Ojibwe Traditional Dancer

In a study done in 1995 in Hennepin County, health care providers identified the following barriers to health care as they perceived problems caring for patients from cultures other than their own (Ohmans, 27-29).

1. Gender: In traditionally sensitive areas of health care, gender is extremely important. One may be caring for a torture survivor and therefore the gender issues become critical. Also certain cultural groups will not allow a person of the opposite sex to touch them.
2. Class: There is a strong tie between a patient's social status and educational attainment, which in turn affects health behavior. Not all refugees are poor, but many have had significant class changes when immigrating to the United States.
3. Age: This barrier varies greatly from young to old and among various cultures. Providers should be sensitive to the age factor when caring for a person of any culture.
4. Intrusive or invasive procedures: Practices involving removal of blood or tissue or invasive procedures are difficult for many immigrant patients. Try to negotiate with patients about the amount taken or timing of the procedure whenever possible.
5. Systems differences: Western medicine is seen as highly mechanistic. It does not take into account the spiritual or metaphysical causes of ill health. Such system differences put barriers between providers and immigrant patients.
6. Mistrust of health care institutions: Many immigrants have fears and doubts about health care institutions usually related to their country of origin. Latinos may fear deportation, Russian immigrants may fear political repression.
7. Non-recognition of medical need by patient or provider: Some cultures have illnesses that have non-physical manifestations which make it difficult for the provider to find cause or disease if there are not physical manifestations. At the same time, some cultures believe that there are certain illnesses with which one should not interfere. This creates problems for providers and the patients.
8. Lack of acknowledgment of family systems: Many practitioners had a difficult time accommodating members of an immigrant patient's extended family who felt they should have a say in the patient's care. This can be a very difficult subject for confidentiality issues while trying to respect the patient's cultural beliefs.
9. Practitioner perceived as alien or distant: What is otherwise considered "culturally appropriate" bedside manner may vary greatly with the culture and the patient.
10. Stigma or shame over certain conditions: Many conditions, not just diseases, are stigmatized among immigrant patients. Some seemingly minor conditions may seem overwhelming to some immigrants while others refuse to discuss or acknowledge certain conditions such as rape or pregnancy.