Overcoming Cultural Concerns
By M. Lapham
An elderly Chaldean immigrant sits in a doctor’s office. He has prostate cancer and feels nervous and scared. Aside from medical care, he needs someone who understands his cultural concerns.
Finding a doctor who understands the privacy Chaldeans expect makes all the difference in his treatment. Bridging that gap is the most important reason to bring Chaldean doctors into as many fields as possible.
Many patients feel uncomfortable when discussing more intimate parts of their body. Oftentimes they associate the issues with age, or simply don’t keep track of them.
Dr. Firas Abdollah (left) and Dr. Marcus Jamil (right)
“Even though it might be perfectly normal, they may not know the cause,” said Dr. Marcus Jamil, a resident at Henry Ford Health System - and the son of immigrants.
Along with the culture barrier comes the language barrier. While many immigrants speak English, it is not their primary language, which can contribute to their unease. A doctor who understands the cultural differences and speaks the same language has a major advantage over one who doesn’t have those skills, which adds an extra level of comfort with the patient.
“Being Chaldean in southeastern Michigan, we have an amazing (cultural) support system,” said Jamil.
Expanding that system to healthcare is why he and his colleague, Dr. Faris Abdollah, want more Chaldean doctors to go into medical specialties, especially their field of urology, where preventive care means so much. Abdollah, an immigrant himself, understands the culture and knows the anxiety common among Chaldean and other Middle Eastern immigrants, sometimes even including those born here in America.
This is especially true in metro Detroit, which has one of the largest Middle Eastern populations in the country, and the largest Chaldean population outside the Middle East.
Finding doctors and other healthcare professionals who can reach out to the Chaldean community – parents, grandparents, or other family members – to get basic health information can lead to early screening and save lives.
For example, one of the best indicators of potential prostate cancer is if a person’s father or other family member had the disease. If that’s the scenario, the risk is higher.
The best way to gather that data is with face-to-face conversations between doctor and patient, which can be difficult in the Chaldean community. To find out the risk, doctors must dive deep into a patient’s private life, a rare conversation even among close friends.
The ability to engage one-on-one with the community is especially important because there is little data collected specifically on the larger Chaldean community and their health issues. There needs to be more targeted information that can alert people to their higher risks.
“One potential obstacle we face as urological researchers is that Chaldean (information) is not routinely collected in large databases as a separate ethnicity or race, making retrospective investigations far more difficult,” says Jamil.
When the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (SEER) did a check in the Detroit area looking at the Arab and Chaldean communities, it found some shocking results.
When compared to non-Arab Whites, Arabs and Chaldeans had higher rates of leukemia (29%), multiple myeloma (46%), liver (64%), kidney (33%), and urinary bladder (26%) cancers.
Arab and Chaldean women had a much higher rate of leukemia (23%), thyroid (57%), and brain (35%) cancers than their non-Arab White counterparts.
“Given that Michigan is home to one of the world's largest Middle Eastern populations outside of the Middle East, this is an area of research that myself and Dr. Abdollah will likely be investigating in the future,” said Jamil.
Speaking openly, and often, to a doctor is a key to prevention - which most would agree is better than treatment after the fact.
For example, as a urologist, Jamil said bladder cancer can be treated, or even avoided, with education. Smoking is the primary cause of the disease, and Chaldeans have a higher-than-average number of smokers.
A cancer surgeon, Abdollah points out there’s a high survival rate when patients come to him with an issue and are diagnosed early. Other potential forms of cancer urologists can screen for include kidney, bladder, prostate, testicular, and penile cancer.
Regular checkups also can find and treat issues such as kidney stones, enlarged prostates, infertility, and erectile dysfunction early on.
Erectile dysfunction is something men of any background can struggle to speak about, and the sensitive nature can only make it harder for Chaldeans. While that can be a sign of cancer, it could also be an indicator of diabetes or cardiovascular issues. Both can be manageable if caught early and are much more serious if ignored.
Women also face sensitive health issues which can be addressed by urologists.
“Certain urologists specialize in female pelvic medicine and reconstructive surgery, which is the treatment of pelvic floor disorders, which include urinary incontinence, vaginal prolapse, and pelvic pain in women,” Jamil said.
Left untreated, those issues can lead to long-term health problems.
In all cases, early screening is essential. Doctors who understand the cultural and linguistic boundaries in the Chaldean community can play a huge role in getting patients to recognize what is needed and save lives.
“The fundamental thing is education and knowledge,” Jamil said.
Abdollah is the director of the Vattikuti Urology Institute Center for Outcomes Research Analytics and Evaluation, and vice-chair of academics and research, Department of Urology. Jamil is a graduate of the Wayne State University School of Medicine.