understanding indian health culture

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Culture and Health: Understanding Indian Health CultureArindam Basu MB BS MPH PhDSchool of Health Sciences, University of Canterbury,Christchurch, New Zealand,arin.basu@gmail.comOutline of the PresentationSouth Asian/Indian Health CultureHealth Profiles of South Asians/Indian Immigrants in NZCommunication and UnderstandingSouth AsiaIndia and Neighbouring Countries (India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, Maldives) Total Population ~ 1.7 Billion

About 9 Trillion US Dollar Economy

Major Languages and ReligionsHindi, Bengali, Urdu, Punjabi

Worlds second largest English Speaking Country

Diversity of religions - Hinduism, Islam, Christianity, Buddhism, Sikhism,

Distribution of Death and Disability Adjusted Life YearsInfectious, Cardiovascular, Neonatal, Respiratory, and Behavioural Diseases are Top 5 Serious Risks in IndiaDistribution of DALYs from Noncommunicable, Communicable, and Injuries in India, 2012 In India, currently, death and disability from noncommunicable diseases have exceeded the mortality and morbidity from communicable diseases; the burden of injuries is still low. Organisation of Health Care Services in India. Note that patients may have several pathways of entry and interacting with the system

An Indian Drugstore: patients or patient party submit prescriptions that are then filled and refilled and given back to the patients or their caregivers

A Prescription by an Indian Doctor within India on his writing pad: this sheet is for the patients to keep

Other Systems: HomeopathyIn addition to Western Medicine, Indians also rely on Homeopathy, Ayurvedic, Unani, and other systems of health services, here a homeopathy clinic face is shown.

An Ayurvedic procedure named Shirodhara is being conducted on a patient - I am not sure what that means or why that is done.

A Unani procedure named Turkish Bath is being done on a patient

Moving from India to New Zealand

Healthy Migrant EffectBetter quality of health of the first generation migrants compared with natives in the countryPossible causes - selection bias, medical tests during immigration and visa proceduresThe effect dissipates in about 10-15 years of adoption in the new country in some cases

Patterns of Indian Immigration (Auckland Region, 2004-2011)

Causes of Potentially Avoidable Hospitalisations among Indian Immigrants in Auckland Region, 2008-2010

Pattern of Medication Dispensing to Indian Immigrants in the Auckland Region, 2010-2011

Profiles of Health Behaviours of First Generation Immigrant Indians in NZ (2012 Auckland DHB Report)Lower Prevalence of Fruits and Vegetable IntakesLow Prevalence of Physical ActivitiesHigher Prevalence of Adult Obesity

Image Courtesy: http://www.cadiresearch.org/wp-content/uploads/2011/10/052-Fig.jpg Patterns of Health Services Utilisation among IndiansHigh Coronary Procedure RatesHigh Needs for Dispensing of Pharmacotherapy for CVDHigh Care Plus or Chronic Disease Management EnrolmentHigh Proportion of Diagnosed Diabetes who receive annual reviewsBut also healthy migrant effectsBarriers: Access to Health ServicesLanguage related barriersLack of Knowledge about NZ Health SystemCultural Differences in Assessment and TreatmentLack of Cultural Competency among Caregivers

What can be done?Develop Cultural CompetencyUnderstand the health practices among Indian immigrantsBeing Visual or Using Visual Methods May WorkSkills of working with support persons or guardiansNonverbal messages of reassurance and good eye contact

2006 Statement on Cultural Competence (Medical Council of New Zealand)A Useful Resource

Continuum of Cultural Competency

[source: http://www.asianhealthservices.co.nz/documents/Publications/bestpracticeCALD.pdf]

Source: http://www.asianhealthservices.co.nz/documents/Publications/bestpracticeCALD.pdfCompetencyInstance of Competency ActionsCultural DestructivenessGenocide/Ethnocide, Forced AssimilationCultural IncapacityLowered Expectations, Unchallenged Stereotypical BeliefsCultural Pre-CompetenceDelegate diversity work to others, false sense of accomplishment, inconsistent policiesCultural CompetenceAdvocacy, on-going education, equal access is NOT equal treatmentCultural ProficiencyInterdependence, Fight social discrimination, advocate for social diversityUnderstanding Health Practices among Indian ImmigrantsExample: Patients can use a mix of traditional Indian medical practices and modern medicine.

A big problem is the management of burns. Application of toothpaste was common when I worked in Birmingham and it is also fairly common here to find toothpaste applied to burns and scars. Its not a good idea, you have to take it all back off again. They need to know how to cool it with water and use lint free dressing, cling film perhaps...Turmeric is a popular one as well, on cuts and grazes (nurse 7).

[SP Taylor, C Nicolle, and M Maguire. Cross-cultural communication barriers in healthcare. Nurs- ing Standard, 27(31):3543, 2013.]The Power of VisualMedication was also prepared in Dosette boxes for patients as required by the (UK) Equality act 2010 to make it easier for them to remember to take their medication and to confirm, visually, whether or not they had taken the dose for the time of the day:Visually, it looks much easier than popping something out of a blister or opening a bottle and taking something out and reading a label (Pharmacist 3).

Source: SP Taylor, C Nicolle, and M Maguire. Cross-cultural communication barriers in healthcare. Nursing Standard, 27(31):3543, 2013.In Summary India and South Asia is a complex region with several different ethnic groups, languages and culturally diverse communitiesMigration from the Indian subcontinent to NZ is increasingCultural Competence to interact with patients from the Indian subcontinent will benefit all concernedIndividuals from the Indian Subcontinent have characteristic health needs and barriers to access, some of them have cultural nuancesUnderstanding language barriers, use of visual cues, and others can be beneficial