication. Illness prevention and screening are not part of the Somali medical culture, where there is also no concept of chronic disease. Because disease is viewed as a symptom, many Somali patients have difficulty understanding a Western medical diagnosis of a chronic illness with a long-term pill-based treatment. Somali patients commonly discontinue medications as soon as symptoms disappear. It is not unusual for friends to compare or even share or exchange their medications.

• What are the CLAS Standards?

ABLE 1.1 National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care Statement of Purpose The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health and health care organizations to: Principal Standard 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. Governance, Leadership, and Workforce Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy, practices, and allocated resources. Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are responsive to the population in the service area. Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis. Communication and Language Assistance Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services. Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area. Engagement, Continuous Improvement, and Accountability Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organization's planning and operations. Conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality improvement activities. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to inform service delivery. Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the cultural and linguistic diversity of populations in the service area. Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent, and resolve conflicts or complaints. Communicate the organization's progress in implementing and sustaining CLAS to all stakeholders, constituents, and the general public.

• You are a foreign-born healthcare professional. What do you need to remember when communicating with American-born patients and colleagues?

Americans focus almost entirely on the words that are spoken and the order in which the words words. Americans use pitch at the end of a sentence to communicate and interpret -whether the message is a question, an order, a request, and so on. They may therefore misinterpret something said by a foreigner who has not mastered the complicated system of communicating in American English. Because the majority of Americans are mono-Meaning Drawn from Explicit Information lingual, many do not understand how long it takes Meaning Drawn from Contextual I to master a foreign language or how difficult it is to communicate effectively in another language

• Given the most recent census data what percent of American Indians and Alaska Natives live on federally recognized reservations and tribal areas

Approximately 5.2 million American Indians and Alaska Natives live in the United States, constituting 1.6 percent of the US population. The median age of the AIAN pu-lation is 31.3, and the US Census Bureau (2012) predicts growth to 8.6 million-or 2 percent of the total US population- by 2050. According to a 2010 census brief, the AIAN population increased at a rate nearly twice that of the general US population during the previous decade (Norris, Vines, and Hoeffel 2012). Although a discussion of the distribution of AIAN tribes is beyond the scope of this book, Figure 3. 1 provides a general picture of cultural types of AIAN peoples in North America at the time of European contact. The state with the largest proportion of American Indians and Alaska Natives is Alaska, where this group accounts for 19.5 percent of the state population. California, Oklahoma, and Arizona also have large AIAN populations. There are 566 federally recognized AIAN tribes, 325 federally recognized tribal reservations, and 618 AIAN legally recognized areas or villages. In 2010, 78 percent of the total AIAN population lived outside of these reservations or designated tribal areas (Norris, Vines, and Hoeffel 2012).

• To what is illness attributed within Haitian traditional medicine?

Approximately 80 percent of Haitians are Catholic. In recent years, conversions to oth forms of Christianity has become a trend, due in part to increased missionary work in - it; and in Haitian communities in the United States. In addition to belonging to a Christin: religion, many Haitians follow some of the practices of Voodoo. The belief systems of me ny Haitians are therefore a combination of Christianity and Voodoo. Voodoo is a belief in a powerful spirit world in which neglected ancestors, bad spirits, and zombies (living dead) bring misfortune to the living. There are a variety of Voodoo reli-sious practitioners, all of whom place significance on curing illness. These include readers or diviners; male Voodoo priests, called hungan or papaloi, and female Voodoo priests, called mambo; herbalists or leaf doctors; midwives, called matron or fam saj; bonesetters, referred to as docte zo; and injectionists, called pik irist. Some Haitians may wear a Voodoo amulet that may be mistaken as a Catholic charm. Although educated Haitians may have experience with modern health care and may understand scientific explanations for illness, many either follow traditional health beliefs or mix and match these disparate disease etiologies. Traditional Haitian folk medicine classifies any illness as either supernatural or natural. Causes and Cures of Supernatural Illnesses Supernatural illnesses commonly occur when one's connection to God is strained. Some also believe that illness is the result of a curse by a jealous neighbor or rival. Another cause of illness is when the person has offended an Iwa, or spirit, who then needs to be bribed or appeased. Supernatural healers are the healers of the highest status, generally called sorcerers, Voodooists, or root doctors, who are allowed to treat supernatural (magical) illnesses. The most powerful supernatural healers are those believed to have been selected by God at birth. The seventh child of the same sex, the first child born after twins, and any child born with "the Vail" or caul (amniotic membrane) are likely to have been chosen. These healers are generally treated with deference from birth and many have practiced healing since childhood. Reports of the details of Voodoo healing rituals are sparse, but one of the most important rituals involves the reading of animal bones. The bones (the source animal appears to be on the floor, and the healer interprets the arrangement. unimportant) are linked to physical attributes or body parts; the patient arranges the bones summarized in a blog by Kemp (accessed 2014) as follows: The names and descriptions of some supernatural culture-bound illnesses were • Pedisyon (perdition) is a common culture-bound illness in which a woman is thought to be pregnant but the flow of blood to the uterus is diverted to menstrual blood and the pregnancy is thus arrested. The belief is that this state (characterized by menstruation) may last for year until a cure is obtained and the pregnancy then resumes.

• What is the religion of the majority of Arab Americans?

Arab Americans are Christian.

• What are Bosnian beliefs and practices when they become ill?

Caregivers should use caution when discussing a serious illness directly with a Bosnian patient. As with many cultures in the world, in Bosnian culture, patients are never told that they have a life-threatening or terminal illness. Doing so is considered a death sentence-especially in the case of cancer. The family may be informed of the prognosis but should be consulted regarding how much information to reveal to the patient and in what manner. While caregivers in the United States might consider this a breach of patient physician confidentiality or a practice that robs the patient of autonomy, patient autonomy and sharing in medical decision making are unusual in most cultures outside the United States. A Bosnian patient may neither wish to be informed nor be ready to accept information regarding the seriousness of the illness. Family members will generally want to be present during the final moments of a patient's life.

What forms the basis for the Asian American's concept of health?

Chinese culture and ancient medicine have had a sipnificant influence on most cultures in Asia. Many aspects of Traditional Chinese Medicine, especially acupuncture, are now accepted- and sometimes practiced by those who have received the special training it requires - by American physicians. Acupuncture is also covered by some US health insurance policies. This section explains the concepts behind some of these ancient, but widely used practices. It is important to note, however, that the experiences and uses of traditional Chinese medicine by Asian immigrants and non-Asians who follow some aspects of the practices may differ greatly. The following health concepts are shared by most Asian groups.

• Compare and contrast the views towards death · dying, and refusal of treatment held by Christian Scientists and Jehovah's Witnesses. What about minor children?

Christian Scientists usually forgo life-sustaining treatments and instead choose to rely completely on God. In the same manner, they do not condone suicide, assisted suicide, or euthanasia; they believe God can cure all illnesses, including terminal illnesses, and a resignation to death denies a belief in that power. Autopsies are not forbidden and are suggested if a member of the church dies suddenly or without apparent cause. In the case of a natural death, church members prefer for female bodies to be handled by female attendants and for no autopsy to be performed. The Christian Science doctrines mention neither last rites nor special rituals regarding bodily remains. The choice of cremation or burial and any services to be performed is left to the family (Abbott and Gottschalk 2002). Jehovah's Witnesses Death and Dying Death is considered a termination of conscious existence. People who die before Armageddon will experience death as sleep, which will last only until Jehovah's call to rise from the tomb. While death is not welcomed, loyal Witnesses claim not to fear death because they believe in resurrection at Armageddon. Ethical and Legal Considerations Many caregivers are uncomfortable accepting Jehovah's Witnesses as patients. This is especially true for surgical procedures (including obstetrical procedures) and in oncology, where chemotherapy commonly produces anemia. Despite the conflict between the caregiver's medical pledge to do no harm and the patient's right to refuse treatment, the Jehovah's Witnesses' refusal to receive blood transfusions has resulted in many medical advances for avoiding the use of blood and blood products. When a mentally competent adult declines medical treatment, a court will not overrule this decision. If the patient is unconscious, and no information is available to suggest that a departure from standard emergency care is preferred by the patient, a transfusion should be administered if needed. If a family member refuses a transfusion for an unconscious patient whose wishes are not known, the caregiver should seek an emergency court order. In the case of children of Jehovah's Witnesses, the decision depends on the age of the child. The Family Reform Act of 1969 allows children over age 16 to make their own decisions; even so, caregivers should seek legal advice in these cases from an expert in medical law. In an emergency, a lifesaving transfusion may be administered to a minor without parental consent, but caregivers should ask two senior physicians to document the circumstances and need for the procedure.

• What lifestyle habits have caused health problems for older immigrants from Poland Russia, and the Ukraine?

Dietary and Cardiovascular Diseases Food plays a major part in the religious traditions and hospitality customs of Eastern European cultures, and many Eastern European immigrants continue to prepare food in traditional ways in the United States. The long and cold winters experienced by much of Eastern Europe inform the diet of this population, which is similar in Russian, Ukrainian, Bosnian, and Polish cultures. The harsh winters made root vegetables more available than leafy green vegetables, and their use in stews and heavy soups means that most of the nutrients are removed during cooking. The need to preserve food without refrigeration has made dried sausage and pickled meats, fish, and vegetables (which have high salt content) popu-lar. Many of the foods in these cultures are high in saturated fat. All Eastern European ethnic groups use large quantities of butter on bread, which is an important food for all groups. Although observant Russian Jews (and Bosnian Muslims) do not eat pork-a common meat in the Polish diet-chicken fat is used in Jewish cooking and lard is used in Polish cooking. While it is customary for Russian Jews to eat chicken (which is usually boiled with the skin on) and Poles to eat carp (commonly boiled or fried in lard) on Friday nights, the fat content and thorough cooking of vegetables is probably similar in both cultures. A high-fat diet, combined with a lack of regular exercise, especially for older members among Eastern European immigrants. of this population, contributes to the propensity for obesity, diabetes, and heart disease

Why is understanding of the Hmong culture and health beliefs important to healthcare professionals?

Each body part is essential to the entire body and, as such, each body part has a soul. Because the brain is the thinking center and protects the body, the anterior fontanel of an infant is considered sacred and may not be washed until it hardens. The Hmong as well as other Asian groups consider the head sacred. Casual touching of a person's head by others, such as an adult rubbing a child's head, is considered disrespectful and degrading. The soul, which is reincarnated, lies in the heart, which provides the body with blood and life. However, unlike in Western culture, the liver, not the heart, is the seat of emotions. One-half of the liver represents goodness and the other half badness. When the larger half of the liver represents goodness, the person is good-hearted, and vice versa. Hmong share the traditional Chinese belief that blood is finite and not replenished. Hmong, therefore, may oppose blood draws because they believe that loss of too much blood will make a person weak. It is important to note that certain Hmong phrases denoting parts of the body do not directly correspond to the names used in English. Medical oversights and errors can be avoided by making sure that a professionally trained interpreter is present during examinations.

What thing(s) is it important to consider when treating an AIAN patient?

Economic factors, knowledge about and access to herbs, and distance from medical care commonly influence the decision to seek home treatment. However, as more over-the-counter remedies become available at trading posts and cash-and-carry stores, these remedies are becoming more popular than herbal remedies for a wide number of symptoms.

• How should a patient's health beliefs and expectations be assessed?

Ensure information is easily accessible. ... Communicate in a way the patient can understand. ... Check the patient's understanding and let them ask questions. ... Show empathy and understanding. ... Be open to feedback

• What explains the growth of the Church of Jesus Christ of Latter Day Saints (LDS)?

Estimates of the number of Latter- Day Saints in the United States vary widely. The US Census Bureau (2012d) reported a little more than three million members in 2008. In contrast, the LDS Church reported a membership of almost six and a half million members (Church of Jesus Christ of Latter-Day Saints, accessed 2014). This discrepancy might exist because the LDS Church includes children in its count, and Mormon families tend to have larger families than other populations in the United States. The LDS Church is the fastest-growing Christian denomination in the United States. The growth is due in part to a high birth rate; the birth rate in LDS families is the highest among religions in the United States. Growth can also be attributed to the church's strong commitment to proselytizing (converting others to the religion). To this end, young men between the ages of 19 and 21 spend two years as missionaries, and young women spend 18 months conducting missionary work. Part of this missionary work involves proselytizing.

• Why is the ritual of female circumcision preserved by Somali women?

Female circumcision, also referred to as female genital mutilation, is a ritual female genital surgery that has received considerable attention in US medical literature in recent years. There are two types of ritual female genital surgery. Local custom determines the form and age when the surgery is performed, usually between birth and the age of eight. The two types of female circumcision surgery are: Excision involves the cutting or removal of all or part of the clitoris. Infibulation (or radical circumcision) involves excision as well as the suturing closed of the vaginal opening, leaving only a small opening for urine and menstrual blood.

In which Hispanic population is infant mortality greatest?

For some Hispanic populations, infant mortality is greater than for the general American population. For example, Mexican American infant mortality is 19 percent greater than for non- Hispanic Whites. For Puerto Ricans, infant mortality is more than twice that of non-Hispanic Whites. Puerto Ricans also had a higher rate of infant mortality for pre-term related causes (Mathews and MacDorman 2013).

If an AIAN patient believes in and practices tribal medicine. how might they respond to seeing a physician?

In general, most Asians do not seem to perceive a dichotomy between Eastern and Western medical belief systems. Many Asians hold the belief that some illnesses are best treated by traditional medicine (with roots primarily in Chinese medicine), while other illnesses are best treated by Western physicians. For example, Western physicians are generally consulted for problems involving dentistry, fever, allergy, eye problems, heart attack, stroke, surgery, diabetes, and cancer, whereas traditional physicians and herbalists are sought for asthma, arthritis, bruises, sprains, lumbago, stomach problems, and hypertension. It is also not uncommon for some Asians to use both Western and traditional! medicine concurrently to treat a single health problem. It is not unusual for an Asian patient to visit a Western physician for diagnosis and © treatment, and then, once the complaint has been diagnosed, to self-medicate with herbs and over-the-counter medications. Or, if the Western treatment does not bring immediate relief of the symptoms, the patient may seek the care of a traditional Chinese physician or herbalist. A Western diagnosis may also be rejected because it bears a negative prognosis, such as a diagnosis of a long-term illness or an illness that cannot be fully cured, or because surgery is advised. The traditional treatment may be implemented in place of the Western treatment or be used in combination with it; many Asian patients do not believe one must be chosen over the other. Many Asian patients do not disclose the use of traditional care and medications to their Western physicians because they believe the two medical domains- Western and traditional-are separate, though not exclusive, constructs. Another reason for nondisclosure is that they think the physician, who is viewed as an authority figure, might either lose face or disapprove of the use of traditional cures in addition to his treatment recommendations.

• What is the importance of religion to Russian-speaking Jewish immigrants?

In recent decades, differences between the American Jewish and Russian-speaking Jewish communities have become apparent. Russian-speaking Jews have been slow to assimilate into mainstream American life. Many Jewish immigrants from Russia, though ethnically Jewish, are unfamiliar with the Jewish religion and culture. To these immigrants, religion and faith are private practices and more connected to thoughts and feelings than to public actions and displays of prayer. These differences in the perception of what it means to be Jewish has caused Russian-speaking Jews to form their own communities thatThe traditional lifestyle of many Russian immigrants is not conducive to maintaining good health. The majority of people from the former Soviet Union consumed a diet high in fat and low in green vegetables and had no tradition of regular exercise. Although liquor consumption in the former Soviet Union contributed to a high level of liver disease, malnutrition, and cardiovascular disease -as well as mortality from accidents, poisons, and injuries - the majority of immigrants from this region have been Jews and Pentecostal Christians. Pentecostal Christians are forbidden to use alcohol or tobacco, and Jewish culture has always frowned upon the use of alcohol outside of religious rituals. Although very few Jews who grew up during the Soviet period are religious (because religious training was forbidden and atheism was encouraged), many dietary habits and restrictions are followed for cultural, rather than religious, reasons. Pork is forbidden and the kosher home--which also forbids the use of butter with meats (kosher laws forbid the use of dairy products and meat during the same meal)- has traditionally used chicken fat (known in Yiddish as schmaltz) as a substitute for cooking and for spreading on bread. Most families in the Soviet Union were three-generation families. The elderly served the important functions of scavenging for scarce food staples, standing in lines to purchase goods, cooking, and caring for children so both parents could work. Traditional eating habits were passed on by this older generation to subsequent generations.

• Where does the majority of Navahos live?

In the 2010 US Census, the Cherokee (including those of mixed race) were the largest tribal group (with a population of 819,105), followed by the Navajo. However, the Navajo had the largest percentage of non-racially mixed members (287,000 members); see Figure 3.3. The majority of Navajo live in the Navajo Nation, a reservation of 27,000 square miles of semi-arid land in the Four Corners area of Arizona, New Mexico, Utah, and Colorado. The following discussion illustrates the nexus of traditional Navajo beliefs and Western health care. Although traditional beliefs vary by tribe, this description of Navajo beliefs is intended to assist health professionals in understanding how beliefs may affect the health behavior of American Indians from other tribal nations as well. The Navajo were chosen as representative, partly because information on this tribe is readily available and partly because the Navajo who live on the reservation are more likely to adhere to traditional practices than are members of many other tribes. The Virajo cal themselves Diné, which means "The People" in the Navajo tribe language (lo 1993) Navajo society is matriarchal, built on the belief that a goddess known variously as First Woman, Spirit Woman, Whiteshel Woman, Thinking Woman or Changing Woman, created the universe. In Navajo society, women hold a higher position than men. According to tribal custom, the husband moves into the home oft wife's parents upon marriage. The extended family, commonly called a "camp, generd includes the senior married couple, their unmarried children, their married daughters, and the daughters' husbands. Traditional Navajo individuals must obtain permission dl the leading female elder before entering a hospital or undergoing surgery. A fundamental guiding principle of Navajo life is beauty, or hozho. Hozho encompasses the concept of beauty, blessedness, goodness, order, and harmony. It defines the traditional Navajo way of thinking and relating to others and the world. The principle of hozho guides everyday thought, speech, and behavior and shapes Navajo rituals and religious ceremonies. Traditional Navajo religion focuses on maintaining a harmonious relationship with al living things, including the land, one's farm, and ones community. Maintaining this harmonious relationship is essential to one's health; illness will result if one falls into disharmony, illness will result A person maintains balance and harmony with nature through both actions and word Really monitors the spoken word Because words not only describe the world but also create it, words must be chosen carefully. A as rule the Navajo may not seek medical care for a number of discomforts and acute illnesses for which a non- Navajo individual would most likely seek relief. Illness, like death, is simply viewed and accepted as a natural part of life.

• What are appropriate behaviors and expectations if a professional medical interpreter is in the room with your patient?

Interpreters shall be culturally competent, sensitive, considerate and respectful of patients they interpret for. Interpreters should maintain the boundaries of their professional role, refraining from personal involvement. Because of the large number of LEP immigrants in the United States, you will routinely provide services to patients who will not be able to communicate with caregivers without the assistance of an interpreter. Medical institutions that receive federal funding are required to (1) inform patients of their right to a trained interpreter and (2) provide an interpreter when needed, without any cost to patients. Interpreter services may be provided face-to-face, by telephone, or through video. It is now generally recognized that untrained interpreters, including family members (especially children) and untrained employees of an institution, should not be used to interpret medical information (see, for example, National CLAS Standard 7). Unfortunately, not all employees in healthcare organizations (including those in staff and management positions) understand the complexity of medical interpretation. Some may assume that any employee who speaks a patient's language is qualified to serve as an interpreter, which is not correct, even when an employee and patient share a primary language and cultural background. If you speak a language in addition to English, you may be asked to serve as an interpreter. While the law, as yet, does not prohibit such a request, employers have been advised of the dangers of using untrained staff members as inter-preters, regardless of their self-reported fluency in both the patient's native language and English. Medical interpreter preparation includes specialized training in medical vocabulary in both English and the other language(s) the trainee speaks, training in cultural competence, and training in how to effectively represent both patients and caregivers.

Why might an Asian American refuse to permit organ donation or allow an amputation?

It is not unusual for an Asian patient to visit a Western physician for diagnosis and * treatment, and then, once the complaint has been diagnosed, to self-medicate with herb and over-the-counter medications. Or, if the Western treatment does not bring immediate relief of the symptoms, the patient may seek the care of a traditional Chinese physician or herbalist. A Western diagnosis may also be rejected because it bears a negative prog-nosis, such as a diagnosis of a long-term illness or an illness that cannot be fully cured, or because surgery is advised. The traditional treatment may be implemented in place of the Western treatment or be used in combination with it; many Asian patients do not believe one must be chosen over the other. Many Asian patients do not disclose the use of traditional care and medications to their Western physicians because they believe the two medical domains -Western and tradi-tional-are separate, though not exclusive, constructs. Another reason for nondisclosure is that they think the physician, who is viewed as an authority figure, might either lose face or disapprove of the use of traditional cures in addition to his treatment recommendations.

• What health concern is common to both Iranian and Arab Americans?

Major Health Problems of Concern to Arab Americans Hypertension, high cholesterol levels, diabetes, and other health conditions associated with diet are the chief health concerns among Arab Americans. As with immigrants from other countries, the traditional Arab diet is nutritionally superior to the fast-food diet of many Americans. The traditional Arab diet includes a high proportion of fruits, vegetables, and unprocessed grains, and includes only a minimum amount of meat. The quality of this diet deteriorates with the length of time an Arab immigrant has been in the United States. Another contributing factor to health problems among Arab Americans is that life in an urban environment tends to be more sedentary than in the home country. Further, because of cultural stigmas attached to admitting to stress or personal problems, help is often rejected for depression and other psychological issues. There is also a tendency to ignore or cover up physical health problems for fear that an admission of poor health might hurt their children's chance of marriage. Health Problems and Related Issues Common to Iranian Americans In Iran, a number of health problems persist related to an underdeveloped economy, such as protein and vitamin deficiency, hepatitis A and B, tuberculosis, and syphilis. Consanguineous-or interfamily-marriage is routinely practiced in Iran and sometimes maintained by immigrants in the United States. Various health issues, such as epilepsy, blindness, anemia, hemophilia, hearing and vision impairment, and birth defects, have decreased due to an increased public awareness of the dangers of interfamily marriages. Beta-thalassemia (a blood disorder with symptoms that include anemia and skeletal abnormalities; affected persons require lifelong blood transfusions), once prevalent in northern and eastern provinces, is being addressed through premarital screening. Other common problems are vitamin B and folic acid deficiencies and Mediterranean glucose- 6-phosphate dehydrogenase deficiency, a genetic disorder that mostly appears in males.

Mal de Ojo

Mal de ojo (evil eye) is an illness-causing spell commonly cast on a child--without touching him-when a person with the evil eye greatly admires the child. Children are often protected from mal de ojo with special earrings, necklaces, amulets, or other jewelry, which should not be removed from the child's person during examinations. The most common treatment is prayer and sweeping the child's body with a mixture of eggs, lemons, and bay leaves- a treatment called limpia in Mexico and barrida in Puerto Rico. This process is also used to diagnose the spell.

• What has happened to the life expectancy of people from Soviet Bloc countries since the fall of the Soviet Union in the 1980s?

Male life expectancy at birth in Russia fell by six years between 1991 and 1994, from an already-low 63.4 years to 57.4 years over that period, an almost unprecedented decrease in life expectancy in three years. 1 Female life expectancy followed a similar but less extreme pattern, falling from 74.2 to 71.1 years

• Why do many Polish American patients refuse pain medication?

Many Polish immigrants have great trust in "natural" medications and may use them in addition to what American physicians or other caregivers prescribe. To avoid double-dosing with a combination of natural and prescribed medications, healthcare professionals must carefully question patients regarding their use of herbal and other forms of medications. Strong religious faith supports a belief in the supernatural healing powers of persons and sanctuaries. One of the most famous sanctuaries is the icon of the Virgin in St. Mary's Church in Czestochowa, Poland. This icon is surrounded by crutches and other offerings that have been left by crippled pilgrims who supposedly walked away whole and healthy again. Important indications that a Polish patient, especially an older Polish patient, may hold a strong belief in spiritual healing and supernatural powers are religious medals pinned to the patient's undergarments. These should not be removed or ridiculed but should prompt careful questioning regarding the patient's view of the cause of illness and what he has been doing or taking to treat the problem.

• Why might Ukrainian immigrants have a difficult time finding jobs in their professions?

Many Ukrainian immigrants are well educated: 19 percent finished high school, so.1 percent have some college education or hold an associate's degree, 22.2 percent have a bachelor's degree, and 18.7 percent hold a graduate or professional degree (Robila 2007). About 19.7 percent of Ukrainians did not complete a high school education. Regarding English-language skills, 95.2 percent of Ukrainian immigrants speak a language other than English at home and 65.7 percent speak English less than very well. Thus, despite their generally well-educated background, the lack of English-language skills for many Ukrainians makes it difficult for them to find suitable employment and to assimilate into American society. In fact, 26.2 percent of Ukrainian immigrants live below the poverty level (Robila 2007). Ukrainian immigrants also have problems understanding and navigating the American healthcare system, and both Ukrainian and Russian interpreters should be available in healthcare facilities located close to Ukrainian communities.

• When keeping medical records for Hispanic patients which family name should be used?

Most United States forms require a single first, middle, and last name. However, the last, or final, family name listed on (for example Mexican birth certificates and other official papers in Mexico is not the primary (father's) family name but the mother's family name. The name by which a person is addressed in a formal situation is the father's family name, which is the first family name listed on a birth certificate. For example, consider a man named Jorge Victor Ortega Castro. His first name is Jorge, his second given name (or middle name is Victor, his father's family name is Ortega, and his mother's family name is Castro. The proper way to address him is Señor (Mr.) Ortega. Next, consider Mr. Ortega's wife-to-be, whose legal name (on her birth certificate) is Luisa Mara Piñeda Ruiz. Her father's family name is Piñeda and her mother's family name is Ruiz. She may (but not always) be addressed as Senorita (Miss) Pineda. When she marries, she may drop her mother's family name, continue to use her father's family name, and demonstrate that she is married to Mr. Ortega by placing the word "de" (of) before her husband's family name. If she adopts this custom, when she marries Señor Ortega, she would be addressed as Señora (Mrs.) Piñeda de Ortega. Today, fewer women are adopting this traditional naming approach. For example, it is now more customary for women not to add their husband's name to their name, but to retain the name that appears on the birth certificate (the father's family name). Thus, in Latino culture, some husbands and wives use two different family names. If Jorge Victor Ortega Castro and Luisa Maria Pineda Ruiz have a child and name her María Caterina, the child's legal name would be María Caterina Ortega Pineda and her correct form of address would be Señorita Ortega. When entering Latino names into a medical database, which does not provide for more than one first and one family name, the paternal family name should be used. Because this system of naming has not always been understood by American healthcare workers, the mother's family name has sometimes been mistaken for the "last" name (in WS terms) because it the final listed name of what may seem to be a daunting number of names. Thus, many Latinos are listed two or more times in American healthcare databases: nonce under their primary or paternal family name and once under the name that is listed last. In effect, one person becomes separate people in a medical database. Further complicating record-keeping and forms of address, in Mexico a person is commonly known

• What religion are the majority of Bosnian immigrants to the US? How devout are they to their religious practices?

Muslim Social Structure and Family Values All Bosnians, regardless of religion or ethnicity, place a high value on family, strong friend. ship networks, hospitality, and land ownership. In the family, the husband is considered the head of the family, although urbanization and the ability (and need for women to work outside of the home has led to more shared responsibility in family decision making. In rural areas of Bosnia, it was common for three generations to live in one household, with grandparents playing an active role, freeing both parents to work in the fields or outside the home. In urban areas, however, the nuclear-family system was more common because of the lack of space in urban apartments. Customs for dating and marriage are much the same for Bosnians as for Americans and other Europeans, with one exception. Traditionally, Bosnian Muslim newf/weds nasvedia with the husband's family so that the mother of the groom could train the bred moved in her new husband and the family they were expected to produce. During the Soviet period, when religion and ethnic affiliation was deemphasized, many mixed marriages occurred.

• Why might you need a professional medical interpreter to communicate with an Amish patient?

Nurses and nurse practitioners working in Amish communities recommend being flexible in modifying standard practices and policies to accommodate the Amish lifestyle and beliefs. Caregivers need to be aware that the Amish will only accept treatments they feel are consistent with their beliefs and will not hesitate to discontinue treatments they consider inappropriate and seek care elsewhere. The eighth-grade educational level of most Amish should be taken into consideration when advising patients and giving medical instructions. Caregivers who work in Amish communities recommend relying on clinical skills and judgment in order to avoid tests they might order when standard practices are followed. Because of the Amish community's distrust for mainstream American approaches, caregivers should also try to participate actively, both professionally and as a citizen, in community activities, such as selling quilts and attending church picnics. Because the Amish speak a form of German as their first language, an interpreter may be required to help Amish patients communicate with caregivers.

• What is the main reason that some African Americans do not comply with long-term drug treatments?

Patients who are told that they must take a particular medicine for life (for example, for hypertension or diabetes) may not comply because they are concerned that the true cause of the illness has not been identified and that the medicine is only a cover-up for the physician's uncertainty about a cure. They may also fear that too much medication for one illness may tip the balance in the opposite direction; for example, a patient taking medicine for high blood pressure for too long may begin to suffer from low blood pressure.

• To what ethnic group do the majority of Iranians belong and where is their origin? What is their primary language?

Persian, the predominant ethnic group of Iran. he Persian people are united by their language, Persian (Farsi),

• How have pregnancy and childbirth practices changed for many Ethiopian immigrants?

Pregnancy and Childbirth Pregnancy is not discussed in Ethiopia until it is noticeable, and it is considered the role of mothers, other female family members, and female friends and neighbors to assist with pregnancy and childbirth. Women commonly go to the home of their parents in the eighth month to relax and await labor and delivery. Warm foods are eaten during pregnancy and postpartum because they are thought to aid healing. Although many Ethiopian women from urban settings have experience with vitamins during pregnancy, many rural women may resist this common American practice. These rural women believe that vitamins will contribute to the growth of the baby. Because small babies are easier to deliver, which is considered a benefit during the birthing process, some Ethiopian women will avoid vitamins. In Ethiopia, men are absent during the birthing process; in contrast, in the United States, they commonly attend childbirth classes and are usually present during labor. Although circumcision was considered mandatory for both male and female children in the past, female circumcision, as a cultural ritual, is becoming less common in Ethiopia. There is a general understanding among Ethiopian immigrants that only male children can be circumcised in US hospitals.

• Why is teenage pregnancy a problem in Somali communities?

Pregnancy is prevalent among Somali teenage girls. One reason for this is the taboo nature of discussing sexuality in Somali culture. Also, many young Somali girls are sexually active even though the culture dictates that sex be reserved until after marriage. Because birth control methods are little known or used by Somali teenagers, there is a high rate of abortion.

• Within the traditional Hispanic health and illness belief system how are pregnancy, hypertension, and diabetes viewed?

Pregnancy is viewed as a family event and the pregnant woman may arrive at office visits with her mother, sister, aunt, cousin, grandmother, or close friend. Pregnancy is largely women's business. Don't be surprised if her partner is not present - this doesn't mean he is not supportive of the pregnancy.

Where in the western hemisphere was the first medical school established?

Salerno, Italy

• How would you best assess the skin of an African American patient?

Skin assessment is best done in indirect sunlight. Pallor (pale skin, due to shock or loss of consciousness) may be identified by an absence of underlying red tones: brown skin tends to appear yellow-brown, and black skin tends to appear ashen. Erythema, or redness of the skin, can be detected only by palpitation. The skin is warm, tight, and edematous (a swollen condition, due to fluid concentration) in the inflamed area. Deeper tissues are hard. Cyanosis, a blue or purple coloration of the skin due to low oxygen content, may best be observed in facial skin, the earlobes, the nail beds, and around the mouth.Pressure applied to the nail beds or earlobes can be used to determine normal or slow return of color. Jaundice (a condition in which skin and the whites of the eyes show a yellow discoloration due to bile, which is secreted by the liver) can be seen in a generalized yellowing of the sclera (whites of the eyes. Because the normal yellow pigmentation found in individuals with dark skin pigmentation tends to be concentrated in the inner and outer canthi (corners) of the eyes and in the stool, blood tests may be needed to confirm the presence of jaundice.

• What does the Indian Health Service do for all American Indians?

So tie Very he live approaches to health and illness are viewed as distinct but complementary. It is perfectly acceptable for a person to consult a Navajo diagnostician to idlertier the cause of a disease and to arrange a ceremony to eliminate the cause, as wed as to consult a physician to alleviate the symptoms of the disease. Similarly, it is not uncommon for some Navajo to insist on holding a traditional ceremony or ritual before undergoing surgery or treatment at a reservation hospital. An important distinction is that while a traditional Navajo diagnostician or healer may advise the ill person to seek treatment from a physician, the reverse is rarely the case. In 2008, USA Today (Haupt 2008) published a story about the effort at Page Hospital in Page, Arizona, to accommodate the health beliefs of their Navajo patients, who constitute as many as 50 percent of their patient population. The hospital is located close to the Navajo reservation. Not only does the hospital have a medicine man on site, but it also has an on-site hogan, the traditional building used by the Navajo for ceremonial purposes. Before opening the renovated emergency building, the hospital held a traditional Navajo blessing ceremony to make their Navajo patients feel safer using that facility. The hospital also has made accommodations in keeping with Navajo childbirth traditions, such as women in labor are allowed to invite family members into the birthing room, a medicine man may offer prayers and administer herbs to ease the birth, and hospitalstaf will save the placenta so it can be buried at the four corners of the home (Haupt 2008). Various agencies have recommended this approach to improve the behavioral health of American Indians and Alaska Natives. Full traditional Navajo ceremonies and rituals- which may last from five to nine nights and commonly involve hosting large numbers of guests -are becoming increasingly infrequent. the number of qualified medicine men and women has also declined in recent years, largely because many years of training and apprenticeship are needed to learn each major ceremony (as many as eight years for some ceremonies). Most ceremonialists, therefore, limit themselves to performing only two of these major ceremonies.

• How is illness viewed in the Somali culture?

Somalis do not feel comfortable discussing their feelings with healthcare providers. Patients who feel that their illness might have been caused by someone cursing them will usually not disclose this to a healthcare worker. Although anxiety, depression, and post-traumatic stress disorder (PTSD) are common among Somali immigrant patients, mental illness is considered a disgrace and is only reluctantly revealed.

Your patient is a male Sikh. What religious beliefs are important to remember?

The Sikh religion has one of the largest followings in India. As with Indians of other faiths, many Sikhs who have come to the United States continue to follow their religious beliefs. Sikh men wear a dastar or pagri (a turban that consists of wound cloth), a kirpan (a piece of cloth worn on the chest), a kanga (a wooden comb), and a kara (an iron bracelet). For Sikhs and other religious groups, such as Hindus and Muslims, items worn for religious purposes should never be removed without first obtaining permission. The Sikh religion forbids Sikh males to cut or shave any body hair (although some Sikh men, especially younger men, do trim their beards). The taboo against shaving body hair runs against the Western medical custom of shaving a surgical area prior to surgery to reduce the possibility of infection. When preparing male Sikh patients for surgery, the area should be cleansed without removing any body hair whenever possible. In cases where removal is absolutely necessary, this must be carefully explained to both the patient and his family and permission should be Traditional Cultural Practices: Sikh men with and turbans. Some Sikh men now trim their obtained beforehand.

• What aspects of American culture influence the healthcare expectations of mainstream American patients?

The United States has always been known as a nation of immigrants. Before nationhood and during the first century after the colonies declared independence, most immigrants in the region that became the United States were from Northern and Western Europe, particularly Great Britain. These immigrants brought with them cultures that shaped the behavior, language, communication style, values, worldview, work ethic, and institutions of the White Caucasians (non-Hispanics) whose culture is generally referred to as mainstream American culture. The use of mainstream to describe the culture of those with European ancestry is not intended to express an opinion that one culture is superior, nor is use of the term meant in a pejorative manner. It serves merely as a reference point for much of what is discussed in this book.

• How has the life expectancy of African Americans changed in recent years?

The cultural factors include lifestyle and dietary habits. Life expectancy for African American males is 71 years, and for African American females, it is 78 years, as compared to 76 and 81 years, respectively, for White Americans (Hoyert and Xu 2012).

• Why would a Greek Orthodox mother spit upon receiving a compliment of her newborn?

The spitting gesture is supposed to ward off the evil eye and jealous people who would wish you harm.

• Compare and contrast the view towards blood transfusions held by Christian Scientists and Jehovah's Witnesses.

Transfusion and Organ Donation Devoutly religious Orthodox members may not accept organ donations or readily consent to autopsies because they believe in the physical resurrection of the body and a need to respect and honor the body. Likewise, members typically do not authorize cadaver dona-tons for science because they believe the integrity of the human body should be respected for burial. In contrast, there are no restrictions on blood transfusions. JW Blood Transfusions, Organ Donation, and Informed Consent Blood transfusions are forbidden, but "the use of blood fractions, such as clotting factors, immune globulin, interferon, platelet-derived wound-healing factor, and serum made with a blood fraction" as well as hemodialysis, if no blood prime is used, is left to the individual patient's decision (Loma Linda University Health System, accessed 2014, 11). The refusal to accept blood transfusions is a distinguishing trait for Jehovah's Witnesses from the standpoint of health care (Simpson 2002). Because of their literal interpretation of the Old and New Testaments and the references in Genesis and Leviticus prohibiting the consumption of the blood of life, Jehovah's Witnesses believe that blood transfusions are sinful and may lead to the ex-communication of the blood recipient. Excommunication renders a person to exist in a state of eternal damnation. Many Jehovah's Witnesses carry advance directives prohibiting blood transfusions, and many hospitals have specific consent forms for these patients that detail specific exclusions from the refusal. Milligan and Bellamy (2004) recommend that individual patients be interviewed in the presence of independent witnesses and informed of the benefits and possible hazards of a blood transfusion in their particular cases. Caregivers should then carefully document any refusal. A number of blood-conserving treatments are allowed. Medical research has resulted in alternatives to blood transfusions that are acceptable to Jehovah's Witnesses. Examples of these acceptable treatments include laparoscopic surgery, prompt action to stop bleed-ing, and blood recycling by cell-salvage techniques (Milligan and Bellamy 2004). Although Jehovah's Witnesses are prohibited from receiving blood transfusions, the religion does not comment on the donation or receipt of organs. Individuals are allowed to donate and receive organs, but the procedure must not involve a blood transfusion. During surgical procedures, surgeons should attempt to limit blood loss. Various pharmacological agents are available to help reduce blood loss in the surgical setting.

• What are the beliefs involved with voodoo and by whom is it practiced?

Voodoo is a belief in a powerful spirit world in which neglected ancestors, bad spirits, and zombies (living dead) bring misfortune to the living. There are a variety of Voodoo religious practitioners, all of whom place significance on curing illness. These include readers or diviners; male Voodoo priests, called hungan or papaloi, and female Voodoo priests, called mambo; herbalists or leaf doctors; midwives, called matron or fam saj; bonesetters, referred to as docte zo; and injectionists, called pik irist. Some Haitians may wear a Voodoo amulet that may be mistaken as a Catholic charm.

• Why are pregnant Egyptian American women discouraged from exercising?

When a woman becomes pregnant, she is discouraged from exercising because of a fear of miscarriage (A. Meleis and M. Meleis 2013).

• Why do some Arab Americans wrap an infant's abdomen at birth?

When postpartum depression occurs, female family members assume the woman's responsibilities for the children and the rest of the family. The mother is simply told that she needs more rest and help. It is customary to wrap the baby's stomach at birth to protect the child from "cold" or wind, which is thought to enter the child's body through the stomach. Sometimes the Muslim call to prayer is whispered into the baby's ear. Circumcision of the male child is required by Muslim law.

• How long have Polish immigrants been coming to the United States?

between 1820 and 1940 approximately 400,000 the first wave arrived between the 1800s and 1914

bilis

bilis is an illness believed to be caused by strong emotions that result in an imbalance of bile, which "boils over" into the bloodstream. Symptoms include vomiting, diarrhea, headaches, dizziness, and migraine headaches.

What are the top three causes of death for the Asian American population?

cancer heart disease stroke

What Asian health practices could give the impression of physical abuse?

coining and pinching cupping moxibustion acupuncture

health and wellness of the mind

diagnosis of illness is considered supernatural or spiritual, where illness can be brought on by a curse or sorcery or nonobservance of a religious ethic. Illness overall is seen as one's own fate and hospitalization may be seen as a sign of impending death.

embrujado

embrujado (roughly translated as "bewitchment") is a socially accepted psychological disease (in contrast to being considered "mad"). Embrujado may be manifested through physical or psychological illness, depending on the intent of the bewitcher, who is usually female. Some researchers have suggested that embrujado may be a culturally accepted behavior for males who cannot cope with the mainstream American world.

death

merican Indian and Alaska native have 1.6 times the death rate of non-hispanic whites. According to the CDC , the 10 leading causes of death among American Indians and Alaska Natives are the following: Heart disease Malignant neoplasms Unintended injuries Diabetes mellitus Chronic liver disease and cirrhosis Chronic lower respiratory diseases Stroke Suicide Influenza and pneumonia Kidney diseases of nephritis, nephrotic syndrome, and nephrosis (Nephrotic syndrome is a group of symptoms that include protein in the urine, low blood protein levels, high cholesterol levels, high triglyceride levels, and swelling of the face, arms, and legs, or abdomen. Nephrosis refers to renal diseases.)In addition, the CDC lists other health issues of the AIAN population, such as teen pregnancy, infant mortality, HIV/ AIDS, obesity, mental health, alcohol abuse, and tobacco use. The CDC also points out that although the Indian Health Service (IHS) is responsible for providing health care to members of recognized tribes who live on reservations, a large percentage of this population does not reside on reservations and therefore has limited access to health services. The CDC attributes poverty, geographical isolation, and cultural barriers as major contributors to AIAN health problems.

• What are the beliefs of Orthodox Jews towards food?

rowish dietary laws, or kashrut (the state of being kosher), are strictly followed bv all Jentrodox Jews but rarely by Reform Jews. Conservative Jews vary in how strictly they olow the rules of kashrut Keeping kosher requires all food to be prepared in a kiichen hat is kosher and to be served on dishes that are Kosher. To be kosher, meat must come from an animal that has loven hooves and chews its cud. Beef, lamb, and chicken can be kosher if killed according to Jewish law. Meat derived from pigs is never kosher. A special butcher called a schochet must slaughter an animal in a prescribed fashion for its meat to be kosher. The meat must be kashered (soaked and salted) to remove blood, and only certain parts of the meat can be eaten. There are also rules governing fish. Fish must have fins and scales to be kosher, which means that shellfish, such as shrimp, lobster, scallops, and clams, is not kosher. Because of the strict regulations regarding the slaughtering and preparation of meat, many Orthodox Jews will not eat meat unless it is prepared by someone they know personally. They may also refrain from eating fish in nonkosher restaurants. Kosher Jews do not drink milk or eat dairy products at the same time that they eat meat. The amount of time they must wait between dairy and nondairy consumption can vary from three to six hours. In kosher homes, separate sets Beth Israel Synagogue, Milwa of dishes and utensils are maintained for meals that involve meat products and dairy foods. It is important for caregivers to understand the degree to which these rules are observed by their patients. If kosher food is brought to a patient by family members, it cannot be heated in institutional appliances or served on institutional dishes. Kosher Jewish patients will normally seek care in a hospital set up to serve kosher meals, but those who find themselves in a nonkosher facility may order vegetarian meals to avoid issues.

susto

shock, fright, or soul loss is a disease that can attack anyon . regardless of gender, age, racial group, or economic status, and is believed to result from a series of over-whelming events that causes the soul to become dislodgedand escapeee from the body

What body part(s) are sacred in many Asian cultures?

the entire main three important things to remember about social etiquette in Southeast Asia are heads, hands and feet. The head is considered the most sacred part of the body, so touching someone's head is very insulting.

health and wellness of the body

yIn and yang (or hinese word, the concept exists in and um jangilkies. Forexan vin and yangare Chined as an- diwong in Vietnamese and um yang in Korean. Vin, whit. the concepts express dark cold, and feminine side afags, must rennang uhich ерео. the positive, bright, warm, and masculine side of all things, must remain in balance are harmony. When vin and yang are out of harmony, disease and catastrophe occur. a The conceprofyinand yang is sometimes shown symbolically as a circle, as shownin Figure 43. In the figure, the white part of the symbol represents yin. The black part ofthe symbol represents yang. The black cirdle within the white portion and white circle within the black portion reflect the belief that all yin has a component of yang and all yang hasa component of yin. The theory of vin and yang permeates almost every aspect of the Asian wetidview; including lifestyle, values, health, and illness. According to this theory, era acet of life and nature is made up of opposite but comciotentary forces IGURE 4.3 A Yin and Yang Circle that do not exist apart from one another. Bessage everything that is yin has a small amount of yang in it, and vice versa, Asians tend to view things in shades of gray rather than as absolutes. Sometimes this makes it difficult for Asians to accept a Western diagnosis of a single cause of a complaint or to rely on a single form of medical treatment or cure. Traditionally, most groups from Asia define health as the harmonious balance between the forces of yin and yang and the corresponding conditions of "hot" and "cold.? Illness is attributed to an upset of this balance and can be cured only if the balance is restored by decreasing the excessive trait or increasing the deficient one. Most traditional medical investigation involves a search for imbalances within the patient's physical and mental self, and treatment focuses on the restoration of balance.