Fluent Essays

People of Appalachian Heritage.People of Arab Heritage.Please read chapter 8 and 9 of the class textbook and review the attached PowerPoint presentations. Once done answer the following questions;1. Give an overview of the Inhabited localities and topography of the Appalachian and Arab heritage.2. Discuss any similarities in the beliefs of the Appalachian and Arab heritages regarding the delivery of healthcare.3. How the religion or folks beliefs influence the delivery of healthcare in these two heritages. You must cite or quote at least two evidence-based references (besides the class textbook) no older than 5 years old. Please it can not be older than 5 years!!!!!A minimum of 600 words excluding the first and references page is required. textbook_chapters_8___9.docx culture_chapter_8.ppt culture_chapter_9.ppt Unformatted Attachment Preview Chapter5 KATHLEEN W. HUTTLINGER and LARRY D. PURNELL Overview, Inhabited Localities, and Topography OVERVIEW Appalachia consists of that large geographic expanse in the eastern United States that is associated with the Appalachian mountain system, a 200,000-square-mile region that extends from the northeastern United States in southern New York to northern Mississippi. It includes all of West Virginia and parts of Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, and Virginia. This very rural area is characterized by a rolling topography with very rugged ridges and hilltops, some extending over 4000 feet high, with remote valleys between them. The surrounding valleys are often 2000 feet or more in elevation and give one a sense of isolation, peacefulness, and separateness from the lower and more heavily traveled urban areas. This isolation and rough topography have contributed to the development of secluded communities in the hills and natural hollows or narrow valleys where people, over time, have developed a strong sense of independence and family cohesiveness. These same isolated valleys and rugged mountains present many transportation problems for those who do not have access to cars or trucks. Very limited public transportation is available only in the larger urbanized areas. Even though the Appalachian region includes several large cities, many people live in small settlements and in inaccessible hollows or “hollers” (Huttlinger, SchallerAyers, & Lawson, 2004a). The rugged location of many communities in Appalachia results in a population that is often isolated from the mainstream of health-care services. In some areas of Appalachia, substandard secondary and tertiary roads, as well as limited public bus, rail, and airport facilities, prevent easy access to the area (Fig. 5–1). Difficulty in accessing the area is partially responsible for continued geographic and sociocultural isolation. The rugged terrain can significantly delay ambulance response time and is a deterrent to people who need health care when their health condition is severe. This is one area in which telehealth innovations can and often do provide needed services. Many of the approximately 24 million people who live in Appalachia can trace their family roots back 150 or more years, and it is common to find whole communities comprising extended, related families. The cultural heritage of the region is rich and reflected in their distinctive music, art, and literature. Even though family roots are strong, many of the region’s younger residents have left the area to pursue job opportunities in the larger urban cities of the north. The remaining, older population reflects a group that often has less than a high-school education, is frequently unemployed, may be on welfare and/or disability, and is regularly uninsured (20.4 percent) (Virginia Health Care Foundation, 2001). In fact, of the total current population in Appalachia, 12.4 percent are 65 years or older (Haaga, 2004). The lack of education has often been associated with nonparticipation in health promotion activities (Graduate Medical Education Consortium [GMEC], 2001). Graduation rates from high school in the year 2000 vary widely from 60.7 to 91.4 percent, with the lowest number of graduates occurring in West Virginia, southwestern Virginia, eastern Kentucky, and northeastern Tennessee (Haaga, 2006). © 2008 F A Davis HERITAGE AND RESIDENCE Appalachians generally identify by family name and by their country of origin, such as German, Scotch-Irish, Welsh, French, or British, the primary groups who settled the region between the 17th and the 19th centuries. It is important to remember that migrating into the area does not make one an Appalachian. Historically, the population has been predominantly white, although many maintain a strong family identity with Native American groups who once populated the area (e.g., Cherokee, Choctaw) (Huttlinger, Schaller-Ayers, Kenney, & Ayers, 2004b). Appalachians in general cannot be distinguished from other white cultural and ethnic groups by either dress or physical appearance. However, similarities in beliefs and practices, tempered by the primary and secondary characteristics of culture (see Chapter 1), give them a unique and rich ethnic identity. Like many disenfranchised groups, the people of Appalachia have been described in stereotypically negative terms (e.g., “poor white trash”) that in no way represent the people or the culture as a whole. They have also been called “mountaineers,” “hillbillies,” “rednecks,” and “Elizabethans.” The media perpetuates these stereotypes with cartoon strips such as “Li’l Abner” and “Snuffy Smith,” television programs such as the Dukes of Hazzard, and stories of the feuding Hatfields and McCoys and the Whites and Garrards. Interestingly, these feuds were among wealthy families over salt deposits and land and families who had high political profiles. Failure of the courts to intervene and a propensity of Appalachians to “handle things themselves” perpetuated the longevity of the feuds. In reality, Appalachians value a deep-seated work ethic, a low cost of living, and a high quality of life. Appalachians see themselves as loyal, caring, familyoriented, religious, hardy, independent, honest, patriotic, and resourceful (Huttlinger et al., 2004a). Other groups in the region who may identify with Appalachian culture include Native Americans, African Americans, and Melungeons, who are of mixed African American, Native American, Middle Eastern, Mediterranean, and white ethnic descent (Costello, 2000; Kennedy, 1997). Although Melungeon heritage is often denied, there is, of late, a resurgence of identification of Melungeon ancestry. In fact, annual Melungeon get-togethers are now held once a year in Appalachia (Kennedy, 1997). With the increase in immigration to the United States since the 1970s, the Appalachian region is becoming more ethnically and culturally diverse, and it is now common to observe various southeast Asian, Chinese, and Hispanic groups. REASONS FOR MIGRATION AND ASSOCIATED ECONOMIC FACTORS Approximately 300 years ago, people came to Appalachia to seek religious freedom, land for themselves, and personal control over interactions with the outside world. Over the years, mining and timber resources became depleted, farmland eroded, and jobs became scarce, which resulted in an out-migration of people, especially those of working age, to larger urban areas of the North such as Cincinnati, Cleveland, and Louisville. This migration began after World War II and has remained constant ever since (Obermiller & Brown, 2002). Those who moved to urban areas often felt alone and sometimes became depressed as they were separated from family and friends. Many feared the large cities because of high crime and their unfamiliarity with how to get along in an urban environment. Those who remained in urban settings have become bicultural, adapting to the culture of urban life while retaining, as much as possible, their traditional Appalachian culture. The limited opportunities for employment in Appalachia often require wage earners to leave their families to seek work elsewhere, returning home only to maintain close ties with their kinfolk as resources allow. Their migration pattern is regional, where individuals from one area primarily migrate to the same urban areas as their relatives and friends—a pattern that is common with many migrants. This practice helps decrease the occurrence of depression and feelings of isolation and provides a support network of family and friends so important for members of an Appalachian culture. Appalachian migration patterns reflect the economic conditions found in the area as well as some of the cultural values of home, connection to the land, and importance of the family. Working-age individuals move from Appalachia to make their living but often return to the area to retire. Because of these patterns, Appalachia has one of the highest existing aging populations (Haaga, 2004). The pattern of returning home to retire has given rise to challenges for health-care delivery. In fact, older people were once able to rely on home care services, but severe budget cuts in 1977 left home care health service unreliable and ineffective. Therefore, older people and the chronically ill have to rely on options for short-term and expensive hospital care, nursing homes, or no care at all (Hurley & Turner, 2000). For generations, the region has been a symbol of poverty in a land of wealth and opportunity. During the 1960s, the Appalachian Regional Commission (ARC) appropriated funds for building roads to attract industry and provided loans for residents to start their own businesses. In many areas of Central Appalachia, the 96•CHAPTER 5 FIGURE 5–1 Before the construction of the New River Gorge bridge, many people were isolated from health care. (Courtesy of West Virginia Division of Tourism and Parks.) © 2008 F A Davis unemployment rate and the number of people living in poverty have remained consistently above the national average, while the per capita income has remained below the national average. Eight of the 13 states in Appalachia have an unemployment rate higher than the national average of 4.8 percent, and the national poverty rate of 12.6 percent is exceeded by 10 of the 13 states in Appalachia. The average per capita income rate in Appalachia is $20,872. Not one Appalachian state achieves the national per capita income of $25,470. Of 410 counties in Appalachia, 77 are considered economically distressed, 81 are at risk, and 222 are transitional (ARC, 2006a). Even though the cost of living in much of the area is lower than that in many other parts of the United States, costs for transportation of food, basic living supplies, and transportation fuels rise, thus creating hardships for an area that is already economically stressed (ARC, 2006a). EDUCATIONAL STATUS AND OCCUPATIONS Although many of the original immigrants to this area were highly educated when they arrived, limited access to more formal education resulted in the isolation of later generations with fewer educational opportunities. Despite the value placed on education, a disparity in the number and placement of educational facilities exists throughout the region. Access to colleges and universities has improved, but there is still a lack of knowledge about life outside of Appalachia and the educational opportunities available. Examples of universities and colleges in Appalachia include, but are not limited to, West Virginia University, Appalachian State, University of Virginia’s College at Wise, East Tenneesse State, Shawnee State, and the University of North Alabama. A dichotomy between those who are poorly educated and those who are extremely well educated still exists today (Huttlinger et al., 2004a). Because isolationism results in a cultural lag, IQ scores of children from Appalachia are sometimes lower than those in the populations outside of Appalachia who have access to larger schools and live in urban settings. However, with television and the Internet now available throughout the area, this cultural lag has been slowly improving. In fact, U.S. Representatives from many of the districts that lie in Appalachia made it a priority to have broadband and Internet connections made accessible. Factors such as improved mobility, access to better schools with qualified teachers, increased employment opportunities in some regions, and greater use of technology are responsible for improving socioeconomic conditions and better performance on standard IQ tests (ARC, 2006a). Although a value is placed on education, many see education beyond high school as not as important as earning a living to help support the family. Many Appalachian parents, and especially those who belong to more conservative and secular religious sects, do not want their children influenced by mainstream middle-class American behaviors and actions. However, fewer children drop out of school today than in previous decades. One interesting fact is that several states in Appalachia have laws that grant permanent driving privileges only upon completion of high school, which has lowered dropout rates significantly. Parents who value higher education encourage their children to seek quality education at the best institutions possible. Despite this value, the graduation rate from college has remained at 36 percent, compared with 45 percent for non-Appalachian counterparts (ARC, 2006a). Unfortunately, the highly educated, including healthcare workers, who return to the area are often unable to secure financially lucrative employment. Because educational levels of individuals within the Appalachian regions vary, it is essential for health-care providers to assess the health literacy and basic understanding of health and disease of individuals when providing any kind of intervention. Educational materials and explanations must be presented at literacy levels that are consistent with clients’ understanding. If materials are presented at a level that is not understandable to clients, providers may be seen as being “stuck-up,” “putting on airs,” or “not understanding them and their ways” (Huttlinger et al., 2004b). PEOPLE OF APPALACHIAN HERITAGE •97 VIGNETTE 5.1 The Carter Family Fold lies deep in Appalachia at the base of Clinch Mountain in the Maces Springs or Poor Valley Community of southwestern Virginia. The Carter Family Fold is the home of the musical Carter family who provided the country with the rich legendary “Carter” family, a museum, a church, a cemetery, and a music center where lively concerts featuring local, national, and international musicians are featured. The concerts are family centered and, in keeping with a traditional style, feature only acoustic instruments (no electric instruments allowed!). Seating is in a barnlike structure with tiered platforms with seats made from discarded buses, cars, and tractors. The hospitality is contagious and as welcoming as the bluegrass and country musical tradition of the Appalachian culture. The “fold” includes the home sites of the family. Outsiders, young and old, are encouraged to dance, sing, and celebrate the rich musical heritage of the area. Go to the Carter Family Fold website at http://www. carterfamilyfold.org/ 1. What is the Center’s objective? 2. For what are Maybelle, Sara, and A. P. Carter given historical credit? 3. How do the Fold and Center contribute to Appalachian culture? Communication DOMINANT LANGUAGE AND DIALECTS The dominant language of the Appalachian region is English, with many words derived from 16th-century Saxon and Gaelic. Because the Appalachian dialect tends to be very concrete, continued exposure is necessary to avoid misunderstandings. Negative interpretations of Appalachian behaviors by non-Appalachian health-care © 2008 F A Davis workers can be detrimental to positive and facilitative working relationships. Some of the more isolated groups in Appalachia speak an Elizabethan English, which has its own distinct vocabulary and syntax and can cause communication difficulties for those who are not familiar with it. Some examples of variations in pronunciation for words are allus for “always” and fit for “fight.” Word meanings that may be different include poke or sack for “paper bag” and sass for “vegetables.” The Appalachian region is also noted for its use of strong preterits such as clum for “climbed,” drug for “dragged,” and swelled for “swollen.” Plural forms of monosyllabic words are formed like Chaucerian English, which adds es to the word, for example: “post” becomes postes, “beast” becomes beastes, “nest” becomes nestes, and “ghost” becomes ghostes. Many people, especially in the nonacademic environment, drop the g on words ending in ing. For example, “writing” becomes writin’, “reading” becomes readin’, and “spelling” becomes spellin’. In addition, vowels may be pronounced with a diphthong that can cause difficulty to one unfamiliar with this dialect; hence, poosh for “push,” boosh for “bush,” warsh for “wash,” hiegen for “hygiene,” deef for “deaf,” welks for “welts,” whar for “where,” hit for “it,” hurd for “heard,” andyour’nfor “your.” However, when the word is written, the meaning is apparent. Comparatives and superlatives are formed by adding a final er or est, making the word “bad” become badder and “preaching” become preachin’est (Wilson, 1989). If health-care workers are unfamiliar with the exact meaning of a word, it is best to ask clients to explain. Otherwise, miscommunication can occur and will probably result in incorrect diagnoses and/or other poor health outcomes. The health-care worker may want to ask the person to write the words (if the person has writing skills) to help prevent errors in communication and to improve outcomes and following directions with health prescriptions and treatments. CULTURAL COMMUNICATION PATTERNS Appalachians practice the ethic of neutrality, which helps shape communication styles, their worldview, and other aspects of the Appalachian culture. Four dominant themes affect communication patterns in the Appalachian culture: (1) avoiding aggression and assertiveness, (2) not interfering with others’ lives unless asked to do so, (3) avoiding dominance over others, and (4) avoiding arguments and seeking agreement (Smith & Tessaro, 2005). Appalachians often tend to accept others and do not want to judge others. This value is reflected in written and oral communications in which fewer adjectives and adverbs are used. Thus, many Appalachians may be less precise in describing their emotions, may be more concrete in conversations, and will answer questions in a more direct manner. Accordingly, the health-care worker may need to use more open-ended questions when obtaining health information and eliciting opinions and beliefs about health-care practices. Otherwise, Appalachian clients are likely to give a yes or no answer without expanding or clarifying their answers. In general, Appalachians are a very private people who do not want to offend others, nor do they easily trust or share their thoughts and feelings with outsiders. They are more likely to say what they think the listener wants to hear rather than what the listener needs to hear. In addition, because of past, and often unfavorable, experiences with large mining and timber companies, many Appalachians dislike authority figures and institutions that attempt to control their behavior. Individualism and selfreliant behavior are idealized; personalism and individualism are admired; and people are accepted on the basis of their personal achievements, qualities, and family lineage. Appalachians’ perceptions of themselves, their community, and their families influence many aspects of their communication styles. Families are more than genetic relationships and are described as including brothers, sisters, aunts, uncles, parents, grandparents, cousins, inlaws, and out-laws (those related by marriage). This perception of family and community transcends the concept of self as “I.” The use of the pronoun “we” throughout speech patterns recognizes the concept of self. Thus, “we can make it,” “we will survive,” “we will be there” may refer to only the person speaking. An example of a typical interaction in an Appalachian community may be illustrated by this statement from a key informant in the Counts and Boyle (1987) Genesis Project, which took place from 1985 to 1994. Miss Ruth, a 94-year-old native Appalachian, was interviewed in the house in which she was born. In fact, she had her appendix r ... Purchase answer to see full attachment