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Accessing a Vulnerable Population
Demographic Characteristics of Chinese American Immigrants:
• 11.9 million Asian Americans live in the US.
• 2.4 million (20%) are Chinese Americans.
Gateway to Chinatown - SF
• 1.7 million are foreign born and 80% of the elder population is foreign born. • Of this total 48% are male and 52% are female.
(Source: 2000 Census) (Source: Pediatric, May 2005)
Demographic Characteristics of Chinese American Immigrants:
• Population is concentrated in California, New York, and Hawaii.
• 96% live in metropolitan areas.
Population Distribution Other 47 States 46% California 38%
New York 5%
(Source: 2000 Census) (Source: Pediatric, May 2005)
(Source: 2000 Census) Chinatown . • Approximately 236. • Average household size is 3.6 million being 25 years of age or older.Demographic Characteristics of Chinese American Immigrants: • Median age is 35 with 1.000 are over 65 years of age.SF .
org ) College Education High School Education Illiterate .Educational Characteristics of Chinese American Immigrants: • Majority have high school or better education. • 10% are illiterate.wildflowers. (Link: http://www.
• 59% elderly do not speak English well. (Source: 2000 Census) (Link: http://factfinders.9 million Chinese Americans speak a language other than English at home. • Mandarin is the official Chinese language but many Chinese Americans speak Cantonese and other dialects.Linguistic Characteristics of Chinese American Immigrants: • 1.gov) .census. • Individuals who speak any of the dialects can read the Chinese written language as it is not necessarily tied to the spoken language.
Occupational Characteristics of Chinese American Immigrants: • 1. Professional Occupations Service Industy Operators • Median income level is between $36. (Source: 2000 Census) .000 and $ 41.2 million Chinese Americans are in the labor force. • Predominantly work in the service industry.000.
878 Chinese families live below the poverty level.uscensus. • 320.gov) .577 Chinese individuals live below the poverty level. (Link: http://www.Characteristics of Chinese American Immigrants: • 60.
Spirituality." Asian Nation: The Landscape of Asian America) Religious and Denominational Affiliations of Chinese Americans in the U.Religious Characteristics of Chinese American Immigrants: • Major traditional religions/philosophies: Confucianism Buddhism Taoism and ancestor worship • Many Chinese Americans practice Christianity. and Faith.S.gov) (Source: "Religion. Catholic Protestant Buddist/Taoism/Confucianism Muslim Jewish Christianity 42% 13% 28% 13% 1% 3% . (Source: 2000 Census) (Link: http://factfinder.census.
SF History of Chinese Americans Chinese Immigrant Panning for Gold Chinese Immigrants Working the Fields .1800’s Chinatown .
History of Chinese Americans • Immigration began in the middle of the 1800’s and consisted primarily of young male peasants. Young Chinese Immigrants – 1860’s (Source: American Immigration Law Foundation .2000) (Link: http://www/ailf.org) . • The Chinese were considered an excellent source of cheap labor.
2000) (Link: http://www/ailf.History of Chinese Americans • The early Chinese labored in the fields and farms.org) . Chinese Immigrants Working the Fields .1880 Chinese Immigrants Working the Fields .1850 (Source: American Immigration Law Foundation .
History of Chinese Americans • The immigrants who arrived in the late 1840s and early 1850s were usually sent to the mines because of the gold rush. Chinese Immigrants Panning for Gold (Source: American Immigration Law Foundation .2000) (Link: http://www/ailf.org) .
000 Chinese were hired by the Central Pacific Railroad to build the Transcontinental Railroad.History of Chinese Americans Chinese Immigrants Working on the Railroads From 1862-1869. This rail path spurred the development of the surrounding territories.org) .2000) (Link: http://www/ailf. (Source: American Immigration Law Foundation . approximately 15.
org) . 25% of California’s workforce was of Chinese descent. Chinese Immigrants Clearing Land (Source: American Immigration Law Foundation . land development. and irrigation.History of Chinese Americans • By 1880.2000) (Link: http://www/ailf. • Their contributions included labor in mining.
History of Chinese Americans Chinatown – Late 1800s • Demand in jobs in mining and the railroads dwindled in the late 1800’s. the Chinese worked in urban manufacturing making shirts. (Source: American Immigration Law Foundation . making their presence more apparent. • Around 1870. boots and cigars.2000) (Link: http://www/ailf. • Many Chinese began congregating in large cities.org) . shoes.
2000) (Link: http://www/ailf. and shabby apartments that were perfect havens for opium smoking. (Source: American Immigration Law Foundation . alleys. gambling joints. and brothels. • Most Chinatowns had narrow streets.History of Chinese Americans • The large populations of Chinese coming to American cities usually squeezed into a few blocks where Chinatowns would emerge. Chinatown – Late 1800s • These social evils were attributed to the Chinese and sensationalized by whites.org) .
Chinese Immigrant Working on the Docks (Source: American Immigration Law Foundation . • The fear of the masses was that they were occupying too many jobs within the cities.org) .History of Chinese Americans • Post.2000) (Link: http://www/ailf.Civil War depression contributed to a hostile environment for the Chinese. and they experienced the brunt of antiimmigration sentiments.
• They were forced to open their own small business . or grocery stores – or work in the coal mines.org) . laundries.History of Chinese Americans • Although Chinese worked in places like fish canneries and organized themselves. or on farms. racism forced them out of wage labour. (Source: American Immigration Law Foundation .restaurants. except for domestic work as cooks or houseboys.2000) (Link: http://www/ailf.
2000) (Link: http://www/ailf. (Source: American Immigration Law Foundation .angelislang.org) (Link: http://www.gov) Angel Island 1915 Holding Area Angel Island 1915 Sleeping Areas . • In 1910 the Angel Island Inspection Station was built in San Francisco to enforce this law.History of Chinese Americans • This led to the 1882 Chinese Exclusion Act which prevented those Chinese without family already in the US from entering.
org) (Link: http://www.History of Chinese Americans • In 1943 the Chinese Exclusion Act was repealed.2000) (Link: http://www/ailf.gov) . (Source: American Immigration Law Foundation . • In 1952 the Walter-McCarren Act allowed first generation Chinese-Americans to apply for citizenship.angelislang. Angel Island 1940s • The 1964 Immigration and Nationality Act removed the last barriers to Chinese immigration.
many continue to seek political asylum from governmental upheaval and human rights violations in China. • Today.2000) (Link: http://www/ailf. (Source: American Immigration Law Foundation .History of Chinese Americans • Since 1965.org) . many well-educated and highly specialized Chinese professionals have entered the US in order to realize the American dream of prosperity related to high-tech and engineering fields.
Belief Systems and Values of Chinese American Immigrants .
Belief Systems and Values of Chinese American Immigrants Concept of being “Chinese” = Speaking. (Source: Chinese Beliefs ) (Source: Health and Health Care for Chinese American Elders) . & accepting Chinese system of cultural values …. behaving. Belief system: ”Being Chinese is not based on race.. rather it is a cultural concept”. a great period of historical significance). Chinese refer to themselves as Han or sons of Han ( as in Han Dynasty.
Belief Systems and Values of Chinese American Immigrants Values & roles of Chinese are based upon religious & philosophical beliefs: Taoism – teaching based upon doctrines written by Lao Tzu. “Inner peace of individuals & harmony with their surroundings”. (Source: Chinese Beliefs ) (Source: Health and Health Care for Chinese American Elders) .
(Source: Chinese Beliefs ) (Source: Health and Health Care for Chinese American Elders) .Ethical belief system based upon relationships from Confucius (Chinese philosopher born 55 B. • Emphasis on family & family honor. • Every relationship has the dual aspect of responsibility & obligation.C). • Relationship between all members of a family has responsibility & obligations.Belief Systems and Values of Chinese American Immigrants Confucianism .
(Source: Chinese Beliefs ) (Source: Health and Health Care for Chinese American Elders) . • Responsibility & obligation beyond family. • “If responsibility & obligations (of individuals) are observed then society will be a just and harmonious one”.Belief Systems and Values of Chinese American Immigrants • Family members expected to “know their place” in society & give the family a good reputation.
Belief Systems and Values of Chinese American Immigrants Buddhism – Teaching from Siddhhartha Gautama (Buddha or “the Enlightened One” form 65 A. overcoming our desires we can overcome our pain. hence.D). Overall goal was to reach “Nirvana” by following Enlightened path. “Enlightened path” – like 10 commandments. • Desires are the source of pain. (Source: Chinese Beliefs ) (Source: Health and Health Care for Chinese American Elders) • • .
(Source: Chinese Beliefs ) (Source: Health and Health Care for Chinese American Elders) .General laws of opposing forces ….Belief Systems and Values of Chinese American Immigrants Ying / Yang. Yang = male. hot. Everything needs a balance. negative energy. positive energy. cold. • • • Yin = female.
earth metal & water.Belief Systems and Values of Chinese American Immigrants Chinese astrology & calendar. dog. Both animals & elements are reflective of people’s personality. monkey etc). fire. A person’s character is determined by the year of their birth. (Source: Chinese Beliefs ) (Source: Health and Health Care for Chinese American Elders) . Entire animal & element cycle takes 60 years to complete. Years are also associated with 1 of 5 elements: Wood.associated with Buddhism …. • • • • • • Used before Gregorian calendar & similar to Gregorian calendar. Years named for animals of Chinese Zodiac (Rat.
Belief Systems and Values of Chinese American Immigrants Other belief systems: Christianity: • Existed in China since 17th Century from Jesuit missionaries. Folk religion: Local religions based on local gods & served local people. Islam: • Came to China from Central Asia. (Source: Chinese Beliefs ) (Source: Health and Health Care for Chinese American Elders) .
Healthy People 2010 – Chinese American .
It can be used by many different people. communities.Healthy People 2010 • Healthy People 2010 is a set of health objectives for the Nation to achieve over the first decade of the new century. • Goals – Increase Quality and Years of Healthy Life – Eliminate Health Disparities . and others to help them develop programs to improve health. States. professional organizations.
Healthy People 2010 • The Leading Health Indicators are – – – – – – – – – Physical Activity Overweight and Obesity Tobacco Use Substance Abuse Responsible Sexual Behavior Mental Health Injury and Violence Environmental Quality Access to Health Care .
Physical Activities of Chinese Americans Type of physical activities No leisure-time physical activities % who participated in physical activities in 1997 42% % who participated in physical activities in 2002 39% Mod. regular physical activities Vigorous physical activities Muscle strength and endurance Flexibility 27% 16% 17% 34% 27% 17% 20% 35% (2001) .
– Increase muscular strength.gov/data2010) . (Link:http://wonder.cdc. – Increase physical activities in physical education class. – Reduce television viewing time. endurance and flexibility.Healthy People 2010 Focus Areas on Physical Activities and Fitness in Chinese Americans • Physical Activities and Fitness – Increase moderate and regular physical activity.
black and Latino population.htm) • . from 7% to 15%. cancer and hyperlipidemia. Obesity increases the prevalence of diabetes.Overweight and Obesity in Chinese Americans • The rate of obesity in low income Chinese Americans will soon catch up with low-income white.gov/statistics/index.php?newsid=15362) • • • The total cost of treating obesity in 2000 was $117 billion.niddk.com/printerfriendlynews.nih. • Chinese/Asian children in California who are overweight increased more than double between 1994 and 2003. Unhealthy acculturation-related change in diet and a sedentary life style in Chinese/Asian Americans result in overweight and obesity. cardiovascular diseases. Obesity individuals have a 50% to 100% increased risk of death from all causes. (Link: http:www.medicalnewstoday. (Link: http://win.
• Reduce the rate of total fat.Healthy People 2010 Focus Areas on Obesity in Chinese Americans • Reduce the rate of overweight and obesity in adults and children. and grain product intake. vegetable. . saturated fat and sodium intake. • Increase the rate of dietary/ nutrition counseling during physician office visit. • Increase the rate of fruit.
Tobacco Use in Chinese Americans
• According to the data from Morbidity and Mortality Weekly Report, the prevalence of smoking among male Chinese Americans aged 18 or above was 19.3%.
• Lung cancer was the leading cause of cancer death (22.3%) in Chinese/Asian Americans in 1993.
• Focus areas of Healthy people 2010 on tobacco use.
– Reduce the rate of cigarette smoking in Chinese/Asian population. – Reduce rate of exposure to environmental tobacco smoke. – Increase the rate of smoking cessation.
Substance Abuse in Chinese Americans
• Approximately 11% of preventable deaths are related to alcohol and illicit drug use.
• Alcohol use
– The rate of heavy alcohol use in Asian youth was nearly doubled from 1999 to 2000 (0.5% to 0.9%). – Chinese immigrants have the highest prevalence of alcohol use when compared with other Asian populations.
• Illicit drug use
– Southeast Asians rank first in cocaine and amphetamine use. – Prescription drug abuse is tripled in Chinese/Asian American youth from 1999 to 2000.
Healthy People 2010 Focus Areas on Substance Abuse in Chinese Americans
• Reduce the rate of alcohol related motor vehicle accidents deaths.
• Reduce the rate of cirrhosis deaths. • Reduce the rate of drug induced deaths. • Reduce the rate of consumption of alcohol beverages and illicit drug use. • Increase the rate of treatment for substance abuse.
• Increase the rate of risk perception of substance abuse in adolescents age 12 to 17.
• Only 13% of 11th and 12th grade Chinese American students in San Francisco are sexually active.Healthy People 2010 Sexual Behaviors • Sex is a taboo subject in contemporary Chinese culture. (Link: http://www. • Chinese women are more reluctant to seek care for their sexual and reproductive health. • Discourages Chinese women from gaining knowledge regarding sexuality. • Ham suup is a Cantonese term used to describe anyone who is sexually inappropriate. Parents and health professionals are reluctant to discuss sexuality. • Talking about or touching one’s body is considered ham suup.com/library/docfree.asp?DOCID) . • • Sex education in schools is minimal.highbeam.
gov) . (Link: http://www. • Chinese Americans are more likely to exhibit somatic complaints of depression than are African Americans or non-Hispanic whites.Healthy People 2010 – Mental Health • Chinese Americans have a lifetime & one-year prevalence rates for depression of about 7% & 3%. • Chinese Americans have a lower suicide rate (8.3 per 100.000 per year) than white Americans (12.8 per 1000.000 per year).samhsa.mentalhealth.
html) . (Link: http://www.htm) • Chinese American women age 65+ have three times the suicide rate of whites in the U.Healthy People 2010 – Mental Health • Depressed elderly Asians (over 95% ethnic Chinese) have the highest rates of suicidal thinking among all racial & ethnic groups.edu/group/ethnoger/chinese.stanford. the rate is seven times that of white women. (Link: http://www. • Chinese American elders are less likely to communicate their intent to commit suicide. • Chinese American women tend to hang themselves.camsociety.S. • Among Chinese women aged 75+.org/issues/crisisinmentalhealth. • Chinese American men tend to use medications.
Healthy People 2010 – Injury and Violence In a survey of 262 Chinese men & women in Los Angeles County: • 18. • 8% reported experiencing “severe physical violence”. (Link: http://www.org/apidvinstitute/PDF/Fact_Sheet.apiahf.1% reported experiencing “minor physical violence” by a spouse or intimate partner.pdf\) .
tongs. violence occurs with guns.Healthy People 2010 – Injury and Violence Gang Violence: • Chinese criminal organizations include gangs. Taiwanese organized crime groups.gov/nij/international/ctoc.html) . (Link: http://www.ojp. • Disputes among gangs are resolved using Kong So (a process of peaceful negotiation) & if not resolved. secret societies. and strictly US-based tongs & gangs.usdoj. triads.
ethnic & racial populations.S.Healthy People 2010 – Environmental Quality Liver Cancer & Hepatitis B: • Chinese Americans have the highest rate of liver cancer among all U. (Link: http://www.stanford. whereas. •Liver cancer is associated with Hepatitis B in the Chinese.edu/group/ethnoger/chinese.html) . •Hepatitis B is present in 80% of liver cancer cases in the Chinese. liver cancer is associated with alcohol in whites.
• Risk factors include use of estrogens.html) . nulliparity.stanford. (Link: http://www. • Chinese women are less likely to receive mammograms.S.edu/group/ethnoger/chinese.Healthy People 2010 – Environmental Quality Breast Cancer: • Breast cancer is most commonly diagnosed in Chinese females in the U. & obesity. older age of first birth. fewer births.
(Link: http://www.org/issues/crisisinmentalhealth.htm) Additional Barriers: • • • • • Mistrust Lack of culturally competent services Geography Conservatism with regards to sexual matters Family responsibilities and elderly respect (Link: http://www.html) .edu/group/ethnoger/chinese.camsociety. • Education – Less awareness of the treatability of medical health illnesses.Healthy People 2010 – Access to Healthcare Barriers to Care: • Language – Lack of available bilingual medical health professionals. • Economic – Lack of insurance coverage of medical health professionals.stanford.
Chinese American Health Beliefs .
html) 1) .baylor. (Link: http://www3. 3) Belief in western allopathic medicine.Health Beliefs OVERVIEW OF 3 CONCEPTS Balance as expressed by the Yin-Yang symbol.edu/cne/resources/multicultural/chinese_american.html) (Link: http://www.edu/~Charles_Kemp/chinese. 2) Traditional Chinese Medicine (acupuncture & use of compounds).ucdavis.ucdmc.
baylor.edu/~Charles_Kemp/chinese.S. 3) First & second generation Chinese Americans .ucdavis. (Link: http://www3.ucdmc.html) (Link: http://www.mostly oriented to Western medicine.html) . 2) Newer immigrants – combine Chinese folk & Western traditional medicinal practices. Three major groups & health practices: 1) Early immigrants – strongest believers in Chinese folk medicine.Health Beliefs Chinese health beliefs vary according to length of time in the U.edu/cne/resources/multicultural/chinese_american.
edu/~Charles_Kemp/chinese.edu/cne/resources/multicultural/chinese_american.baylor. harmony of mind.ucdavis. Screening Chinese patients: Allow family involvement & participation.html) . respect privacy issues. body & spirit.ucdmc. Health promotion & prevention: preventing illness & promoting good health means eating a diet balanced with Yin & Yang foods. For language barriers.Health Beliefs HEALTH PRACTICES: Concept of health: maintaining balance between Yin & Yang in body & environment. (Link: http://www3.html) (Link: http://www. interpreters are recommended.
baylor. hospital: People go to hospitals to die. Home vs. dying at home will bring bad luck.html) .edu/cne/resources/multicultural/chinese_american. pregnancy is a “cold or Yin condition” (Link: http://www3.edu/~Charles_Kemp/chinese. Pregnancy Care: Certain activities will affect the baby during pregnancy.ucdavis. Medications: Less acculturated Chinese-Americans believe that Western medications are too strong.html) (Link: http://www.ucdmc.Health Beliefs HEALTH PRACTICES: Surgery: Many Chinese avoid surgery d/t the belief that the body needs to be kept intact so the soul will have a place to live.
baylor.html) (Link: http://www. Mental illness is caused by a lack of harmony of emotions.html) .ucdavis. (Link: http://www3. in some cases is thought to be caused by evil spirits.ucdmc. “something she did or ate”.edu/cne/resources/multicultural/chinese_american.edu/~Charles_Kemp/chinese.Health Beliefs ILLNESS: Physical illness is caused by an imbalance on Yin & Yang in the body. Genetic defects are usually blamed on the mother.
colic.ucdavis.edu/~Charles_Kemp/chinese.edu/cne/resources/multicultural/chinese_american. Professional Chinese practitioners prescribe herbs & acupuncture based on diagnosis. indigestion. (Link: http://www3. Will seek Western medicine for more serious ailments such as cancer.html) (Link: http://www.Health Beliefs ILLNESS: Ginseng root is a common folk remedy for several ailments (anemia. Other Chinese remedies include deer antlers.ucdmc. turtle shells & snake flesh.baylor. depression.). etc.html) .
baylor. vegetables & other Yin foods. be aware of nonverbal cues. Fatigue – caused by too much Yin. (Link: http://www3.Health Beliefs SYMPTOM MANAGEMENT: Pain – may not complain of pain.html) .ucdmc.html) (Link: http://www.ucdavis. Depression – mental health problems are viewed as shameful & are not readily discussed. will treat with hot soups or Ginseng. treat with fruits.edu/cne/resources/multicultural/chinese_american.edu/~Charles_Kemp/chinese. Constipation/diarrhea – caused by too much Yang.
hot soups/liquids. fried foods (Link: http://www3. eggs.html) (Link: http://www.meats.Health Beliefs FOOD GROUPS: Yin (Cold) .ucdmc.edu/cne/resources/multicultural/chinese_american.html) .fruits.baylor.edu/~Charles_Kemp/chinese. cold liquids & beer Yang (Hot) . vegetables.ucdavis.
Chinese American Death & Mourning Practices .
Coping Strategies for Chinese Americans • During the ceremonies.. (1997).Death and Mourning . • The burning of incenses & paper money. there are much sound and lamentation – a form of therapeutic catharsis. • The practitioners of “fung-shui” often advise a change in the home environment to remind the mourners to start a new life-style without the deceased (Source: Mak. K. cars and houses that symbolize luxuries for the pleasure of the deceased in the next world. • Various rituals soothe the mourners and symbolize that the deceased can cross over the boundary into heaven or an eternal world.. • Relatives and friends who attend the ceremonies provide comfort and counsel to the mourners. Hong Kong Practitioner. Ma. L. K.. 192-198. & Chan. Management of grief (bereavement).) .
uk) .co.chinatown-online. • Improper funeral arrangements can wreak ill fortune and disaster upon the family of the deceased. (Link: http://www.Death & Mourning Practices • The burial of the dead is a matter taken very seriously in Chinese societies.
Death & Mourning Practices Chinese funeral rites and burial customs are determined by the age of the deceased. status. • According to Chinese custom. His parents cannot offer prayers for their son. (Link: http://www. and marital status. manner death. if the deceased is a young bachelor his body cannot be brought home but is left in a funeral parlor. the child is buried in silence. an older person should not show respect to a younger. as respect cannot be shown to a younger person. being unmarried he has no children to perform these rites either. position in society.uk) . • If a baby or child dies no funeral rites are performed.chinatown-online. • Thus.co.
(Link: http://www. • Preparation for a funeral often begins before death has occurred: if a person is on his/her death bed a coffin will often have already been ordered by the family.uk) .Death & Mourning Practices • Funeral rites for an elderly person must follow the prescribed form and convey relevant respect: rites befitting the person’s status.chinatown-online. must be performed even if this means the family of the deceased must go into debt to pay for them. age.co. etc.
• It is believed that one who sees the reflection of a coffin in a mirror will shortly have a death in his/her family.Death & Mourning Practices • When a death occurs in a family all statues of deities in the house are covered with red paper (so as not to be exposed to the body or coffin) and mirrors removed from sight.co. (Link: http://www.chinatown-online.uk) . • A white cloth will be hung across the doorway of the house and a gong placed on the left of the entrance if the deceased is male and right if female.
(Link: http://www.chinatown-online.co. dusted with talcum powder and dressed in his/her best clothes from his/her own wardrobe (all other clothing of the deceased is burnt and not reused).Death & Mourning Practices • Before being placed in the coffin. the corpse is cleaned with a damp towel.uk) . • Then the corpse’s face is covered with a yellow cloth and the body with a light blue one.
one part retained by the family. (Link: http://www. and wreath. • Food is placed in front of the coffin as an offering to the deceased.co. The deceased’s comb will be broken into halves.uk) . gifts and a portrait or photograph of the deceased are placed at the head of the coffin. one part placed in the coffin.chinatown-online.Death & Mourning Practices • The coffin is placed with the head of the deceased facing the inside of the house resting about a foot from the ground on two stools.
• Wailing is particularly loud if the deceased has left a large fortune.Death & Mourning Practices • During the wake. (Link: http://www.uk) .chinatown-online. red being the color of happiness. the family does not wear jewelery or red clothing.co. • It is customary for blood relatives and daughters in-law to wail and cry during mourning as a sign of respect and loyalty to the deceased.
the family of the deceased gather around the coffin.co. grandchildren blue and great grandchildren light blue. (Link: http://www. • The eldest son sits at the left shoulder of his parent and the deceased’s spouse at the right. • Special clothing is worn: children and daughtersin-law wear black (signifying that they grieve the most).chinatown-online.uk) . positioned according to their order in the family. as they are considered outsiders. • Sons-in-law wear brighter colors such as white. • The children and daughters-in-law also wear a hood of sackcloth over their heads. • Later-arriving relatives must crawl on their knees towards the coffin.Death & Mourning Practices • At the wake.
(Link: http://www.chinatown-online. as money is always offered as a sign of respect to the family of the deceased: it will also help the family defray the costs of the funeral. • Joss paper and prayer money (to provide the deceased with sufficient income in the afterlife) are burned continuously throughout the wake. • Funeral guests are required to light incense for the deceased and to bow as a sign of respect to the family.uk) .co. • There will also be a donation box. is placed at the foot of the coffin.Death & Mourning Practices • An altar. upon which burning incense and a lit white candle are placed.
co.uk) .. • The length of the wake depends upon the financial resources of the family. it also helps to lessen the grief of the participants. (Link: http://www. • The corpse has to the “guarded” and gambling helps the guards stay awake during their vigil. but is at least a day to allow time for prayers to be offered.Death & Mourning Practices • During the wake there will usually be seen a group of people gambling in the front courtyard of the deceased’s house.chinatown-online.
co.Death & Mourning Practices • While the coffin is in the house a monk will chant verses from Buddhist or Taoist scriptures at night. • Prayers.uk) . chanting and rituals offered by the monks help to smooth the passage of the deceased’s souls into heaven. (Link: http://www.chinatown-online. • It is believed that the souls of the dead face many obstacles and even torments and torture (for the sins they have committed in life) before they are allowed to take their place in the afterlife.
chinatown-online. • During the sealing of the coffin all present turn away from the coffin.co.Funeral Ceremony & Procession • When the prayer ceremonies are over the wailing of the mourners reaches a crescendo and the coffin is nailed shut (representing the separation of the dead from the living). as watching a coffin being sealed is considered very unlucky.uk) . (Link: http://www.
the better its situation is thought to be. The further up the hill the grave is. Family members and other relatives throw a handful of earth into the grave before it is filled.uk) . • At the graveside all present turn away from the coffin as it is lowered into the grave. (Link: http://www.The Burial • Chinese cemeteries are generally located on hillsides as this is thought to improve the feng shui.chinatown-online.co.
(Link: http://www. also a sign of gratitude but also for funeral guests to wipe off perspiration • The eldest son of the deceased will retrieve some earth from the grave to be placed in an incense holder.co. and the money contained in it must be spent) and a white towel.chinatown-online.uk) . and the deceased will be worshipped by the family at home using an ancestral tablet.The Burial • Family members and relatives are presented with a red packet (a sign of gratitude from the deceased family.
uk) . (Link: http://www. • A period of mourning is not expected if children die. and green by the great-grandchildren. and a husband is not compelled to mourn the passing of his wife.Mourning • Although the funeral rites are now over. • A piece of colored cloth is worn on the sleeve of each of the family members for the 100 days to signify mourning: black by the deceased’s children.co.chinatown-online. blue by the grandchildren. the period of mourning by the family continues for 100 days.
Mourning • Chinese belief holds that seven days after the death of a family member the soul of the departed will return to his/her home.uk) . (Link: http://www.chinatown-online.co. • A red plaque with suitable inscription may be placed outside the house at this time to ensure the soul does not become lost.
uk) .chinatown-online.Mourning • After the funeral. all clothes worn by the mourners will be burned in order to avoid the bad luck associated with death.co. (Link: http://www.
Cultural Implications for Planning and Providing Healthcare to Chinese Americans .
(Link: http://www.asianweek.html) (Link: http://www.stanford. Language and Health Care • There is an Increase demand for Mandarin and Cantonese Interpreters and Translated materials. Nihao (Hello).org) (Link: http://www. Teng (Hurt).edu/group/ethnoger/chinese.apiahf.html) .com/121887/bay. • CLAS standards (Culturally and Linguistically Appropriate Standards) • Language assistive services must be offered to patients at no • additional cost • QBS/Language Line • It is important for providers to understand some words in Mandarin.Cultural Implications for Planning and Providing Healthcare to Chinese Americans The Chinese American population is growing annually and it is vital that caregivers are able to adapt the care to incorporate the diverse needs of Chinese Americans and provide culturally competent care.
com/121887/bay.html) .mental health and crisis prevention awareness. Traditional medicine screening .edu/group/ethnoger/chinese.Cultural Implications for Planning and Providing Healthcare to Chinese Americans Health Screening and Education • • • • Increase need for breast. (Link: http://www.html) (Link: http://www. Infectious disease education and screening programs for tuberculosis and Hep-B.stanford. and colon cancer education / screening. Given the increase suicide rates .apiahf. prostate.asianweek.org) (Link: http://www.the elderly often self medicate or delay treatment.
org) (Link: http://www.stanford. • 3rd party insurance approval delays. (Link: http://www.apiahf.html) (Link: http://www.asianweek.com/121887/bay. • May need assistance navigating the system.Cultural Implications for Planning and Providing Healthcare to Chinese Americans Systemic Barriers to Health Care • Not understanding the western healthcare system.html) .edu/group/ethnoger/chinese. • Lack of knowledge of public assistance programs such as medicare or medicaid.
asianweek.com/121887/bay. • Women may avoid all cold foods postpartum. (Link: http://www.stanford. Women often skip screening because of modesty.html) (Link: http://www.apiahf. Women may expect a longer post partum stay 5-7 days.Cultural Implications for Planning and Providing Healthcare to Chinese Americans Women and Health Care • • • • Breast cancer is most common. Women may not bathe for up to a month post-partum to avoid the cold element.org) (Link: http://www.html) .edu/group/ethnoger/chinese.
• Illness is often interpreted as an imbalance between Yin and Yang.edu/group/ethnoger/chinese.stanford. No yes/no inquiries.org) (Link: http://www. Many elders are non-compliant or stop meds prematurely.apiahf. Allow incorporation of traditional medicine where possible. (Link: http://www.asianweek. Name is very important when addressing patient.com/121887/bay. The sick person may often assume a passive role in their care and the family may take over.Cultural Implications for Planning and Providing Healthcare to Chinese Americans Culture and Health Care • • • • • • When giving instructions ask patient to repeat.html) .html) (Link: http://www.
tradition. and family relationships as important aspects of health that are interrelated. Family Life Culturally Sensitive Healthcare Spirituality Traditional .Cultural Implications for Planning and Providing Healthcare to Chinese Americans Many Chinese Americans view spirituality.
Adaptation of Healthcare to Provide Culturally Sensitive Care .
Review of Health Risks RELATIVE RISKS RESOURCE AVAILABILITY HUMAN CAPITAL • Low Income • Poverty • Menial Job • High School/College Education • Low-income Housing SOCIAL CONNECTEDNESS • Discrimination • Language • Culture • Traditional Values/Respect for Elders • Family/Community Values SOCIAL STATUS • Low Social Status • Language Barriers/ESL • Patriarchal LIFESTYLES/BEHAVIORS/CHOICES • Poor Diet • Obesity • Substance Abuse • Smoking • Violence & Abuse • Traditional Medicine versus Western • Limited Exercise MORBIDITY & MORTALITY • Cancers • Hepatitis • Suicide • Diabetes • GI Disorders • Depression • Tuberculosis • HTN ENVIRONMENTAL RESOURCES • Medically Undeserved • Uninsured • Lack of Language and Competent Services .
herbal medicine.Adaptation of Healthcare to Provide Culturally Sensitive Care Traditional medicine such as acupuncture. qigong. Traditional medicine is an integral part of Chinese Culture. • American health systems must look at the effectiveness of traditional medicine in treating illness but also the interconnections between traditional Chinese medicine and the Chinese culture and beliefs.camsociety. and oriental massage have a long history in Chinese Society. acupressure. • Integration of Chinese and Western medicine would aid in the delivery of health care to the Chinese population and foster cross-cultural understanding. (Link: http://www.org) .
camsociety. • A balanced diet creates. restores or preserves a balanced physical being.Adaptation of Healthcare to Provide Culturally Sensitive Care Nutrition is important in traditional medicine and there is a close relationship between diet and health. • Modern medicine is just now recognizing the importance of this relationship. (Link: http://www.org) .
camsociety.Adaptation of Healthcare to Provide Culturally Sensitive Care Traditional medicine treats the person as a whole.org) . (Link: http://www. • Modern medicine is life-saving in a crisis. but fails to cure chronic disease whereas traditional medicine seems to excel. • American health systems must be willing to use a combination of traditional and western medicine because each has strengths and weakness. Western medicine sees the person as separate systems.
Adaptation of Healthcare to Provide Culturally Sensitive Care Many Chinese immigrants are low-wage workers without health insurance and have significantly less access to health care. • Programs and services should consist of culturally and linguistically appropriate health education materials and health promotion and disease prevention interventions. • Community assessments must be conducted and community based clinics that promote health and wellbeing should be established to provide programs and services to the immigrant population. .
their decisions to these contrasting systems can have consequences on the outcome of their health.Adaptation of Healthcare to Provide Culturally Sensitive Care Chinese immigrants are forced to confront a world in which they have medical options from two very different cultures. • American health care systems cannot overlook diseases that are more prevalent in the Chinese because they have a low prevalence rate in the American culture. .
• American healthcare providers must recognize the cultural beliefs and practices and value Chinese culture if they are to be successful in providing appropriate and effective care. .Adaptation of Healthcare to Provide Culturally Sensitive Care Chinese culture condemns the HIV and AIDS virus and its resulting illness as a disgrace to the family of the afflicted individual.
Yue (known as Cantonese). Wu.Mandarin groups are also called the Southern dialects. (Link: http://ethnomed.jyi. Min. • The major dialects groups are: Baifanghua (known as Mandarin). • Mandarin is the largest dialect group that many native Chinese speak. (Link: http://www. vocabularies and grammar.Adaptation of Healthcare to Provide Culturally Sensitive Care Chinese immigrants report that language and communication difficulities are the main reasons they choose not to see American doctors. • The non.html) • There are seven major groups of Chinese dialects that are differentiated on the basis of phonological features. and Gan. Xiang.html) . Kejia (known ass Hakka).org/ethnomed/cultures/chinese/chinese_cp.org/volumes/volume6/issue5/features/feng.
Adaptation of Healthcare to Provide Culturally Sensitive Care
• Hospitals must provide qualified, full-time interpreters to help patients and health care providers communicate. • A Chinese interpreter call center that can help patients make appointments and navigate the healthcare system would also be beneficial. • Provision for written health education materials, and hospital signage is also necessary in the appropriate language for the population served.
Adaptation of Healthcare to Provide Culturally Sensitive Care
Sociocultural differences between provider and patient can result in poor adherence to medication and health promotion strategies as well as poor health outcomes.
• Clinical decision making by providers must take into account sociocultural factors if they are to refrain from stereotyping.
• A diverse health care workforce will decrease disparities in the delivery of care.
Meeting the healthcare needs of Chinese Americans requires us to look beyond our healthcare values and systems …. to incorporate the beliefs and values of the Chinese American … to better service this vulnerable population.
Traditional Healthcare Practices
Chinese American Immigrants
Family and Cultural Values
… Michael Domingo Healthy People 2010 …. Denise Gerbi Powerpoint ……………………......Mariellen Faria History ………………….. Robin Hanna Belief Systems ……….. 2006 (Year of the Dog) Prepared by Union City Group: Demographics ………….N524 – Cultural Presentation February 23rd. Dupriest Hall Adaptation of Services ……. Mary Wheaton . Alice Chiu Kathy Garcia Lwin Health Beliefs/Practices ……. Rizpah Domingo Death and Mourning ………… Janet Sevieri Implications for Care ……….
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