Harmony through health

Gordon Begay* was visibly angry when asked about foods that may have elevated his blood sugar level, a question that seemed logical to the nurse. Begay was complaining about fatigue, excessive thirst, and frequent urination. Diabetes was marked on his medical record. Culture was the missing piece from this health care encounter. Begay was a Navajo medicine man, Barth explains. His defensive behavior stemmed from the turmoil he felt between adhering to his diabetic diet and not offending other Navajos who offered him food to eat before a visit or ceremony, as was customary.

When Begay next returned to the FHC, Barth began the health care dialogue. They discussed a healthy eating plan for patients with diabetes and Barth helped Begay decide what to say to his people so as not to offend them if he couldn’t accept their food. “A significant problem is he doesn’t want to refuse their offering,” says Barth.

Begay became part of Harmony Through Health, a program developed because of the high incidence of diabetes among Native Americans — the prevalence of Type 2 is 12.2%, with a 40% incidence among Navajos, according to the Association of American Indian Physicians. Harmony Through Health includes patient education and a visit with a registered dietician at least once a year. The dietician tracks and recalls patients for nutrition reviews, foot exams, and blood work. Through federal funding, the program provides diabetic supplies and medications to those with no insurance.

“For good health, Native Americans believe that everything has to be in balance or harmony,” says Barth. The program and the FHC aim to help them achieve this balance.

Respecting beliefs

On the east side of Oakland, Calif., nurses at Clinica de la Raza care for the surrounding Hispanic population — mostly Mexicans, some Guatemalans, and South Americans. They are the poor and the disenfranchised.

Scott Taylor, RN, case manager, is a jack-of-all-trades who spends his day in patient triage and tackling paperwork for the HIV Access Ryan White Program funding. Taylor also educates patients, especially those with diabetes — a disease rampant among the clinic’s Mexican clients. “CHCs are especially equipped to educate patients,” says Taylor. Spanish-speaking nurses and staff facilitate the learning.

The staff understands about culture-based illnesses. Taylor explains empacho. Mexicans believe an incorrect balance of hot and cold foods causes a lump of food to form in the gastrointestinal track, resulting in empacho. Sometimes patients go to a healer who massages the area. If that doesn’t work, they come to La Clinica. In babies or young children, empacho is colic or gastroenteritis, according to Taylor. Another common illness is aire , believed to result from air entering into the body. Patients may complain of muscular or joint discomfort. After assessment, nurses usually find a muscle strain or dyspepsia.

“We show respect for patients’ cultural beliefs and assess them for teaching or for a health care provider visit,” he says.

Watch guards

Taylor calls CHCs “watch guards” for the community. “If it weren’t for CHCs, infectious diseases like TB, pertussis, chlamydia, and others would go undetected and/or untreated until later stages,” he says.

Without CHCs, Taylor’s patients would go to the county system for care — into the overburdened and underfunded EDs.

“Patients receive better care at CHCs because we can deal with problems in a timely framework, with little waiting time, and follow-up visits are closer,” says Taylor. At La Clinica, patients return to the same health care provider, a contributing factor in reducing and eliminating health care disparities.

It’s typical for patients to return to La Clinica for years. Maria Suarez* came for diabetes-related care for some 20 years. She received diabetic teaching and nutritional counseling. As a result, Suarez had a better quality of life, says Taylor. “Everyone knew her. She became part of the La Clinica family until she passed away,” he says.

Taylor sees his work as a giving back to the community, a role that gives him great satisfaction.

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Lorraine Steefel, RN, MSN, CTN, is a senior staff writer for NurseWeek.

*Names are pseudonyms.

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