The U.S. Department of Health and Human Services has identified a significant increase in the number of reported cases of asthma across the United States with many of those cases being in patients of Latino origin1. Currently there is no cure for asthma but there are many treatments and activities that can be used to reduce the symptoms. The American medical community often faces difficulty implementing some of these treatments possibly due to its approach to patients with ethnic backgrounds that have very different views about medicine, family, and life priorities and activities.
The case study of Alejandro Flores shows many of those differences. Alejandro is no longer taking the medication that was prescribed but rather is following a regime set out by an espiritista contacted by his mother. This shows the start of a conflict between the family and the medical clinic and even an apparent conflict within the Flores family as it appears that Senor Flores does not seem to know that Alejandro has been taken off his medication so he continues to blame the clinic for the lack of improvement in his son’s condition.
Senor Flores holds the view, as the man of the family, it is his responsibility to provide for the physical needs of his family so he is constantly worried about financial matters and earning the money needed to look after his family. He also feels that it is his mother-in-law’s place to be at the clinic with his wife as it is her role to look after the well-being of the family along with his wife. Senor Flores demonstrates another cultural difference related to time. He and Dr. Jean take very different views about appointment time. Where Dr. Jean expects patients to arrive on time for appointments Senor Flores sees no problem arriving late and has difficulty understanding why the doctor and the receptionist have concerns about their arrival time.
Senora Flores really expresses this difference regarding time as she can not understand why the receptionist is ‘rude’ just because the family is a little late for the appointment. She too recognizes that it is her mother that should have come with her to the appointment as it is not her husband’s place to be there and involved in the physical well-being of the family. Senora Flores is caught between the two cultures with respect to communication as she does not ask questions of the doctor. The language issue only adds to the communication problem. Like many parents with limited medical knowledge she can not understand the different degrees of an illness so she has trouble understanding the seriousness of Alejandro’s condition since she and her other children all have asthma but do not require the same medical treatment as does Alejandro.
Senora Flores does not seem to see that the prescribed medicine and treatment regime take time to work and that it is often necessary for changes in the regime to find the most effective course of treatment. Since she has not yet seen improvement and because she comes from a culture which looks at many other methods of treating illnesses she will turn to an espiritista for help. The espiritista is the type of person who will do and recommend the forms of treatment that she was raised to believe in. The espiritista’s requirement for prayer comes from the cultural belief that Alejandro’s condition results from God. This leads Senora Flores to wonder if God is punishing them for some reason. She even worries about her own status since Alejandro may be weak at school and be picked on by the other children thus making her look like a poor mother. Her beliefs are built on the view of the espiritista as someone who can rid the patient of disease by ridding the patient of the evil spirits which are causing the disease. This is accomplished through the use of herbs, prayers, rituals, massage, the lighting of a candle, amulets, metals, and special stones.
Dr. Jean displays many of the sympathetic and empathetic traits that we hope all doctors have. She cares about the health and well being of her patients and trusts in the medical treatments she prescribes. She has trouble seeing alternatives to her approach to treatment and demonstrates little understanding of the cultural differences she is dealing with. By changing her approach so that it recognizes those cultural differences she would be more likely to achieve success in treating Alejandro’s asthma. According to The Providers Guide to Quality & Culture2 it is only by respecting traditional healing methods and by honoring cultural values and, where possible, incorporating them into the treatment of the patient that success can be achieved.
Normative cultural values are very apparent throughout the clinical experience described through the thoughts of the three main participants in the discussion. Senor Flores is at the clinic despite missing work and loosing income because the needs of the family over-ride personal needs. Both Senor and Senora Flores indicate that it should be Senora Flores’ mother who is at the clinic rather than Senor Flores as it is the woman’s role to take care of the family. Generally, Latinos are more relaxed about time hence, they are more often late whereas people from western cultures are generally more driven by time and the meeting of appointment times and deadlines. Senora Flores expresses concern that the receptionist was rude because they were late which indicating other cultural values that kindness and politeness are important even in stressful situations and that all people are treated with respect regardless of the situation. The Flores family comes from a culture which respects folk medicine and traditional healing methods so there is difficulty accepting the doctor’s advice and direction choosing instead to use a familiar approach which involves an espiritista to provide the necessary help to Alejandro.
Cultural differences play an important role in this situation and could result in only temporary relief for Alejandro while making it difficult for Dr. Jean to identify an effective treatment regime for him.
References
Cross Cultural Health Care (2009). The Case of Alejandro Flores. Retrieved from http://support.mchtraining.net/national_ccce/case3/case.html (2012, April 23)
Cross Cultural Health Care - Lecture (2009). The Case of Alejandro Flores. Retrieved from http://support.mchtraining.net/national_ccce/case3/lecture.html (2012, April 23)
In Providing medical care to the Hispanic patient. www.alcoholpolicymd.com/marketing_to_the_hispanic.pdf
The Providers Guide to Quality & Culture. http://erc.msh.org/mainpage.cfm?file=5.4.5a.htm&module=provider&language
=English
U.S. Department of Health and Human Services (2012). Updates on Asthma. http://www.hhs.gov/. Monday 23 April 2012
