Cultural Considerations: Working with the Filipino Community

PRESENTATION TO KAISER SOUTH SAN FRANCISCO April 14, 2010

Jei Africa, PsyD, MSCP, CATC Office of Diversity and Equity Behavioral Health and Recovery Services San Mateo County Health System Statement of Disclosure y Kaiser South San Francisco Continuing Medical Education has determined that the speakers and the planning committee for this program do not have any affiliations with any corporate organizations that may constitute a conflict of interest with this program. Objectives y To learn about the uniqueness of Filipinos/Filipino American experience (in the United States) y To become familiar with cultural beliefs and values as it relates to health, wellness and help-seeking behavior y To learn culturally responsive approaches in working with Filipinos/Filipino American clients and families Why are you (really) here?

Why this particular training? Acknowledge your work y See many patients y Limited time y Pushed for efficiency and accuracy (and perfection?) y Clients present with multiple issues (some contradicting information, at times) Where is the largest concentration of Filipinos outside the ?

y 1) San Diego y 2) Daly City y 3) Los Angeles y 4) Sacramento y 5) San Francisco Which of these names are Filipino? y 1) Juan Cruz y 2) Joseph Ferrer y 3) Francisco Sy y 4) Maria Chu y 5) Luis Kintanar How many dialects and languages are spoken in the Philippines? y 1) 15 y 2) 50 y 3) 100 y 4) 150 y 5) 200

Some teasers… y Prevention is a new concept y Stigma plays a role y Authority as a double-edged sword y Economic consideration y Building rapport pays off y Gift giving is a possibility A little bit of Philippine History y Pre-colonial y Spanish (1565-1898) y American (1898-1946) y Japanese (1941-1946) Impact of Colonization

Spanish US y Strong influence of religion y Importance of education y Catholicism in Filipino y Use of English as the social customs and events primary language y Close relationship between y Disestablishment of church and state Catholic Church as the State religion y Gender roles y Machismo and Marianismo y Competition and individualism y Regionalism 13 Indigenous Health Beliefs

y A) Principle of Balance (Timbang) y Maintaining a balance (body, food, diet) y Rapid shifts from hot to cold y “Warm” environment – good y “Cold” environment – not so good y “Fat” – is good; maintains warmth y No cold drinks in the morning y “Na-hanginan” (exposed to too much wind) 14 Indigenous Health Beliefs y B) Theories of Illness y 1) Mystical – stronger life-force, retribution from ancestors, wandering or lost souls (when sleeping), “”

y 2) Personalistic – punishment or retribution from supernatural beings such as witch, an evil spirit, sorcerer (mangkukulam); healer is needed; wearing of , holy oils, etc.

y 3) Naturalistic – range from natural events (thunder, lightning, etc.) to stress, incompatible drugs, genes; “”

y 4) Inappropriate behavior, sensitivity to shame, conflict or violence and social irresponsibility Mythical Creatures

Nuno sa Punso 16 Indigenous Health Beliefs y C) Cultural Healers y 1) – herbalist but also traditional general practitioner

y 2) (bonesetter) and magpapaanak (traditional midwife)

y 3) Mangluluop/Manghihila/Mangtatawas (traditional diagnosticians)

y 4) Faith healers – use of psychic surgery 17 “Local” pharmacies Cultural Values y Kapwa – sense of shared identity with others y Pakiramdam – shared inner perception; having a heightened awareness and sensitivity to others y Accomodative y Utang na loob (gratitude/solidarity versus debt of gratitude) y Hiya (sense of propriety versus shame) y Confrontative y Bahala na (determination versus fatalism) y Lakas ng loob (internal strenght) Filipinos in the US y Mariners in Morro Bay, CA y Manila men y Manongs: Sakadas, Pensionados, farm workers, factory workers, service workers y “Brain drain”: WWII vets, professionals y Professionals, asylum seekers, seeking safety from political unrest Filipinos in the US y Land of opportunity y Experienced y Discrimination y Isolation y Poor working and living conditions y Spectrum of affinity to Philippines y Spectrum of social class y Diverse views y Generational Implications for Help Seeking Behavior y Authority as a double-edged sword y Advice seeking; medical model y Polite and (might) not be always truthful – building rapport y “I can speak English” y Family member (can) play a huge role y Source of support versus burden y “Monitor” – medication Implications for Help Seeking Behavior y When seeking help y Might have “seen” someone else (or have tried something already) y Most of the time, someone had “convinced” them to seek help y Confidentiality y When seeking medical help y Acute, severe y Experienced symptoms for a while y When seeking psychological help (if at all) y Physical description of symptoms y AOD & MH – “mandated” y “I’m not crazy” Implications of being diagnosed y Go back to their definition of the problems y Go through the consequences y Judgment about a behavior/lack of it y Economic repercussion “Folk Catholicism” y Historical and/or indigenous practices/beliefs y Animism, rituals and dances y Folk healers – arbularyos, , spiritistas y Religious (Catholic) practices y Penance, offerings, psychic healing y Western medicine

y Blending of all these Suggestions

Building Rapport Intervention y Learn a Tagalog word or y Use feeler statements two y “Po” or “Opo” y Never ask “Do you understand?” y Kamusta po? y Educational materials – go y Start by using Mr. or Mrs. through it with them y Consider using humor (if y Be ready to repeat, remind appropriate) and ask a few times Challenge: To try one thing from what you learned in this presentation.

Know if may (or may not) work. 27 References y Enriquez, V. (1994). From colonial to liberation psychology: The Philippine experience. Taft Avenue, Manila: De La Salle University Press. y Jocano, F.L. (1997). Filipino value system: A cultural definition. Manila, Philippines: Punlad Research House. y Lagmay, A. (1976). Bahala na. Ulat ng Ikalawang Kumperensiya sa Sikoohiyang Pilipino. Lunson ng Quezon: Pambansang Aklatan sa Sikolohiyang Pilipino. y Mataragnon, R. H. (1987). Pakikiramdam in Filipino social interaction. Foundations of Behavioral Sciences: A book of readings. Diliman, QC: Social Science I Committee, University of the Philippines. y Osias, C. (1940). The Filipino way of life: The pluralized philosophy. Boston: Ginn. y Strobel, L. M. (2000). Coming full circle: The process of decolonization among post-1965 Filipino Americans. Quezon City, Philippines: Giraffe Books y Thompson, S., Manderson, L., Woelz-Stirling, N., Cahill, A. and M. Kelaher. (2002). The social and cultural context of the mental health of Filipinas in Queensland. Australian and New Zealand and Journal of Psychiatry, 36, 681-687. A Patient’s Dream? Contact Information

San Mateo County y Behavioral Health and Recovery Services y 650-573-2714 y [email protected]