As the primary conveners of the kidney community throughout the Pacific Northwest, the Northwest Kidney Council hosts a series of “Council Conversations” with our partners from Oregon and Washington that provide an opportunity to discuss the latest updates from our various organizations and hear from guest speakers.
This week, the Northwest Kidney Council was pleased to host Dr. Cristina Trevizo, Manager of Health Equity for Fresenius Medical Care, and Amy Hewitt, Executive Director of the National Kidney Foundation, West Coast Market.
Our discussion, fueled by the collective experiences of the panelists, provided us with valuable insights and strategies to enhance cultural competency throughout the kidney community.
Here is what they had to say. You can watch the full recording below.
How do you each define cultural competency as it relates to kidney care?
Amy Hewitt — "For me, I'm going to depart from the question a little bit, because I think sometimes, competency suggests a mastery, and we need to take a more humbled approach and a position of always learning. I like the term cultural humility.
I speak on behalf of NKF and for myself, that I think when we're discussing matters regarding kidney disease, that cultural humility offers this opportunity to learn from patients about their experience. It's also acknowledging the fact that NKF does not know everything about every cultural group who's experiencing kidney disease...."
Dr. Cristina Trevizo — "Cultural competency, if you just look at it as a definition, you'll find different definitions for that. It's the ability to tailor your healthcare delivery to individualized patients. You're taking into consideration their beliefs, their culture, their language.
At Fresenius, we've opted to look at it as a journey. You can't take a cultural competency course, and you're competent. It's a lifelong journey. It's something that you're continuously learning about. That is not just through training per se. It's through our individualized interactions with different people...."
Can you elaborate on any specific cultural, social, or economic factors that you see as contributing to the increased prevalence of kidney disease within communities of color?
Dr. Cristina Trevizo — "We look at the numbers and we see that our African American and Latino populations have a greater prevalence to kidney disease, but we know that race is a social construct, and there should be no differences in kidney disease or any other disease..... Probably the three that stick out to me.... Housing insecurity, food insecurity, transportation. Those are the common themes that we see continuously come up with our patients."
Amy Hewitt — "When you look at income as another example, that transcends all of those things. Income is an indicator of where you can live, what schools and academic resources you have access to, what foods you can afford, and then, obviously, what kind of medical care you can afford to receive too. All of those things factor in."
We're seeing a rise of in-home hemodialysis. How has the training for care providers who are going into someone's home differ from in-clinic?
Dr. Cristina Trevizo — “I love that there's this focus, there's a change in perspective, where we're looking at everybody through the lens of cultural competency, and now we're seeing our patients as a whole and really taking that initiative and that desire to really understand our patients and why they do this and why this is important to them, and be respectful of that.
Historically, our home therapy nurses have had a little bit more insight into the homes of our patients. In general, they have a little bit more understanding of those cultural nuances because they are walking into the patient's homes. They might see a prayer mat or a crucifix.
Then you see another side of your patient. They're like, 'Oh, OK. Maybe I should come from a different perspective when I'm talking to my patient because these are the beliefs that are important to them. How do I integrate that into their care?' Again, that should be across the board."
Amy Hewitt — “Cristina, again, was right on having to get to know the patients and learn and develop that trust is key into having any success in a new modality for patients. Again, it comes back to meeting them where they are and what's important to them."
Is there research being done to better understand the cultural aspects of kidney disease disparities?
Amy Hewitt — “One of the things that NKF is really focusing on, and I won't say research priority, per se, but it's really trying to build the awareness. We all know that 90 percent of people with CKD don't know they have it even in the later stages. There are 50 percent of people that aren't aware that they have a CKD diagnosis.
At NKF, we're really trying to elevate the importance of getting people assessed for their risk. As matter of fact, we're going to be doing it in the Bay Area in Ending Disparities Leadership Summit. We've been doing these throughout the country, and really trying to focus on how can we get people diagnosed earlier and get them upstream in primary care."
Dr. Cristina Trevizo — “As far as research goes, we're exploring that interaction between social determinants of health and the biological susceptibility to kidney disease, how it impacts individuals. Obviously, we know it impacts, but specifically for our kidney patients.
We know how social determinants of health impact health in general, but we're looking at those individual groups, how it impacts those groups in there. Not just susceptibility, but how fast it progressed to kidney disease and the outcomes that are coming from that. That's one area that we're looking at.”