“Health Care & World Religions”

UNIITE’s 2006-07 series on cultural competency for health care professionals

Funded by Blue Cross and Blue Shield of Minnesota Foundation

Location: Abbott Northwestern Sartell Outpatient Center

“South Asian Hindus & Health Care”

Phase B, Case Story

presented by

Mariani Nazareth

Case Story Presenter: Mariani Nazareth

Case Story of a South Asian Hindu woman called Lakshmi who was admitted as a patient in a Central Minnesota hospital

Mariani Nazareth, R.N.(case story presenter)

Personal Profile

Born and educated in India

Trained in India, France, and Britain

Served as public health nurse in rural and suburban India

Arrived ’91 in USA

Employed in Presbyterian Medical Center, Philadelphia, PA till ’98

Working ’98-present in Med-Oncology at St. Cloud Hospital

Lakshmi’s Case Story (1)

Lakshmi: mother of Ramesh her only son; traditional Hindu familyRamesh: goes to USA in ’90 as computer programmerUpon settling down in a couple years, Ramesh brings his mother to live with himLakshmi communicates only in Hindi language

Lakshmi’s Case Story (2)

One day in winter, Ramesh leaves very early for work

Lakshmi awakens to her first ever sight of snowflakes falling

Giving into temptation,she ventures out to catch a flake in her hands

She falls and is unable to rise

A neighbor sees her and calls 911

Lakshmi’s Case Story (3)

Lakshmi is rushed to a nearby hospital and Ramesh is called to ERIn ER, Lakshmi is approached by a male doctorLakshmi is crying and not allowing the doctor to examine herShe is more cooperative with a female nurse, but verbal communication is still a problem

Lakshmi’s Case Story (4)

Ramesh’s arrival enables communication with ER staff Ramesh remains with Lakshmi until all admission processes are complete X-rays indicate hip fracture; Lakshmi is admitted to orthopedic floorAfter Ramesh’s departure, hospital staff tries to communicate with Lakshmi via interpreter phone; unsatisfactory When lunch arrives, Lakshmi finds beef patties in her tray

Lakshmi’s Case Story (5)

Lakshmi refuses to eat She’s horrified because she is vegetarian and beef is doubly tabooNurse thinks that Lakshmi isn’t hungry and that she’s depressedNurse calls spiritual care departmentChaplain, who is wearing a clergy collar, attempts to communicate via interpreter phone; Lakshmi is not respondingWhen Ramesh return to his mother’s bedside after work, he finds that she hasn’t eaten all day

Lakshmi’s Case Story (6)

Ramesh learns about the non-vegetarian food and the Christian chaplain’s visitRamesh requests vegetarian food for his mom; Lakshmi still doesn’t eat much although now she’s very hungry The food is too bland for her taste, so Ramesh requests permission to bring food from homeNurse responds that this would go against hospital policy . . .

Analysis of Case Story: 4 Identifiable Barriers

1. Gender-appropriate physical exam

2. Language

3. Food

4. Spiritual care

Suggestions to overcome barriers

First, have a female physician available especially in ER to do physical exam

Second, in place of interpreter phone, employ interpreters on on-call basis

Third, make arrangements for non-western food catering service or change hospital policy re. home food

Ensure that chaplains are culturally competent

1. Female physical exam

For a traditional South Asian Hindu female, it is inappropriate to be examined by a male physician

2. Hindi language interpretation

The problem of language arises largely in the case of new-immigrant seniors from South Asian communities (or other communities, whatever their religion)Interpreter phone poses challenges both for health care professional and for patients; impersonal, distant, inappropriate, and impractical for health- care purposesIf adult family member is willing to remain with patient for duration of hospital stay, in some cases this might resolve the problem of translation/interpretation—despite confidentiality requirements

3. Food compatibility

New immigrant seniors are used to their own ethnic foods especially if there are cultural and religious restrictions on foods and beverages

Some Hindu seniors may be staunch vegetarians Most all Hindus consider the cow to be sacred;

serving beef products as part of their hospital diet would be offensive to their religious and cultural beliefs and practices

If food is brought from home, patient should not be billed by catering department

4. Spiritual Care

Chaplains need to have adequate understanding of the principal faith traditions of area populations served by area hospitals/clinicsKnowledge of demographics and of the religious traditions of local populations-- essential For example, in St. Cloud: Native Americans, Hindus, Buddhists, Muslims, Jewish, Mormons, Jehovah’s Witnesses, Baha’is . . .