Monday, April 27, 2009

Cultural Health Literacy

Our gardener is from Honduras but he speaks excellent English as a second language and has lived in the U.S. for many years. Despite this, his understanding of medical issues is quite limited, both by language and education. Today we were talking about the Swine Flu outbreak in Mexico and I was giving him what I thought was simple education. The conversation switched to immunizations and that is where I realized even simple explanations didn't work.

Raul believes he had a vaccination for Tuberculosis at a local community clinic before he recently returned to Honduras for a visit. He also had another vaccine that he has no idea what it was. I explained the TB skin test to him and the fact that there are no vaccinations for TB. (Actually in some foreign countries they do vaccinate with a drug called BCG but it is not used in the U.S.) He insisted that he tested negative for TB but was given 8 months of pills to take as a vaccine.

I am clear what happened. Tuberculosis exposure is treated with INH (Isoniazid) pills daily for 6-8 months. He probably had a positive TB skin test and because he travels back and forth to a TB endemic area he was given INH for "latent" TB and to prevent active infection.
This is not what we know of as a vaccine. Even more worrisome is the other vaccine that he received for unknown reasons. It could have been tetanus, polio, yellow fever or measles. And we have no idea what preventive immunizations he is missing.

Very few patients, no matter where they are from, remember when and where they were vaccinated. As a comprehensive Internist, I keep a record on my patients but fewer and fewer patients have a continuity physician. Patients who are seen at various emergency rooms, urgent care, travel clinics or other community clinics have no real records to fall back on.

At the very least, patients should be given a laminated card to carry in their wallets that list immunizations and dates. This should be standardized across the U.S., much like a drivers license. Is that so hard to do?


Anonymous said...

The laminated card is a really great idea!!

Anonymous said...

At the very least, patients should be given a laminated card to carry in their wallets that list immunizations and dates. Although this is great for most people try getting an illegal to get immunated never mind carrying a card. They move from place to place, state to state spreading whatever it is they are carrying putting health care workers and the public at risk.

jenny said...

Swimming: the Sport to Gain some Height
Swimming is one of the healthiest sports that are available today. It helps in a lot when it comes to the cardiovascular system and the pulmonary system. With swimming, the heart is strengthened, making it more capable of pumping blood into the rest of the body. If you have a good heart, you are less likely to have high-blood pressure and cardiac arrest. With swimming, your lungs are also improved, which is important since a body needs to maintain clean fresh oxygen to work properly.
Truly, swimming has a lot of advantages. But did you know that swimming can also help increase the possibility of a person way beyond his puberty age to grow taller? Yes, it can! One of the basics of swimming is the stretching of the legs and arms during the swim. The freestyle, the butterfly and the breast stroke all involve the complete stretching of arms and legs, especially breast stroke. For more information, visit here .
Not only has that, swimming helped you to improve posture. We know that many short people are guilty of not maintaining the right posture. If you stand properly – straight and proud – you will notice that you will actually gain some height. Many people realized that once they have improved their posture, they grow at least an inch taller.
Furthermore, will floating in the water, the body experiences less gravity, being buoyed up by water itself. This relaxes the bones in your body, especially the spine.
Aside from utilizing this sport, it is also necessary to have a balanced diet, have enough sleep and have a daily dose of growth enhancers such as Growth Flex V Pro System. Go to .

flin said...

Nutrients for Growth
One of the reasons why a person fails to grow taller as he should is because of poor diet. Without the proper nutrition, the body will not be able to produce the right amount of hormones that the body needs. The body’s defenses are lessened and the ability to the various activities is likewise decreased. If your body could not even keep up with its daily activities, how much more would it be able to properly produce growth hormones that one needs to grow tall? Being deficient in nutrients can inhibit a person’s growth.
Having the right amount of nutrients is then necessary for growth, whether you are in your teens, in your twenties, thirties and forties. The six essential nutrients that the body needs are vitamins, minerals, fats, carbohydrates, proteins and of course, water. When the body has enough of these, you can be sure that the body will function well. Furthermore, you will increase the possibility of growing a few more inches. Go to .
It is important to note that the body needs a balanced diet; this means you should not take any more than what is necessary. Too much of anything can be bad. Food that has been fried in oil has too much fat, same as with junk food. To make sure that you have the right nutrients for growth, check the label in the packaging of the food.
It would also be better if you can have some dietary supplements. Remember, since they are supplements, they cannot be used as replacement for real food. A regular dose of growth enhancers such as Growth Flex V Pro System can help. For more in details, go to .

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