Map of life expectancy at birth from Global Education Project.

Tuesday, December 21, 2004

Cultural competency -- a case study

Dramatis personae: Nurse=NP002
[Translation from Spanish, by Cervantes, is in italics ]

NP002: Okay. No allergies, no medications, very healthy. Has she ever been in the hospital overnight?
INTERPRETE: ¿Ella ha estado interna en el hospital por alguna razón? Has she been admitted to the hospital for any reason?
DELIA: No. Antes sí, pero ya ahora . . . No. Before, yes, but now...
INTERPRETE: ¿Cuándo? When.
DELIA: Hace mucho. Cuando ella estaba recién . . . más pequeñita. Como de tres años o dos años. It's been a long time. When she was recently ... much tinier. Like three years or two years.
INTERPRETE: Por qué? Why?
DELIA: Bueno, porque yo en el embarazo perdí el papá de ella . . . Well, because I lost her father during the pregnancy...
DELIA: Tenía tres meses de embarazo, y ya tú te puedes imaginar todo lo que yo pasé. Entonces de ahí, la niña me salió como con un problema en el estomaguito, que no digería bien, y todo. Y yo la llevé a un pediatra allá, y en la . . . me la . . . I was three months pregnant, and already you can imagine everything that I went through. From there, the girl came out of me with a stomach problem, so she couldn't digest well and everything. And I took her to a pediatrician there, and in the, to me she...
INTERPRETE: ¿Cuando tenía tres años la internaron? When she was three they admitted her?
DELIA: Sí, dos años. Yes, two years [old].
INTERPRETE: ¿Por ese mismo problema? For that same problem?
DELIA: Por ese mismo problema, pero ya ahora ella no tiene problemas. For that same problem, but now she doesn't have problems.
INTERPRETE: She says when she was either two or three years old, she had problems digesting food, and they admitted her. They admitted her. She says that she's okay now.
NP002: Okay.
INTERPRETE: She doesn't have any problems now.

As we can see, the interpreter doesn't bother to tell most of this story to the NP. But the interpreter didn't get most of it either. We did.

Delia is from the Dominican Republic, a very poor country. When she was two, the little girl, Susana, nearly died. Delia could not afford medical care for her. Desperate, she dressed Susana in a white robe and carried her barefoot around the church, lighting candles. Then she stood before the virgin and made a promise: if the virgin would allow the little girl to live, Delia would put her in school. (Poor children in the Dominican Republic, especially girls, usually get little education.)

The miracle was done. A cousin came up with the money, and Susana had her operation (probably for pyloric stenosis). That is why Delia was here in our city, to keep her promise to the virgin. She is lonely and homesick, with few friends and little family, but the promise must be kept. Susana is unhappy, she grinds her teeth at night and has made few friends. But maybe here she has a future.

How does this matter to primary pediatric care? How could this encounter have been more culturally competent? Would it have helped at all for the NP to have been taught in advance about promesas a la virgin? Or is the point really something else?

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