The primary responsibility of health care providers is to furnish the highest quality health care to their patients. Within the boundaries imposed by lack of available time, facilities, and financial resources, providers have certain non-medical responsibilities that directly affect the quality of care.
Involving the Family
The cultural groups which are predominant in migrant farm work place a premium on the family unit. This means that the majority of treatment in migrant health centers, and especially the treatment of children, will involve the family, whether or not the provider is aware of this involvement. Family decisions, including compliance with therapy, are not solely made on the basis of an individual's needs, but on the needs and the resources of the entire family group. The best way to assure compliance with a patient's treatment is to make sure that the entire family is involved in the process. With a child's treatment, it is crucial to involve both parents.
Utilizing the Whole Health Care Team
Primary Care is best delivered by a team of people who cover all aspects of delivering care to migrant families. No one individual can or should try to do it all. What is unique about this team approach is the level of responsibility that staff other than a physician or dentist have for making things work. In contrast to this, many traditional medical settings expect a physician to organize and direct everyone's efforts.
These functions include transportation, outreach, social services, translation, and transfer of patient medical records. In a health center serving migrant patients, with its built-in diversity in cultural populations, staff providing ancillary services may become the most important sources of vital information about a patient's medical or dental needs. They assure that health education needed by patients gets done, and that the providers' recommendations for treatment are followed correctly. These team members are important resources for identifying and solving patient problems caused by misunderstandings or cultural differences.
A brief medical or dental examination rarely provides time for successful and in-depth patient education. Health education is better when there is sufficient time to assure that an exchange of knowledge occurs. When education is needed, it can be referred to another team member who has both the time and the cultural background to educate the patient.
It is a social responsibility of providers in a migrant health center to avoid stereotyping. There is a very strong human tendency to seek general patterns. This trait is part of the mapping process of all cultures, and is fairly useful since it reduces the amount of diversity that has to be accommodated within a culture. Between cultural, ethnic or racial groups, however, stereotyping is counterproductive.
There are many counterproductive stereotypes about particular ethnic or cultural groups which include migrants. Stereotyping leads to treating everyone the same, and routinely treating them badly. In migrant health, as in all health care settings, it is necessary to treat everyone as an individual.
Respect means acknowledging the right of another person to act or behave as they are used to without judging them. Farmworkers from other countries are learning the ways and customs of the United States. Clinicians also need to learn something about the cultures of farmworkers. Your initial contact with a new culture may present things that you don't really understand. Take time to learn - ask questions, watch people interact, and take notice of situations you haven't seen before. As you allow people to be comfortable and be themselves around you, you will pick up information that will help you make respectful suggestions and decisions in the future.
Although a smile may be universal, eye contact and handshakes are not. Being friendly and observing the subtleties of communication, both verbal and non-verbal is usually a good start. The best idea is to be as professional as possible, telling farm workers who you are and what your purpose is. You will learn the proper greeting terms, body gestures, etc. as you proceed.
Confidentiality is an absolute requirement. This a legal and ethical issue that must be thought through carefully and be a permanent part of your mindset. Breaches in confidentiality are not usually deliberate, but occur as "slips of the tongue" or lack of care in transferring or storing paperwork. Information about an individual's health status or personal concerns are to be held in confidence unless the person has agreed to your sharing the information for the purpose of referral or consultation. Verbal discussion within an outreach team or among clinic staff about a problem or concern must be conducted discreetly so as not to be overheard or misconstrued by others. Your respect for confidentiality will set the tone both in the field and in the clinic setting and will result in greater trust and openness in sharing concerns.
Advocacy may be seen as bridging the gaps in understanding that cause farmworkers to be underserved or even mistreated by certain groups or individuals. As a migrant health clinician, you are in an ideal position to educate and raise the level of tolerance. You can advocate on many levels. Frequently just noticing a grimace or disrespectful remark and taking the opportunity to engage the person in open discussion about their attitude can open the door to better understanding. You may also advocate in your workplace by offering speakers, videos or discussion in inservice presentation. In the community at large, you may be involved in media coverage or programs for specific groups, e.g. schools, churches, professional organizations. Advocacy is a tough job. Don't expect to know what to say in every situation, but note the specifics to review with a colleague so you will be prepared next time!
Portions excerpted from:
Orientation to Multicultural Health Care in Migrant Programs, Robert T. Trotter, 1988
Orientation Manual, North Carolina Outreach Task Force, 1995.