Cultural issues in first aid

Especially in a diverse area such as Silicon Valley, California, everyone anticipating giving first aid

    should consider that some victims may have very different expectations about how they should be treated

    and be familiar with some of the cultural differences they may encounter.

In some cultures it is a sign of disrespect to touch someone’s head without their express permission, in others you would be disrespecting anyone you helped if you did not touch their head, in others it is disrespectful to touch the feet before touching the head.

But how can a first aider or first responder know what each person from each culture expects? How can you be sure that the person you are helping, who looks and dresses a lot like people from your own culture, actually believes the same as you do?

The answer is that you can’t expect, even with years of experience, to know all the details. BUT you can still help people in a culturally sensitive way if you follow the basic rules taught in Red Cross classes of getting consent from each conscious, sane, sober, not drowning adult victim or the parent or guardian of a child who is present with the child before you even touch them.

When you obtain consent (get permission) before providing care, you need to

    identify yourself

    state your level of training

    explain what you observe

    explain why you think help is needed

    and explain what you plan to do.

You need to keep explaining what you are doing and keep getting consent as you go along, especially when you need to touch the victim to give care.

Always remember that if a victim seriously needs help you do not need permission to call 911 or the local emergency number.

Here are some cultural diversity issues that you can expect and should respect:

You have a personal space you are used to. When someone from another culture gets too close to you, you might feel uncomfortable. When someone backs off you might feel they are reacting the wrong way to you, or trying to tell you something, but either might just be a reflection of their personal space.

Some conversation styles can be quite different than you are used to. A loud, abrupt or blunt voice that might seem to you to be anger, might actually be a normal way of speaking. Some cultures get very quiet when discussing serious issues. Your loudness might be interpreted as disrespect or even violence.

Direct eye contact might be what you expect from people but avoiding eye contact is a sign of respect in some cultures. In others, looking away is a huge sign of dishonesty or disrespect. Some may consider your prolonged, direct eye contact rude.

Crying and/or laughing are normal. But the victim might be embarrassed at doing so. Tell the victim their response to pain and/or fear is normal, if you can say it genuinely.

A victim may be embarrassed to ask questions.

When some people say ‘yes’ it can mean yes, or it can mean ‘I hear you.’

Someone might not understand exactly what you are saying, but want to please you so they say or nod yes.

In some Native American cultures a softly spoken yes, or silence or changing the subject in answer to your question can mean no. Directly saying ‘no’ can be considered rude or cause loss of face (loss of respect).

People in some cultures smile when they are angry or when they are embarrassed.

Some will not understand the question of how do you rate your pain on a scale of one to ten. Nearly all people feel pain the same way, but different cultures (or people with different personal histories) may either be more expressive about their pain, or more stoic. Some will need more reassurance even in the face of what seems to you like a minor problem. Others will not want to express complaints about discomfort or even major pain.

Some cultures/individuals may express pain/discomfort more than you are used to, or may seem to over-express it, but their pain should not be minimalised or dismissed. Work with their assessment of their level of pain, not your assessment of it.

An elder or the family or spouse, not the adult individual, might make decisions about health care and/or first aid. Women might express opinions, but men make the decisions.

Some women are taught to not touch their own bodies.

It might not be okay for the father-to-be to be present during labor, even an unexpected emergency delivery away from a hospital.

Touching within genders might be okay, but not across genders. Example: You might need to have a friend or family member who is with the victim stop bleeding by using direct pressure instead of doing it yourself.

You rarely need to touch near genitals when giving proper first aid care. But even talking about genitals, much less touching near them, can be acutely embarrassing to a victim, or culturally inappropriate.

Removing clothing from victims is not always needed for effective first aid. Some adult victims will not allow it. If it is allowed at all, some clothing and amulets provide powers of healing and should not be removed, but might be moved aside. Consult with the victim, victim’s parents.

Shortness of breath is considered a sign of death in some cultures and may cause acute anxiety and hyperventilation.

Some may assume that their condition is much more serious if they are given oxygen.

Fatigue is in some cultures believed to be a symptom of problems it has nothing to do with. In some, fatigue is thought to be primarily a sign of anemia or a displaced life force.

A simple sneeze may be a sign of illness.

Losing even a little blood can be seen as seriously weakening the body.

Vomiting, constipation or diarrhea might be too embarrassing to mention to you, even if you specifically ask.

Even a small amount of vomiting might be very alarming to the victim.

Diarrhea in a child might be interpreted as caused by a hex on that child.

Gastrointestinal disturbances might be referred to as a ‘liver problem’.

Some believe that every ailment is caused by the supernatural, evil spirits, bad luck, or bad morals.

Some believe that good health is a gift from God and they have very little control over avoiding illness.

Some believe that being ill is a punishment from God or a test of faith in God. As a result, some may not properly use prescribed pain medications since they believe God will give them the strength to bear the pain.

The American sign for okay of making an O with thumb and fingers is obscene in some cultures.

Translating:

Remember that if a family member or friend is translating for a victim, they might not exactly translate what you are saying. An example could be that they feel the victim would be embarrassed to hear what you are saying so they don’t tell them. In some cases, if the interpreter is of the opposite sex, the victim may deny that some problems exist.

The translator might not have a direct translation of medical vocabulary you use. If you speak using simple terms instead of technical jargon you will be more easily understood.

Look at and speak to the victim, not the translator. Watch for facial expressions to tell you things, (but in some cultures facial expressions are controlled).

If you doubt the translation you can somewhat check the translation by asking the victim to repeat back to you what they expect will be done. You can point to body areas, equipment. You can show what you will do by doing it to yourself or another person first.

Don’t assume that the person being translated for does not understand your language at all.

– Speak slowly and clearly, using short sentences and pausing between thoughts.
– Restate important instructions/questions, using different words to express the same idea.
– Prioritize and sequence instructions.

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Always remember that if a victim seriously needs help you do not need permission to call 911 or the local emergency number.

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Any given person is a combination of cultures, including, age, race, ethnicity, national origin, sex, sexual orientation, gender identity or expression, marital status, political belief, religion, immigration status, income/employment status, mental or physical disability and even the way they choose to look/dress/do their hair. Their home and family/roommates culture often differs from their workplace culture, school culture, social group culture, athletic team culture or religious organization culture.

You can’t expect to reach a full understanding of what truly is someone else’s culture. But you can aim for cultural sensitivity, that is, being aware of differences in people without assigning them a value (good or bad, right or wrong). Don’t think in stereotypes or let your personal biases impact the way you help people.

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http://www.ada.gov/lawenfcomm.htm has what percentage of speech reading (reading lips) by deaf people is understood (about one third of spoken words are understood) and practical suggestions for effective communication.