HEALTH ADVOCATES Issues in Immigrant and Cross-Cultural Health Course Syllabus € Spring 2001 The Course Issues in Immigrant and Cross-Cultural Health is designed for health care professionals and students who anticipate working in the U.S. with patients and clients whose country of origin, language, customs and values may differ from their own. The course is open to anyone interested in immigrant and cross-cultural health issues, but it will be particularly useful to physicians, nurses, and allied health professionals, as well as to professionals in public health, mental health, and social work. The course draws upon the collective knowledge of many local professionals with extensive experience in immigrant and cross-cultural health. Sessions on topics such as immigrant demographics in Minnesota, epidemiology of diseases and conditions that are more prevalent among immigrants, and effective use of medical interpreters, will be paired with descriptions of specific immigrant communities in Minnesota. Many classes will be supplemented with handouts and recommended readings, videotapes and in class activities. This syllabus outlines the course's schedule of classes, describing their content and learning objectives. Sponsors Issues in Immigrant and Cross-Cultural Health is presented by Health Advocates, Community Health Consultants, in collaboration with the Center for Cross-Cultural Health and the Refugee Health Program of the Minnesota Department of Health. Health Advocates is a partnership of health professionals offering consulting services in training, research, communication and program planning to community organizations. Course coordinators are Patricia Ohmans, MPH, and Barbara Babbitt, RN, MA, both consultants with Health Advocates. They can be reached at 651-489-4238, or by e-mail at pohmans@tc.umn.edu (Patricia) and bab@intknowsys.com (Barbara). Time and Place This year's course is offered on Tuesdays, for nine weeks from March 27 through May 22, at the Minnesota Department of Health Service Center, 1645 Energy Park Boulevard, Saint Paul. Free parking is available in front of the building. Accreditation Issues in Immigrant and Cross-Cultural Health has been designed to meet Minnesota Board of Nursing continuing education requirements, and may in some cases be used to fulfill elective credit requirements in both undergraduate and graduate programs of the University of Minnesota and other colleges and universities. Course Schedule Session One March 27 Background and Overview History of Immigrant Health Barbara Babbitt and Patricia Ohmans Demographics of Immigration Ann O¹Fallon Session Two April 3 Trauma and Its Impact on Health Kathi Antolak The Health of Refugee Children Mirjana Bijelic Session Three April 10 Essentials of Cultural Competence in Health Care Patricia Ohmans Language Interpreting in Health Care Ellen Rau Session Four April 17 Cross Cultural Issues in Mental and Spiritual Health David Berg Session Five April 24 Prevalence, Prevention and Treatment of Chronic Disease in Immigrants Phua Xiong Chronic Disease in Eastern European Communities Asya Fridland Session Six May 1 Prevalence, Prevention and Treatment of Infectious Diseases in Immigrants Infectious Disease in Latino Communities Miguel Ruiz Session Seven May 8 Public Health Education Strategies for Immigrant Communities Diana DuBois Reproductive Health Issues in Somali Communities Qamar Ibrahim Session Eight May 15 Immigration Law and Its Effect on Health Julie Zimmer Social Adjustment and Health Xong Mouacheupao Session Nine May 22 Ethical Issues in End of Life Care Dorothy Vawter Cross-Cultural Issues at the End of Life Okokon Udo Class Descriptions Session 1 March 27 Course Overview Barbara Babbitt, RN, MA History of Immigrant Health in Minnesota Patricia Ohmans, MPH Demographics of Immigration and Health Ann O¹Fallon, MPH Our first class provides a time for introductions, as well as a quick overview of the course content and structure from course coordinator Barbara Babbitt. Co-coordinator Patricia Ohmans will briefly summarize immigrant health history in Minnesota. In the second half of the session, Ann O¹Fallon, the state¹s Refugee Health Coordinator, will offer an overview of relevant immigration statistics and briefly describe the refugee health screening process. Session 2 April 3 Trauma and Its Impact on Health Kathi Antolak, MD The Health of Refugee Children Mirjana Bijelic, MSH The sad truth is that many of Minnesota¹s newest residents arrive in the state after having endured the traumas of war, displacement, flight, and even torture. Kathy Antolak, a physician at the Center for Victims of Torture, will talk about the effect of trauma on an individual¹s health and the unrecognized sequelae of torture in immigrant patients. Her colleague, Mirjana Bijelic, will describe the Center¹s efforts to alert school health staff to the hidden symptoms of trauma in refugee children. Session 3 April 10 Essentials of Cultural Competence in Health Care Patricia Ohmans, MPH Language Interpreting in Health Care Ellen Rau, BA The increase in immigrant patients is testing Minnesota¹s health care and social service institutions¹ mandate to provide quality care and access for all. Patricia Ohmans will talk about challenges facing health care organizations on the road to culturally competent care. We will also review federal standards for cultural competence in health care. A major barrier between most first-generation immigrants and their Minnesota health care providers is language. What are the skills providers need to learn to work well with interpreters? Ellen Rau, who has many years¹ experience training medical interpreters and providers to work together, knows the signs. We¹ll watch some instructive videos, and carry out role plays. Session 4 April 17 Cross Cultural Issues in Mental and Spiritual Health David Berg, M.Div., MA Only in Western culture have spirituality, mental health and medicine been separated. In other cultures, it is often the spiritual elders who are the healers, and many cultures recognize ³mental illness² as a state of spiritual imbalance. David Berg, a medical chaplain who works with a wide cultural variety of patients, will use case studies, exercises and anecdotes to highlight the importance of attending to cultural sensitivity in the delivery of quality mental health care. Session 5 April 24 Prevalence, Prevention and Treatment of Chronic Disease in Immigrants Phua Xiong, MD Chronic Disease in Eastern European Communities Asya Fridland As a practitioner at Model Cities Health Center and one of the first Hmong female physicians, Phua Xiong has acquired a deep knowledge of the clinical differences in the health of immigrants and non-immigrants. Dr. Xiong will focus on the increasing prevalence of chronic diseases such as diabetes, heart disease and obesity in immigrant populations, as well as addressing the clinical treatment of these and other conditions. The Russian community in Minnesota is made up of two major groups‹Jews, who are heavily urban, and Christians, often rural in origin. Asya Fridland, coordinator of refugee resettlement for Jewish Family and Children¹s Services, will look at the demographics and community groups representing immigrants from Russia, focusing on chronic disease issues. Session Six May 1 Prevalence, Prevention and Treatment of Infectious Diseases in Immigrants Infectious Disease in Latino Communities Miguel Ruiz, MD A practitioner from Spain, Miguel Ruiz sees a diverse patient population at La Clinica, a community clinic on Saint Paul¹s West Side. In this lecture, Dr. Ruiz will focus on infectious disease, with an overview of such challenges as treating HIV infection and tuberculosis among recent and sometimes undocumented immigrants. Session Seven May 8 Public Health Education Strategies for Immigrant Communities Diana DuBois, MPH, MA Reproductive Health Issues in Somali Communities Qamar Ibrahim, MPH Much of health education depends on a patient¹s ability to understand the written word. How does one design health education materials for individuals whose ability to read English is very limited and whose concepts of appropriate discussion topics may differ wildly from the norm? Diana DuBois, former reproductive health specialist for Twin Cities neighborhood clinics, will walk the class through the steps in the creation of a culturally and language-appropriate booklet on reproductive health methods for Somali families. Qamar Ibrahim, a Somali community leader with a public health degree, will contribute a look at the underlying beliefs that one must be familiar with in order to provide culturally sensitive reproductive health care for Somali families. Session 8 May 15 Immigration Law and Its Effect on Health Julie Zimmer JD Social Adjustment and Health Xong Mouacheupao An immigrant¹s health status is affected by many factors: access to care, values, legal status, finances, to name just a few. In this session, Julie Zimmer, an attorney who works with Minnesota Advocates for Human Rights, will discuss the stressful legal context in which immigrants to Minnesota work to maintain their health in their new home. In the second half, counselor Xong Mouacheupao will decribe some of her experiences working with Southeast Asian clients who are struggling to adjust to the unfamiliar expectations of a new society. Session 9 May 22 Ethical Issues in End of Life Care Dorothy Vawter, PhD Cross-Cultural Issues at the End of Life Okokon Udo Different values between cultural groups can lead to difficult ethical problems in caring for patients at the end of life. Values regarding respect, trust, health care decision-making and other issues can be understood through a cross-cultural ethical framework, which will be discussed by Dorothy Vawter of the Minnesota Center for Health Care Ethics. Living and dying have different meanings in different cultures. Okokon Udo will deliver a lecture summing up the extent of these differences and their challenge to those who provide care. Learning Objectives Objectives are listed for each class session. At the end of this course, participants will be able to: Session 1. Describe four early immigrant groups in Minnesota, define two historical and continuing immigrant health concerns and quanitfy the current immigrant and refugee population in Minnesota. Describe the refugee health screening purpose and process. Session 2. Describe the impact of trauma, flight and torture on an individual¹s physical and mental health. Discuss the impact upon children of torture experienced by parents or other family members . Session 3. List five challenges facing medical and public health institutions in providing culturally competent health care and access for all. List three ways in which health care providers can communicate more effectively with immigrant patients and their families. Cite four standards for competent medical interpreting. Session 4. Explain the connection between spiritual health and physical health in almost all cultures. Cite two ways in which differing cultural definitions of mental health might affect treatment for a person suffering from emotional distress. Session 5. List four chronic health conditions that are more prevalent among immigrants than among non-immigrants. Explain how their etiology, prevention and treatment may differ. Describe the Russian community in Minnesota in terms of demographics and chronic health issues . Session 6. List four infectious diseases or conditions that are prevalent among immigrants. Explain how their etiology, prevention and treatment may differ. Describe the Latino community in Minnesota in terms of demographics and infectious diseas issues. Session 7. List three ways in which health educators should assess the needs and tailor education materials for immigrant audiences. Describe the Somali community in Minnesota in terms of demographics and major health issues and list two issues in reproductive health for Somali families. Session 8. List four examples of the effect of poverty, ethnicity or citizenship status on an immigrant person¹s health. Describe three obstacles encountered by immigrants seeking to fit in to a new social structure. Session 9. Explain how cultural values regarding trust, respect, health care decision-making and other issues affect end of life care. Describe three differences in approaches to death and dying among cultures.