Question
Part A: Prepare 3 recommendations to provide culturally competent care for a clinic that deals with Amish or Roma American clients.
Part B: Describe how Arab American clients might view American health practices differently from other patients.
Submission Instructions:
- Your initial post should be at least 500 words, formatted, and cited in current APA style with support from at least 3 academic sources
Answer
- Understanding Amish or Roma American Culture
The Roma originally migrated from the Indian subcontinent to places in the Middle East, Eastern Europe, and North Africa starting hundreds of years ago. There are various groups referred to as “Roma,” such as the Sinti in Germany and Resande in Scandinavia. Their migration can be attributed to push factors such as persecution and discrimination, as well as pull factors such as escaping the caste system in India. Millions of Roma were killed during the Porajmos (holocaust). Currently, the largest Roma populations are in Eastern Europe, with significant numbers in the Balkan Peninsula.
The Amish are a conservative Christian group that originated from Anabaptist origins in Switzerland. They are closely related in beliefs to the Mennonites. When led by Jakob Ammann in 1693, the Amish people split from the Mennonites. This happened due to a dispute regarding practices of shunning, the excommunicating of members who did not obey the church’s teachings. Those who were excommunicated and shunned were later referred to as Amish. There are currently over 2000 Amish congregations, with the largest in Elkhart County, Indiana. The Amish have continued traditions from the 18th century and are often considered to be a group frozen in time from 300 years ago.
1.1 History and Background
The history and experience of the Amish in settling in and migrating across the United States is directly related to forms of health and illness. Different groups of Amish vary in their practices and beliefs regarding health and illness. However, over the long haul, most Amish have tended to use traditional home remedies and treatments to cope with health problems. In instances of serious illness needing hospitalization, there has sometimes been a great deal of negotiation and advocacy on the part of Amish patients and their families to gain access to medical systems that can be quite daunting and foreign. The negotiation and advocacy reflect both a deep desire to ensure the best care for loved ones and concern about the impact of that care on Amish religious and community identity. In recent years, a number of situations involving the Amish and medical care have raised questions of bioethics and have led to studies by social scientists and others. It is essential that health care professionals interacting with Amish people understand the history of the particular group with which they are working and the decentralized and informal way in which decisions about care may be made. This understanding can only result from careful listening and observation and from building relationships of trust. These general rules in cultural competency affect care for all Amish and also have relevance for work with traditional Gypsy Roma individuals and the Irish and Finnish Travelers who practice similar forms of traditionalism.
1.2 Values and Beliefs
Amish value simplicity and are separated from the world, preferring autonomy. They are pacifists and conscientious objectors to world military systems. They believe in following the teachings of Jesus Christ and the New Testament. The Amish resistance to assimilation is based on a religious devotion to a community that is separated from the world and deeply rooted in traditions. Amish religious beliefs are virtually the same as those of conservative Mennonites according to Christian scriptures. Like the Mennonites, the Amish are descendants of the Anabaptist movement during the Reformation in 16th century Europe. Many Anabaptists were tortured and killed in various parts of Europe for their beliefs. The ancestors of the Amish were often refugees, moving from place to place. This common heritage of suffering has contributed to the Amish solidarity as a people and a strong sense of who they are. The Amish also share a common identity in their Swiss Anabaptist beginnings. This shared history and the endurance of faith under adverse conditions have fused the Amish people into a deeply religious and social group. Values of the Amish are drawn from their religious tradition, which involves Ordnung. Ordnung, which means order, involves the concept of Gelassenheit, which means yielding, submission, and letting-be. The practice of Gelassenheit is a yielding to higher authority and is fundamental to the Amish identity. These concepts define the ideal Amish life – a life of yielding to God, the church, and community. A life of Gelassenheit, with its spirit of submission and self-denial, is guided by the unwritten rules of the church and by the older traditions of the community. This is the Amish way.
1.3 Traditional Practices
The Amish and Roma use practices in daily life that are an integral part of their culture and religion. It is essential to be aware of these practices and understand their effect on health and healthcare. “Folk” or “popular” medicine is the most common method of health care for these communities. Examples of these practices are “staying in” where the Amish will refuse to seek outside help until a certain period of time has passed using at home treatments or remedies. Roma will rely on various taboos and rituals to cure an illness and may not inform healthcare providers of an illness until it reaches a critical point. Both of these practices can result in seriously ill patients seeking help when it is too late or result in exacerbation of the illness while the traditional method is attempted. It is important to respect these practices but encourage prompt seeking of healthcare if it is necessary. Trying to understand each community’s own system of health and illness is important to providing optimal care.
1.4 Language and Communication
Languages spoken by the Amish and Roma Americans are officially English. However, both cultures have a mother tongue and value bilingualism. The Amish speak Pennsylvania Dutch, also known as Alemán Deitsch, which is a dialect of Swiss German. Old Order Amish schools teach in Pennsylvania Dutch, with English taught as a second language. Health practitioners must recognize that fluency in English is often limited. Thus, the assistance of an interpreter may be necessary. The client’s comfort level should be assessed, as most, particularly the older generation, may prefer communication in their mother tongue. The use of a bilingual practitioner may be ideal in efforts to gradually transition the conversation to English. The Roma people widely speak Romani, which is an Indo-Aryan language with many dialects. Though younger generations are educated in the country’s language, they also feel more comfortable using modern Romani. Communities today are often bilingual or multilingual. Translation services should be utilized as necessary. However, family members should not be relied upon to translate, as they may edit information they feel is detrimental to the client’s welfare. Questions regarding language preference, ability, and the need for an interpreter should be presented in a respectful manner.
- Recommendations for Culturally Competent Care
2.1 Establishing Trust and Rapport
2.2 Respecting Privacy and Modesty
2.3 Incorporating Traditional Healing Practices
2.4 Providing Interpreters or Language Assistance
2.5 Adapting Healthcare Procedures and Policies
- Overcoming Barriers to Care
3.1 Addressing Language Barriers
3.2 Navigating Cultural Differences
3.3 Understanding Health Beliefs and Practices
3.4 Promoting Collaboration with Community Leaders
3.5 Ensuring Accessibility and Accommodations
- Training and Education for Healthcare Providers
4.1 Cultural Sensitivity Training
4.2 Cross-Cultural Communication Skills
4.3 Understanding Diversity within the Amish or Roma American Communities
4.4 Ethical Considerations in Culturally Competent Care
4.5 Continuous Learning and Improvement