HCA 340 Cultural Diversity in Health & Illness Essay
HCA 340 Cultural Diversity in Health & Illness Essay
Overview
Prepare a 4–5-page review of recent research that examines statistics on the primary health concern of a population, describes the methods and tools used in the research studies, explains the factors that affect health promotion and disease prevention for a population, and recommends a health care initiative.
Note: The assessments in this course build upon each other, so you are strongly encouraged to complete them in sequence.
The ability to locate, evaluate, and apply research is an important skill for nurses to develop in order to provide evidence-based care for individuals, families, communities, and health care systems. HCA 340 Cultural Diversity in Health & Illness Essay.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
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· Competency 1: Explain the principles and concepts of disease prevention and health promotion for diverse and vulnerable populations.
. Compare the statistics for a health concern of a vulnerable or diverse population to the statistics for the general population, including ethical, legal, economic, and cultural factors.
. Explain the principles and concepts that influence health promotion and disease prevention for the identified vulnerable or diverse population.
. Recommend an evidence-based health care initiative for a specific health care concern of a vulnerable or diverse population.
· Competency 3: Apply basic epidemiological concepts, data analysis methods, tools, and databases to determine the effectiveness of health promotion and disease prevention initiatives for diverse and vulnerable populations.
. Describe the epidemiological concepts, data analysis methods, tools, and databases used in research studies related to health concerns for a vulnerable or diverse population.
. Describe health care initiatives used by organizations to address the health care concerns of vulnerable or diverse populations.
· Competency 5: Communicate in a manner that is scholarly, professional, and consistent with expectations for members of the health care professions.
. Write content clearly and logically, with correct use of grammar, punctuation, APA formatting, and mechanics.
Assessment Instructions
Preparation
Your team has presented its preliminary findings to the executive leadership in your organization, but leadership has some doubts about some of the information they received. Each member of the team has been charged with doing a critical examination of recent research around each member’s area of expertise. As the team’s nursing representative, you need to look specifically at the health care concerns identified in the Windshield Survey assessment. HCA 340 Cultural Diversity in Health & Illness Essay.
The first step in preparing to write a review of the research is to define your topic. For this assessment, your review will provide a comprehensive overview of the needs of the population you identified in the Windshield Survey assessment in terms of health promotion and disease prevention, the factors that contribute to health disparities for the population, and the need for the organization to improve health care delivery to the population.
In the Capella library, search for current scholarly or peer-reviewed professional research articles that:
· Examine the health care risks and needs of your population.
· Analyze the need to improve health care delivery to the population.
· Evaluate, critically, the factors that affect health promotion and disease prevention for the population.
· Examine strategies to reduce health disparities for your population.
Locate at least 5–7 resources so that you can eliminate 2–3 if necessary. You may discover, for example, as you read each article more in-depth, that they may not all have the focus you need for your review.
Requirements
For this assessment, you need to develop several points around which to apply the research from the articles you located. Specifically, you need to:
· Compare statistics for the primary health concern of your population to the rest of the general population in the United States. This would include frequency of occurrence, age groups most at risk, frequency of fatality, and so on.
· Describe the epidemiological concepts, data analysis methods, tools, and databases used in the research studies you located. Address any flaws or biases you believe are present.
· Explain the factors that affect health promotion and disease prevention for the population. (Hint: These may be things such as language barriers, cultural values, generational differences, social fear, and access to services.)
· Describe the types of health care initiatives that have been tried by other organizations specifically for the primary health care concern or the population.
· Recommend one health care initiative for your population, based on your research,
These should be the ideas, or points, that your review is based on. For each point, present all of the evidence you located. For this assessment, that should be at least four current research articles, although not all of the articles will typically offer evidence on all of your points. HCA 340 Cultural Diversity in Health & Illness Essay.
Be sure your assessment includes:
· An introduction that presents the points you will cover.
· The body that presents the research on the points.
· A conclusion that restates the points in your introduction.
Your assessment should be 4–5 pages in length, not including the title page and reference page. Be sure you follow APA guidelines for style and format.
Additional Requirements
· Include a title page and reference page. The completed assessment should be 4–5 pages in length, not including the title page and reference page.
· Reference at least four current scholarly or professional resources.
· Use current APA format.
· Use Times New Roman font, 12 point.
· Double-space.
Multiple Choice Questions (Enter your answers on the enclosed answer sheet)
1. A patient from the Mexican heritage relates using a curandero for health care needs. What are the characteristics of this type of healer?
a. Considered to be a religious figure
b. Was born as a healer
c. Taught the ways of healing through herbs
d. All of the above.
2. In the Mexican health care system, what is the scope of practice of the partera?
a. The care given is confined to the pregnant woman
b. Only provides physical care
c. Acts alone without doing other consultations or referrals
d. Does not participate in labor and delivery
3. During a medical history with a patient from Puerto Rico, what preparations will the nurse need to include?
a. Those obtained from a botanica
b. Those obtained from a botanical center
c. Those obtained from a healer
d. Those obtained from a pharmacy
4. Which is a dilemma encountered by health care providers when trying to accommodate a patient of the Mexican culture’s desire to maintain hot and cold food preferences? HCA 340 Cultural Diversity in Health & Illness Essay.
a. Avoiding all foods that contain certain spices
b. Understanding which foods the patient considers hot and cold
c. Obtaining the unusual foods native to a Mexican patient’s diet
d. Ensuring that all medications are taken with specific foods
5. Where might a patient of Puerto Rican heritage seek help when experiencing signs of a mental illness?
a. Milagros
b. Curanderismo
c. Santeria
d. Partera
6. What is a significant factor when caring for health problems of patients within the Hispanic culture?
a. Lack of Spanish-speaking health care providers impeding appropriate care delivery
b. Failure to highlight common chronic diseases among Hispanics in local media
c. Overall population is elderly
d. Use of folk remedies creating cultural dissonance with the medical establishment
7. What would the combination of a young population, high birthrates, and lower socioeconomic status contribute to in the Hispanic population?
a. Higher incidence of births to women under age 18
b. Lower birth weight infants
c. Higher percentage of first trimester prenatal care
d. Higher infant mortality rate
8. Which health problem does the nurse identify as being a higher risk for the patient from the Hispanic culture when compared to the general population?
a. Septicemia
b. Unintentional injuries
c. Chronic lower respiratory diseases
d. Alzheimer’s disease
9. What would the nurse infer about the incidence of lung cancer being lower among Hispanic women versus that of the general population?
a. Hispanic women are not genetically predisposed to lung cancer.
b. Hispanic women are healthier than the general population.
c. Hispanic women have better preventive health practices.
d. Hispanic women are less likely to smoke.
10. What might a patient of German descent used to treat a stomachache?
a. Drink peppermint tea
b. Stop eating for at least 24 hours
c. Take black draught
d. Eat chicken soup
11. Which actions might a patient of German descent use to treat a cough?
a. Rub goose fat on the chest
b. Eating honey and milk
c. Drinking rum
d. All of the above.
12. When caring for a postoperative wound at home, what would a patient of German descent tend to use?
a. Kerosene
b. Iodine
c. Salves and liniments
d. Onion compresses
13. For what would a patient of German descent use cloves?
a. Headache
b. Rheumatism
c. Toothache
d. Fever
14. What would a patient of Italian descent tell the nurse is the cause of pneumonia?
a. Moving air in the form of drafts
b. Eating food that was not nutritious
c. Improper balance of fluids
d. Not dressing properly
15. What will the nurse assess as an important component of healing for a patient of Italian descent?
a. Religious faith in God
b. Use of garlic and olive oil in tonics
c. Wearing black when a family member is ill
d. Eating pasta at every meal
16. What will a patient of Polish descent tell the nurse is used to treat a cough? HCA 340 Cultural Diversity in Health & Illness Essay.
a. Taking garlic oil
b. Goose grease rubbed on the throat
c. Drinking hot lemonade with whiskey
d. A tomato plaster on the chest
17. What will a patient of Polish descent use to treat a burn?
a. Aloe vera
b. Salt pork
c. Carbolic salve
d. Turpentine and liniment
18. For what would a patient of Polish descent tell the nurse that paregoric is used?
a. Gas
b. Diarrhea
c. Indigestion
d. Cramps
19. In which ways does the current United States health care system create barriers to individuals from different cultures? HCA 340 Cultural Diversity in Health & Illness Essay.
a. Expectation to select a physician from a list
b. Cost of treatments and tests
c. Violation of cultural beliefs and practices
d. All of the above.
20. How would the use of patient advocates bridge the gap of inadequate numbers of health care providers representing culturally diverse population groups?
a. Speak to patients in their native language
b. Coordinate services to meet the patients’ needs
c. Resolve problems
d. All of the above.
21. The health care administrator is identifying ways to improve communication with non-English speaking patients. Which languages would the administrator target as being spoken by hospital employees?
a. Russian
b. Chinese
c. Spanish
d. None of the above.
22. The nurse is experiencing collisions when attempting to improve cultural competency. What types of collisions is this nurse experiencing?
a. Meeting dense cultural barriers
b. Sabotaged efforts
c. Unexpected hills
d. a and b only
23. Two nurses are overhead talking about their experiences with cultural competency. Which experience would be considered an unexpected positive event?
a. Deep love of life and people
b. Role of a healer within a culture
c. Learning a foreign language
d. Being an advocate for funding
24. What self-observation does the nurse make that indicates that the nurse is “on the road” to cultural competency?
a. you should only observe your own health and illness beliefs
b. Individual culture and religion
c. Adhering to ways to protect health that are consistent with the dominant culture
d. Avoiding the use of amulets
25. What action would a nurse take to learn more about the different cultures represented in the community?
a. Walk through the community
b. Prepare a guide sheet with a list of herbs
c. Recognize hot–cold imbalances
d. Recognize folk diseases
Diverse Population Care
Diverse Population Care
uDiverse Population Care
uThe Amish
uThe Inuit
u Two different cultures
The Amish
Founded by Jacob Amman (1644-1720) in Europe.
Originally from Switzerland and south Rhine river region until 18th century migration to USA.
Most settled in Pennsylvania.
Isolated from modern society.
Speak English and Pennsylvania German (“Dutch”).
What is “culture”? Culture is the customary beliefs, social forms, and material traits of a racial, religious, or social group.
Today we are going to discuss two different cultures.
The Amish
The Amish society originated in Europe established by Jacob Amman (1644 to 1720) (Robinson, 2012). Originally, they were part of the Mennonites but separated from the Mennonites because the felt there was a lack of discipline within the Mennonites. They lived in Switzerland and the southern Rhine river region until the 18th century and then migrated to the United States of America (USA), where they settled in Pennsylvania, New York, Illinois, Indiana, Iowa, Missouri, Ohio, and some other states. They try to preserve their origin culture which is based on the late 17th century European rural culture by avoiding modern society and developing practices and behaviors that will keep them isolated from modern society. The Amish speak the language of German known as Pennsylvania German, or Pennsylvania Dutch (Amish America, 2010). There are some comparisons with languages of German spoken in Europe today, though Pennsylvania German consists of many English words. Accents and mannerisms of speaking Pennsylvania Dutch often varies between individual Amish communities. Also, there is no written version of this language.
The Inuit
The two main groups of Eskimos are the Inuit of northern Alaska, Canada, and Greenland, and the Yupik of central Alaska. In most places, the term Eskimo has become a derogatory term (aaanativearts). The term Eskimo has been replaced with the preferred term Inuit. The Inuit are indigenous to Alaska but have traditionally inhabited the area around the pole covering eastern Siberia (Russia), Alaska (United States), Canada, and Greenland. Their evolution is defined as having four phases related to the well-defined differences in their technologies used for hunting and tool making. The earliest known Inuit date back 5,000 years ago in Alaska from people who used Artic small tool traditions. It is possible that they migrated to Alaska from Siberia 2,000-3,000 years earlier, but the history is difficult to determine due to lack commonalities in their languages. The Inuit language has two major divisions: Yupik, spoken in Siberia and southwestern Alaska and Inuit, spoken in northern Alaska, Canada, and Greenland (Babbi & Jackson, 2003). There are different names for the language in some of the regions. Across the North Pole, there are two styles of Inuit written language. One form uses Roman alphabet and the other uses symbols to represent sounds. Both forms were generated by missionaries. The form that was used depended on which missionary was where, hence the lack of commonality in communication. The Roman alphabet is used to write Inuktitut in Alaska. According to Babbi & Jackson (2003), Inuktitut translates as “in the way of the Inuk” (Inuk is the singular form of Inuit).
uCultural health practices of the Amish
uCultural health practices of the
uAMISH health disorders
Rare conditions
Ellis-van Creveld syndrome – dwarfism and polydactylism
Glutaric aciduria – unable to process amino acids causing build up in the blood and urine
Crigler-Najjar syndrome – hyperbilirubinemia causing jaundice and brain damage
Maple Syrup Urine disease – due to inability to process some amino acids properly – causes seizures, coma, and death in untreated infants
u
uINUIT health disorders
Common Conditions
Coronary artery disease – high mortality due to cerebrovascular strokes
Osteoporosis
Parasitic transmission
Environmental pollutants
u
Adult Health Practices including care of the elderly and perspective on death
Amish health care practices vary across the communities and from family to family (Amish Studies). Although they recognize God as the ultimate healer, they do not cite any Biblical reason to oppose traditional healthcare. They do prefer alternative treatments, based in homeopathic remedy. They are not likely to seek medical care for minor aches or illnesses. The prefer folk remedies and are not likely to employ heroic measures to save a life, as they would choose instead to allow nature to take its course. They often feel awkward around advanced technology and find that most providers are not sensitive to their cultural preferences. They may face long journeys to reach medical facilities, especially since they travel by horse and buggy. Furthermore, since education generally stops at the eighth-grade level, they may not understand what providers are trying to tell them.
Labor & Delivery
Childbirth for the Amish woman is a serious life event (Wickwire, 2006). All Amish women are believed to be at high risk for problems during their childbearing period . The Amish do not practice birth control and therefore have large families with closely spaced pregnancies. Also, due to the lack of birth control, the maternal age for pregnancy may be advanced. Stress of worry about adding financial burden to the family also contributes to the high risk of complications, as they are less likely to seek early prenatal care. There is also the mistrust of traditional healthcare, fear of lack of cultural sensitivity, and the inconvenience of traveling long distances to seek services which contributes to high risk for complications.
However, Amish will often select which service best meets their individual and cultural needs. Most deliveries are attended in their own homes by Amish lay midwives and occasionally physicians who provide home care. Some communities have birth centers within them, with midwives who provide prenatal visits, Lamaze classes, and accommodate the use of herbs and complementary therapies.
Pediatrics
The Amish usually keep excellent historical and genealogical records (Vockley, 2019). Given that the communities are known for their self-isolation and little to no migration within the group, it is not uncommon to a loss of genetic variation that would normally result from merging with larger populations. Inbreeding directly results in genetic mutations, also known as the founder effect. Because the Amish typically have larger families, there is usually a significant number of children which provides adequate numbers of affected and unaffected siblings within a sibship. This allows for the study of the genetic mutations.
The most common gene mutations cause mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS); developmental delay, short stature, hypotonia, hearing loss, renal failure, migraines, fatigability, and poor appetite are also common. Recurrent miscarriages are also attributable to these gene mutations. Children as young as 12 years old are reported to have acute strokes with progressive dysphagia, weakness, and respiratory failure, unto death (Vockey, 2019).
Although some communities will participate in childhood vaccinations, parents are usually selective about what vaccines their children will and will not receive, if any at all. Amish prefer the order of natural selection and prefer natural exposure over vaccination.
The Inuit, have accepted that “times change” and favor modern amenities.
Adults
According to the National Earth Science Teachers Association (NESTA), The Inuit communities were most commonly found in the tundra where not many building materials exist. In the winter, the Inuit lived in igloos and in the summer, they lived in huts made from animal skins. Migration between communities was essential for survival. In modern times, materials are often imported, and the Inuit live in houses. Hunting and fishing were common as there was no where to grow a garden on the frozen tundra, thus, meals consisted mainly of meats. Clothing was commonly made from animal skins, including boots and coats. Following the end of World War II, military bases and permanent communities were established. As these areas grew, schools and health care centers were created which brought non-native traditions. Through improved health care, the Inuit population grew and many moved to permanent settlements so that they could have access to jobs and foods.
Aging/ Elderly
The Inuit recognize that age is found in numbers but do not decide that they are “old” based on that number. Most Inuit continue to work, hunt, gather, fish, etc., until they are too tired to do so. According to the Inuvialuit Regional Corporation (Collings, 2000), Inuit reaching the age of 50 begin to receive installment payments resulting from the land claims settlement. Therefore, elderly has been defined as the age of 50 years. In modern times, however, health care and economy has improved and become more available. Inuit are living longer. As they get older, they are more respected for their experiential wisdom. They are expected to pass on their knowledge to younger generations. They receive the same medical care as non-Inuit. The Inuit have long been reported to send their elderly out into the tundra to die, however this was only done during times of great famine and is not a customary process.
Labor & Delivery
According to Ketchum (2019), traditional Inuit customs expect women to endure labor without making noise and without taking pain medications, while standing upright. These traditions have relaxed and in modern Inuit societies, many women birth their children in the hospital setting. Oder traditions dictate the birth of the child through a midwife, in a birthing hut. The midwife is required to “make the baby” by touching its genitals as soon as they are exposed, thereby preventing the baby from changing its sex at the last minute.
Pediatrics
Beliefs that “baby teeth” aren’t important, lack of fluoride, and cost of accessing early dental care causes the high incidence of dental caries and oral infections in Inuit pediatrics (American Academy of Pediatrics, 2011). Infections that may begin as oral infections can also lead to respiratory or ear infections.
Amish Health Disorders
The Amish have some diseases that are rarely seen in other populations.
Ellis-van Creveld syndrome is an inherited disorder that affects bone growth and results in a short stature (dwarfism), extra fingers or toes, malformed fingernails or toenails, and some dental abnormalities (DHH, 2019). Most also have a heart defect which could be life-threatening.
Glutaric Aciduria s a rare but very serious genetic condition that causes the body to be unable to process certain amino acids. This, in turn, causes a harmful build-up of poisons in the blood and urine (NHS, 2018).
Crigler-Najjar syndrome (DHH, 2019) is a very severe hereditary condition characterized by hyperbilirubinemia. Unconjugated bilirubin needs to be converted to a nontoxic form called conjugated bilirubin. In those with Crigler-Najjar syndrome there is a buildup of unconjugated bilirubin causing jaundice. Severe unconjugated hyperbilirubinemia can lead to a condition called kernicterus, which is a form of brain damage. Brain damage caused by the accumulation of unconjugated bilirubin in the brain and nerve tissues causes lethargy, muscle weakness, and hypotonia. Other neurological, including involuntary writhing movements of the body (choreoathetosis), hearing problems, or intellectual disability can also occur.
Maple syrup urine disease (NHS, 2018) is an inherited disorder in which the body is unable to process certain protein amino acids properly. This disease earned its name because of the distinctive sweet odor of affected infants’ urine. It is often characterized by poor feeding, vomiting, lack of energy (lethargy), abnormal movements, and delayed development. If untreated, maple syrup urine disease can lead to seizures, coma, and death
Some illnesses are so uncommon that they are unique to these communities (such as Troyer Syndrome or Amish lethal microcephaly), or rarely seen elsewhere. Some groups of Amish may exhibit diseases more likely to be seen in the general public, but at a higher rate. These include cystic fibrosis, muscular dystrophy and deafness in some communities.
Inuit Health Disorders
According to Dr. McDougal (2015), the diet of the Inuit was limited due to geographical location. Therefore the Inuit ate diets largely comprised of raw meats. After finding and autopsying remains of ancient Inuit and evaluating modern day Inuit, it is noted the most common reason for mortality in this culture is extensive hardening of the arteries. Coronary artery disease has led to cerebrovascular stroke, and death. Mummified remains of two Inuit women of different ages also showed severe Osteoporosis. This is partly due to a diet low in calcium, but also related to lack of sunlight. The typical Inuit diet was high in protein, high in nitrogen, high in phosphorus, and low in calcium.
Other concerns are related to the transmission of parasites from raw meats to humans. Dr. McDougal (2015) cites one example as trichinosis, associated with the roundworm Trichinella spiralis. He reports that this parasite can be found in approximately 12% of older Inuit.
And finally, eating raw and infected animal meat can not only cause infestation from parasites but also expose the Inuit to high concentrations of environmental chemicals. Dr. McDougal (2015) cites the Inuit as having the highest human concentrations of environmental chemicals than any other human population on earth.
Tips for working with the Amish patient
According to Waltman (2005), there are many ways to approach Amish patients in a culturally sensitive manner.
1.It is important to know which group the Amish patient belongs to. Knowing how conservative or liberal the group is will help in the decision-making for cares and services.
2.Amish culture is one where value is placed on face to face communications. The Amish patient may ask personal questions, in an effort to individualize their care giver. It’s important to answer honestly and be as open as possible.
3.Probably the most important issue is to accept Amish values, beliefs, customs, and attitudes, even if they are different from your own.
4.If possible, consider modifying the delivery of the care service to accommodate Amish preferences and overcome the barriers of distance, transportation, and cost. One example might be to place a hitching post for the horse outside of the facility.
5.Just as holidays may be important to you, Amish also recognize holidays. For example, Sundays are a day of rest. It is important to be aware of Amish holidays since their belief in God will have priority over all medical requirements.
6.Talking with Amish patients is no different than talking to any other patient. Talking about the weather or current events is often appreciated. No patient should ever be spoken to in a condescending manner, even an Amish patient. Though it is important to talk slowly and allow time for discussion of issues.
Tips for working with the Inuit patient
Flowers, (2005), determined that It is never wise for any health care provider to stereotype their patient. Cultural issues such as spirituality, language, and healthcare, as well as racial characteristics such as skin color, vary greatly among individuals, especially among Inuit tribes and in families within tribes. Inuit of certain tribes or families may have specific spiritual or healing rituals or ceremonies that they feel necessary to conduct, even within healthcare facilities. It is critical to be in tune to those needs for spirituality. Most Inuit have large families, by blood or not. Nieces, nephews, uncles, and so on, may want to visit. Communication is most important and helpful for providers who wish to make the relationship satisfying for patients as well as providers, keeping in mind that communication is not only what is said in words, but also in body language. Lastly, respect is vital. Even if the care provider does not believe as the Inuit do, it is important to respect their customs and beliefs. HCA 340 Cultural Diversity in Health & Illness Essay
uTips for working with the Amish patient
uConservative or Liberal community
u
uFace to face honesty
u
uAccept Amish values, beliefs, customs, and attitudes, even if they are different from your own.
uService modification
u
uAmish holidays
u
uSocialization and communication
uTips for working with the Inuit patient
uDon’t stereotype
u
uAllow spirituality needs
u
uExtended families
u
uCommunication
u
uRespect
uReferences
Robinson, B.A. (2012, August 24). The Amish: history, beliefs, practices, conflicts, etc. Ontario consultants on religious tolerance. Retrieved from: http://www.religioustoler HCA 340 Cultural Diversity in Health & Illness Essay
ance.org/amish.htm
Dr. McDougall. (2015). Extreme nutrition: The diet of the Eskimos. Dr. McDougall’s Health & Medical Center. Retrieved from https://www.drmcdougall.com/misc/2015nl/apr/eskimos.htm
Amish America. (2010). What language do the Amish speak? Exploring Amish culture and communities. Retrieved from: Amishamerica.com/what-language-do-the-amish-speak/#footer_stallion
American Academy of Pediatrics. (2011). Early childhood caries in indigenous communities. Pediatrics, 127(6). Retrieved from: https://pediatrics.aappublications.org/content/127/6/1190
uReferences
Aaanativearts. (n.d.). Eskimo culture. AAA Native Arts. Retrieved from: https://www.aaanativearts.com/eskimo-culture
Fabbi, N. & Jackson, H.M. (2003, March). Inuktitut – the Inuit language. K12studycanda, pp 1-7. Retrieved from: http://www.k12studycanada.org/files/Inuktitut.pdf
Amish Studies. (2019). Health. Amish studies: The Young Center, cultural practices. Retrieved from: https://groups.etown.edu/amishstudies/cultural-practices/health/
Wickwire, V.L. (2006, January). Amish childbearing beliefs and practices and the implications for nurse-midwives as servant-leader care providers. Dissertation, 1542. Retrieved from: https://digitalcommons.andrews.edu/cgi/viewcontent.cgi?article=2541&=&context=dissertations&=&sei-redir=1&referer=https%253A%252F%252Fwww.bing.com%252Fsearch%253Fq%253Dbirthing%252Bamong%252Bthe%252Bamish%2526FORM%253DHDRSC1#search=%22birthing%20among%20amish%22 HCA 340 Cultural Diversity in Health & Illness Essay
uReferences
Vockley, G. (2019). Genetic disease in Amish. UPMC Children’s Hospital of Pittsburgh. Retrieved from: http://www.chp.edu/research/areas/genetics/projects/vockley/amish
Amish America. (2010). Do Amish have genetic disorders? Exploring Amish culture and communities. Retrieved from: http://amishamerica.com/do-amish-have-genetic-disorders/
U.S. Department of Health & Human Services (DHH). (2019). Ellis-van Creveld Syndrome. GU.S. National Library of Medicine. Retrieved from: https://ghr.nlm.nih.gov/condition/ellis-van-creveld-syndrome
NHS (2018). Glutaric aciduria type 1. Retrieved from https://www.nhs.uk/conditions/glutaric-aciduria/#
Waltman, G.H. (2005). Guidelines for professionals when working with the Amish community. The Pennsylvania child welfare training program. Handout #15, pp. 1-2. Retrieved from: http://www.pacwrc.pitt.edu/Curriculum/522SprvsryIsssInChldSxlAbs/Hndts/HO15GdlnsFrPrfssnlsWhnWrkngWthThAmshCmmnty.pdf
uReferences
Ketchum, D. (2019, September). Inuit pregnancy & conception beliefs. Classroom synonym. Retrieved from: https://classroom.synonym.com/inuit-pregnancy-conception-beliefs-11481.html
Collings, P. (2000). Aging and life course development in an Inuit community. Artic Anthropology, 37(2), pp. 111-125. Retrieved from : https://www.lakeheadu.ca/sites/default/files/uploads/53/outlines/2014-15/GEOG3671/Project/CollingsAgingandLifeCourseDevelopment2000.pdf
National Earth Science Teachers Association. (2019). Inuit culture, traditi
