Clinical scenario

A 60-year-old West African woman presents to the Emergency Room with severe abdominal pain, rating it an 8 out of 10, accompanied by her 29-year-old son, who acts as her translator. Recently moved to the U.S. seven months ago, she is a Muslim with limited English proficiency and expresses a strong preference for traditional herbal remedies such as bitter Leaf and turmeric and some others., which she believes are more effective than conventional treatments. The patient has experienced worsening pain over the past three days, along with nausea and decreased appetite, but denies any recent trauma or fever. While the son is supportive, he is anxious about the treatment options and struggles to navigate the healthcare system. The healthcare team faces the challenge of respecting the patient’s cultural beliefs while ensuring she receives appropriate medical care, necessitating effective communication and education about her condition and treatment options.

Why It Requires Cultural Awareness/Humility

The patient’s strong preference for traditional herbal remedies indicates that her cultural beliefs are central to her understanding of health and healing. Healthcare providers must acknowledge and respect these beliefs to establish trust and rapport.

Limited English proficiency can create barriers to understanding medical advice. Cultural humility allows providers to recognize their own biases and limitations in understanding the patient’s perspective, which is crucial for effective communication and patient-centered care. This awareness helps them approach patient interactions with an open mind and a willingness to learn from the patient’s experiences.

The patient’s right to make informed choices about her health must be respected, which requires understanding her cultural values and beliefs.

Cultural Factors to Consider

The patient may have a holistic view of health, where traditional remedies are seen as the most effective form of treatment. This contrasts with the biomedical model that emphasizes pharmaceutical interventions. Bitter Leaf herb is traditionally used in Africa to treat various gastrointestinal issues, including abdominal pain and digestive disorders. The leaves can be boiled and consumed as a tea or used in soups. Turmeric is known for its anti-inflammatory properties; turmeric may be used for abdominal pain due to its potential to soothe inflammation in the digestive tract. It can be added to foods or taken as a supplement or tea.

The son acts as a translator and support, indicating that family plays a significant role in the patient’s healthcare decisions. The healthcare team should involve him in discussions and decisions, respecting the family dynamics.

As a Muslim, she may have specific beliefs and practices related to health, diet, and treatment options. Muslims follow dietary laws that dictate what is permissible to eat (halal). Foods must be slaughtered and prepared according to Islamic guidelines, avoiding pork and alcohol. Many Muslims believe in the power of prayer (dua) and may seek spiritual healing through prayer, recitation of the Quran, and consultation with religious leaders or healers. This spiritual component can be an integral part of their coping mechanisms for health issues. Providers should be aware of these to avoid recommending treatments that conflict with her religious practices.

Beliefs That Might Differ from Western Medicine

The patient believes that traditional herbal remedies are more effective than conventional medicine, which could lead to conflicts if providers advocate exclusively for standard medical treatments without considering her preferences.

Many cultures view health as a balance between physical, spiritual, and emotional well-being, which may not align with the Western focus on disease treatment.

Areas Where Conflict Might Develop

If the recommended treatment involves pharmaceuticals that the patient perceives as harmful or ineffective compared to herbal remedies, there may be resistance to adhering to medical advice.

The patient may be hesitant to consent to procedures or treatments that conflict with her beliefs, necessitating thorough discussions about risks and benefits.

If the healthcare team does not address her pain adequately or relies solely on medications, the patient might seek alternative remedies, leading to a disconnect in care.

Expectations for Demonstrating Cultural Competence/Humility

The student should practice active listening to understand the patient’s beliefs, preferences, and concerns, allowing her to express her views without judgment. Create a safe space for the patient to express her beliefs and experiences with traditional remedies. Ask open-ended questions about her preferences and previous uses of herbal treatments.

The student should use everyday language when discussing the patient’s health needs and treatment options. For instance, instead of saying “gastrointestinal discomfort,” the student might say “stomach pain” or “upset stomach. “When introducing new concepts, the student should break them down into simple components. For example, rather than saying “antibiotics are used to treat bacterial infections,” the student can explain, “We will give you medicine that helps fight infections caused by germs.”

The student should maintain an open posture, avoiding crossed arms or legs, which can signal defensiveness. Instead, leaning slightly forward can show engagement and interest in what the patient is saying. Smiling gently and expressing concern through facial expressions can help the patient feel more at ease, encouraging open communication. The student can use nodding and other affirmative gestures to convey understanding and support while the patient is speaking. This nonverbal communication reinforces that the student is listening attentively.

Utilizing the son effectively as a translator while ensuring clear communication about medical options is essential. The student should avoid using family members for sensitive information unless explicitly allowed. If the discussion involves sensitive topics (e.g., mental health issues, sexual health, or end-of-life decisions), it may be more appropriate to have a professional interpreter or to provide this information in a private setting without family present. This helps protect the patient’s privacy and comfort.

The student should provide clear and culturally appropriate education about her condition, treatment options, and the potential benefits and risks of both traditional and conventional treatments. They should discuss how herbal remedies might interact with prescribed medications.

The student can propose a collaborative treatment plan that incorporates both traditional remedies and necessary medical treatments, respecting the patient’s autonomy and cultural beliefs.

The student should avoid making assumptions about the patient’s beliefs or preferences based solely on her background. Each patient is unique, and open dialogue is crucial.

Patient Counseling or Education Required

Explain the patient’s abdominal pain, possible causes, and the importance of timely intervention. Use simple language and visual aids if necessary to enhance understanding.

Present both conventional treatments and how they might work alongside her traditional remedies. Present evidence supporting the effectiveness of certain conventional treatments, but do so respectfully, acknowledging her perspective. For example, explain how certain symptoms might necessitate immediate medical intervention even if she prefers herbal treatments. Emphasized that the goal is her well-being and pain relief.

Validate the son’s anxiety about the healthcare system and provide reassurance about the hospital’s support systems, emphasizing that the team is there to help both the patient and her family. Discuss a follow-up plan to ensure ongoing communication and support, inviting her and her son to ask questions or voice concerns at any time. Teach-Back Method can help confirm that the patient and her son understand the information shared during the interactions.