Cultural Competency among Our Heroes
Dana Smith
NUR 531
June 22, 2015
Instructor: Donna Rose

Cultural Competency Among Our Heroes
Fear of the unknown. We as a people have the propensity to respond based on our fears due to lack of knowledge or information. We must realize that the effect of any given action (or lack thereof) does not change because we do not know. For example, if we never read the warning on a package of cigarettes and never had anyone to tell us that smoking cigarettes will lead to cancer, it does not stop cancer from taking root. Let’s say that we don’t watch the news and we are not internet surfers to know what’s going on around us and a comet is headed towards the earth. The earth is about to be destroyed. Our not knowing is not going to turn the comet in another direction nor stop it from coming and destroying planet earth. We will simply die, not knowing what or how it happened. So not knowing or being aware can cost a person to lose on a small scale and on a large scale (with the larger being your very life). Not knowing can be a roadblock to learning and intelligence. Being smart, competent and on top of your game leads to success in any given area. Incompetence or ignorance can lead to failure, death, poverty, and all kinds of damage spiritually, physically, mentally, emotionally, financially, and socially (in relationships). Some people think of incompetence as stupidity, or simply not caring about a particular thing. Many use the word ignorance to insult others. According to Webster’s Dictionary ignorance is either “a lack of experience or knowledge” or “the state of being uninformed”. We come into this world knowing nothing and our level of competence is zilch. As we grow up and go through our lives we start to learn about the world and people around us and we close the “ignorance gap”. Knowledge closes that gap and does just the opposite. Webster’s dictionary defines knowledge as “information or awareness gained from study or experience”. So knowledge is gained by studying and seeking things out until we get the answers we need to do what needs to be done. This requires diligence. So some lack knowledge due to laziness and the unwillingness to put in the work required to actively seek knowledge. As we grow and begin to learn more about the people around us, we realize or notice differences physically, in our thought processes, our religious preferences, food choices and many other things. I remember a song and animation that used to come on television on Saturday mornings in the School House Rock Series called The Great American Melting Pot. The United States is described as a “melting pot” which refers to the many cultures that reside and have made their abode on American soil. The political and religious freedoms along with tremendous financial opportunities have caused a flood of people to come to the United States. Every 31 seconds someone comes from another country to make the United States of America their home (Alexander, 2011 p 523). In 2008, the Census Bureau has foreseen that close to every one in two Americans will be of another race or ethnicity representing the minority (Alexander, 2011). It was also projected that there would be many minorities that would assume the role of majority by 2012 (Alexander, 2012). With that being said, this leads us to the importance of Cultural Competence. Competence, as defined by Meriam Webster is the ability to do something well that is directly related to the knowledge that you have obtained. It is important that we equip ourselves with the knowledge needed to understand people from various backgrounds. Culture is defined by Merriam Webster as, “a way of thinking, behaving or working that exists in a place or organization”. I want to address culture from a different perspective. Let’s talk about culture competence in the workplace with regard to the type of patients that I care for at the VA Medical Center. There are many different races, ethnicities and people with different religious beliefs that come to the VA to receive care whose backgrounds and norms we should be acquainted with, but there is another culture among us which is the veteran population as a whole that we must be aware of in order to give them the quality care that they deserve. We have soldiers who are originally from other countries (or their parents) who enlist from both far and near serve and protect our country. Let’s be mindful that when discussing culture that we are not only talking about those who have immigrated to our country but we are also dealing with diversity in other areas such as age groups, various occupations, and other categorical groupings such as our veteran population.

Cultural Competence WWII Veterans I was a part of a Veterans history project that required that we interview and get live accounts from veterans from different eras in order to be able to preserve their stories for future generations. It was an awesome experience. One of the veterans that we chose for our project to interview was a WWII Veteran. He was in his late 80’s and extremely sharp mentally. He was so proud to have been a soldier for our country. I found that when taking care of patients that served in WWII, that they were easy to love on and care for. Speaking honestly, when most of the older veterans would come to have their colonoscopy procedures done, they required less medication to make it through the procedure as it relates to toughness. Yes I know age, kidney function and other physiological aspects tie into this but they could withstand more discomfort. For example, we have more of the older guys opting to do the procedure without sedation than the younger ones. They may not have a driver to take them home following the procedure or they want to go back to their routine as soon as possible afterwards. They were not “whiners’ so to speak and seemed to be more mentally tough. They believed in doing what they could to take care of themselves and had such a sense of pride. Now do not misunderstand me, this speaks to the majority of the WWII veterans and not all of them. There are veterans from other eras that bare these characteristics as well, but it seems to be more prevalent among the WWII veterans. The WWII veteran spoke of his love for his country and how well they were taken care of by our country. Most of the veterans who fought in WWII said that they felt that the U.S. was there for them and gave them all of the help that they needed (Hernson & Weldon, 2014). He was appreciative, patriotic and talked about the atmosphere when they returned home from the war and how some of the people made them feel like heroes. A lot of the vets took advantage of the use of the GI Bill that was put in place in 1944 and pursued their education, started their own businesses and purchased homes (Hernson & Weldon, 2014). Medically speaking the WWII veterans experienced sickness and death from diseases like tuberculosis, rheumatic fever, hepatitis and tropical diseases and was the primary reason for disabilities following the effects of these diseases (Office of Academic Affiliations, 2015). Their unique health risks were related to chemical warfare agent experiments, nuclear weapons testing or cleanup and cold injury (Office of Academic Affiliations, 2015). WWII veterans were the first “atomic vets” because they were the first to go through the nuclear age. Overall, the WWII veterans were very healthy upon enlistment and those who are still living suffer from diseases related to aging such as cardiovascular diseases, cancer and dementia (Office of Academic Affiliations, 2015). I love working with all of our Veterans but if asked who my favorites I would say the WWII vets were. They are full of wisdom and knowledge and taking care of them comes natural. Thanking them for their service and acknowledging their part in our freedom goes a long way with them. You can’t help but to love them.

Cultural Competence among Vietnam Veterans Let me start off by saying that many of the Vietnam Veterans need a lot of love, even when they can be difficult to love at times. As healthcare professionals, it is important to know and get an understanding of their struggle and what they went through in order to display the empathy that we need to display to perform at our best when caring for them. We must be genuine, gracious and show our great appreciation for what they endured for our country because quite of few of them feel unappreciated. The veterans from the Vietnam era went through a lot in a war that lasted almost 20 years. I have noticed that many of them have this sense of entitlement that can make it challenging at times when delivering care. There is one Vietnam veteran that is on a medication regimen and the cost of medication is beyond what anyone would imagine it to be. The cost of the medicine was explained to him and stressed by the health care provider prior to starting the regimen and the importance of him being consistent and committed to adhering to the instructions for his longevity of life. He lost the medicine twice. The cost of the medicine was 5 figures per year. His attitude was like, “So What, for what I went through I deserve that and then some!” I must reinforce again, that not all Vietnam veterans act in this manner, but this behavior is more prominent with vets from this era than any other.
To better understand and be empathetic let’s look into some of the things that has led some of the Vietnam vets to such bitterness. It is my understanding that they did not receive a heroes welcome home and were the first to ever not receive such (Office of Academic Affiliations, 2015). The elevated number of casualties, higher taxes to cover the expenses of the war made Americans angry and lead to the growing anti-war movement (Office of Academic Affiliations, 2015). The demonstrations grew worse because of the war crimes and the impact of Agent Orange on the environment. Instead of taking their frustrations out on the government itself, Americans launched personal attacks on the Vietnam vets which was so unfortunate (Office of Academic Affiliations, 2015). Many did not feel comfortable wearing their uniforms in public because they were being mistreated (spat on) as they got off the planes at the airport (Office of Academic Affiliations, 2015). So, to be a part of a war that you sacrificed your life for and watched many of you fellow comrades die horrible deaths (dismemberments, decapitations etc.) and come home to be treated the way they were, led them to this place of mental anguish that they feel to this day. My heart goes out to them knowing this information and it helps me to go the extra mile for them and not take offence at the attitudes that some may have. Just as we use universal precautions in the hospital setting when caring for our patients, I provide universal quality treatment to all of our veterans, and I try to go above and beyond even the more when I know that I am caring for a Vietnam vet. I want to dispel the thought in their minds that we don’t care because we do. I want to show every one of them that their labor and signature on the dotted line to sacrifice their lives for our country is appreciated and I make sure that I thank them for it before their departure from facility.
The unique health risks that the veterans experienced during the Vietnam War were related to Agent Orange Exposure and Hepatitis C. They obtained Bacterial and fungal infections, skin diseases, Malaria and many other tropical like diseases (Office of Academic Affiliations, 2015). Approximately, 70.6% of the soldiers that were received into the hospitals during the war were admitted as a result of disease with the rest of being due to combat casualties and non-battle injuries (Office of Academic Affiliations, 2015).. Many of them fell into the trap of substance abuse in order to cope with what was going on around them. After the war was over was when they began to experience the health effects related to Agent Orange exposure. Initially the government did not acknowledge that the symptoms that the vets were experiencing was service connected and related to Agent Orange and herbicide exposure but now service connection has been established for many types of cancers, and spina bifida in offspring (Office of Academic Affiliations, 2015).
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Veterans from both eras had to deal with situations that involved severe life-threatening crises that we now refer to as traumatic stress (PTSD) and these traumatic/stressful experiences lead to an extreme fear of survival. But the Vietnam vets, in my opinion, have had to deal with it over a longer period of time and to a much greater magnitude. I think that the transition to civilization/society was easier for the WWII vets than the Vietnam vets because of the attitudes of the American people along with other factors and as a result they had trouble readjusting when they returned home (Office of Academic Affiliations, 2015). This disorder (PTSD) is known to last as long as 65 years post trauma (Knaevulsrud, Bottche’, Pietrzek, Freyberger, Renneberg, & Kuwert, 2014). Many of the Vietnam vets are mentally ill and homeless. Eradicating homelessness among our veterans is one of Obama’s initiatives on the agenda and the VA hospitals have developed Homeless Patient Aligned Care Teams (H-PACT) in an effort to implement the plan of the initiative.
Cultural Competency among the OEF/OIF Veterans
I decided to get some insight from one of the patient advocates here at the VA about the veterans who fought in Operation Enduring Freedom/Operation Iraqi Freedom. One of the things that he talked about was how they know their rights and are abreast to what they are entitled to. They are not a bitter group overall and they know how to use computer technology to educate themselves on what they need to know about their care. In caring for them I have found this to be consistent with what I have encountered. There are those who have suffered from various things physically and mentally, just like the WWII and Vietnam Veterans but I have found that don’t have to “walk on eggshells” when I am around them. I am not careless in my work/duties but I don’t have to be quite as careful worrying about something that I said being taken out of context due to the vets’ perspective. Perspective effects perception and it is very important to make sure that, as health care providers, we communicate thoroughly to our patients to prevent any misunderstanding(s). We have found that the suicide rate has taken a significant rise among our OEF/OIF Veterans (Kline, Ciccone, Dodson, Black, & Losonczy, 2011). With this information it is important to create an environment that makes them feel comfortable enough to express themselves. I even ask them if they have had thoughts of suicide before they leave the facility. I make sure I give them brochures about suicide and depression with emergency contact numbers that are open 24 hrs/day and 7 days/week. The common thread that has been noted that has attributed to the increase in suicide among the OEF/OIF Veterans is PTSD In an effort to intervene, suicide (Kline et al., 2011).
Conclusion
I have a level of care that I deliver consistently and across the board to all of my patients. Of course there are those patients who you have to give a little extra attention to than others due to some deep seeded issues that surround their situations. One of the things that I have noticed is that quite a few of our veterans from a mixture of all eras gather together often at the VA hospital in the cafeteria even when they do not have appointments. They simply enjoy fellowshipping with each other. They talk about the good times and share information with each other about how to get access to their benefits and do so expeditiously. The ones that had a difficult time getting their benefits try to help the others by sharing what they know so they won’t have to experience the hardships that they experienced. At the end of the day, they are comrades, and there is a strong brotherhood alliance there. When all is said and done, they are all heroes to our nation who sacrificed their lives in order for us to have the freedoms that we now have. Each war era has produced a different kind of veteran that we must embrace and understand. With each era the veterans have different issues because of the things that they faced. Hopefully by seeking to understand the things that they faced we can develop counter measures and strategies to meet their needs. There is a culture there that must be comprehended in order to provide the stellar service that they so deserve.

Reference
Kline, A., Ciccone, D., & Falca-Dodson, M., Black, C. Losonczy, M., (2011, December). Suicidal Ideation Among National Guard Troops Deployed to Iraq. (Journal of Nervous Hernson, P., & Weldon, K. (2014). A Hero’s Welcome: The American Public’s Attitudes Toward Veterans. UConn Today, 1(2), 1-6.
Office of Academic Affiliations. (2014). 1. Millitary Health History Pocket Card for Clinicians; Retrieved from http://www.va.gov/oaa/pocketcard/worldwar.asp?p=6. .