Important Cultural Issues

 Remember: Native Hawaiians and other Pacific Islanders are a very diverse group. It is important to avoid stereotyping. The following is offered only as a guide to be considered when initially assessing the individual elder Native Hawaiian or Pacific Islander patient and may not be universally applicable to all patients.

Approach to the Elder Patient

In order for the clinical interaction to be meaningful, Native Hawaiians and other Pacific Islanders need to develop a sense of trust with their health care providers. Native Hawaiians may initiate this process by trying to establish a “connection” with their physician or health care provider. This connection may involve questions regarding your genealogy, about the community you live in, the school you attended or where you have worked. Not uncommonly, Native Hawaiian patients will start off the encounter by asking questions, trying to “find that connection”.

For example, they may ask, “Where are you from?” They might be interested in seeing if you grew up in the same home town or if you know any of their relatives. Providers should be aware of this need to establish a “personal connection” and be open to responding to this interaction if they hope to establish a relationship based on trust. Physicians should make an effort to answer questions and even assist the patient in trying to find a connection. This is a critical part of the initial encounter and physicians should not rush through it in the hopes of getting to the medical interview.

Native Hawaiian elders or kupuna, as with many other indigenous people, are held in high regard within their community. To develop rapport with the patient and/or the family, the health care provider often must be able to demonstrate a similar level of respect for the elderly patient.

It is permissible, if not necessary, to simply ask the patient how they prefer to be addressed. Initially, do not appear too casual (do not start off with calling them by first names) unless invited. Many elders may prefer to be addressed as “Aunty” or “Uncle” regardless of the fact that they may not be directly related to the interviewer. Using these terms allows the physician to come into the patient’s world at their level. Native Hawaiian patients, like many other minority patients, value physician qualities such as being friendly, personable, thorough and most importantly, taking the time to listen and explain.

Family Involvement

When it comes to describing the illness or the treatment plan, it is best to involve the family in discussions and the decision-making processes. Taking the time to educate the patient and family goes a long way towards developing trust and patient rapport (Mau et al., 2003). It may be more challenging to communicate with the patient if English is not their first language and an interpreter may be needed. Usually this is a family member, many times a young child. In Native Hawaiian and Pacific Islander cultures, out of respect for their elders, it may not be appropriate for a young child to ask certain medical questions.

Caring for a Micronesian Patient

According to existing literature and clinical observations, when addressing an elder Micronesian patient, it is appropriate to initially conduct your interview with the male (usually a male relative) who is present in the room. If he gives his approval to answer, the female or younger patient will then do so. One needs to also ask permission of the patient to perform a physical exam, especially if touching the abdomen, pelvic area and thighs. For Micronesian women in particular, these areas are considered to be taboo and thus may need to be avoided in conversation with the elder Micronesian patient.

Caring for a Samoan Patient

In caring for a Samoan patient regardless of age, the health care provider must realize that questions regarding sexual relations, venereal disease, or menstrual cycles are regarded as distasteful. Moreover, female Samoan patients may find it personally difficult to undress, even minimally, for a young Caucasian physician or other non-Samoan health care providers. Questions dealing with family diseases and/or abnormalities of the genitals are usually not answered directly, as most Samoans are extremely private in these matters and consider it shameful to speak of such things. In caring for an elder Samoan patient, show respect with a reassuring handshake and a smile. If treated with respect, the elderly patient will in turn acknowledge and respect the physician for his/her medical authority. When addressing the family, there will usually be a spokesman, usually the most respected or the most educated person and the physician should address him/her (Palafox & Warren A., 1980).