Refugees and newcomers will be strangers to our Canadian culture, and care providers should endeavour to make patients' resettlement transition an easy and enjoyable experience. Here are some tips on how to provide culturally sensitive medical care to your patients, edited from compiled information found on www.refugeehealthta.org.
To avoid miscommunication and misunderstanding by patients and/or health-care providers, culturally and linguistically appropriate, gender-matched language interpretation should be made available at all times. Interpretation by family members, minors and the lay community should be avoided. Live, in-person interpretation by trained personnel allows direct, hands-on education and counselling, which can be enhanced by the use of audio-visual or pictorial aids and is preferred whenever feasible.
Avoid lapses in insurance coverage, particularly for patients with low literacy for whom letters in the mail may be difficult to comprehend; address transportation needs; promote awareness of available health and social services; be aware of prevailing social/cultural taboos and stigma that may limit a patient's self-efficacy in seeking help; and ensure continuity of care with the same provider whenever possible.
Whenever possible, health-care staff and interpreters should be gender-matched with the patient. However, circumstances may arise in which the only staff available or the most skilled personnel in performing a designated procedure is a different gender than the patient. In this case, counselling should take place in advance with the patient and his/her family to determine whether or not this would be acceptable, If not, an alternative strategy that ensures safety and quality of care while respecting the patient's wishes, as much as possible, should be secured.
Touching private parts of the body may be deemed disrespectful or insulting for a patient, especially if by a health-care provider of a different gender. There should always be a "chaperone" in the examination room, regardless of the provider's gender. In the case of a female patient, if a male interpreter is present, interpretation should be provided from behind a curtain during the examination process. In this case, efforts should be made to keep the woman as fully clothed or draped as is feasible during examinations to minimize skin exposure and patient embarrassment. (The same may apply to male patients, depending on cultural preferences.)
Be cognizant of relevant religious and traditional cultural practices (e.g. female genital cutting, coining, Ramadan, etc.) that may influence a patient's health-care decision-making. Due to the sensitive nature of certain practices, patients may be reticent to readily discuss certain issues, but as trust is built and continuity of care occurs over time, there may be opportunities for more sensitive discussion and disclosure.
While the holy month of Ramadan is a period of spiritual renewal and strength in the Islamic faith, it may pose a challenge for a patient's well-being, especially those with illnesses or in a fragile state of health (e.g. elderly patients, pregnant women, etc.). Patients who plan to fast should meet with their health-care provider before Ramadan to discuss any pertinent advantages and disadvantages of fasting. Medical and health-related conditions that may prevent safe fasting should be assessed and information provided on maintaining adequate nutrition and hydration during this time.
Involving a multidisciplinary team to support refugee patients' health improves the consistency of follow-up and quality of care as patients' self-efficacy in navigating the health-care system increases. Given low health literacy and unfamiliarity with the Canadian health-care system, particularly among new refugee arrivals, efforts should be made to extend the traditional provider network to include social workers, case managers, interpreters and community health workers along with refugee resettlement agencies to facilitate seamless co-ordination of care.