1. Health Care & World Religions UNIITEs 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

2. South Asian Hindus & Health Care Phase B, Case Story presented by Mariani Nazareth

3. 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

4. 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

5. Lakshmis Case Story (1) Lakshmi: mother of Ramesh her only son; traditional Hindu family Ramesh: goes to USA in 90 as computer programmer Upon settling down in a couple years, Ramesh brings his mother to live with him Lakshmi communicates only in Hindi language

6. Lakshmis 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

7. Lakshmis Case Story (3) Lakshmi is rushed to a nearby hospital and Ramesh is called to ER In ER, Lakshmi is approached by a male doctor Lakshmi is crying and not allowing the doctor to examine her She is more cooperative with a female nurse, but verbal communication is still a problem

8. Lakshmis Case Story (4) Rameshs 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 floor After Rameshs departure, hospital staff tries to communicate with Lakshmi via interpreter phone; unsatisfactory When lunch arrives, Lakshmi finds beef patties in her tray

9. Lakshmis Case Story (5) Lakshmi refuses to eat Shes horrified because she is vegetarian and beef is doubly taboo Nurse thinks that Lakshmi isnt hungry and that shes depressed Nurse calls spiritual care department Chaplain, who is wearing a clergy collar, attempts to communicate via interpreter phone; Lakshmi is not responding When Ramesh return to his mothers bedside after work, he finds that she hasnt eaten all day

10. Lakshmis Case Story (6) Ramesh learns about the non-vegetarian food and the Christian chaplains visit Ramesh requests vegetarian food for his mom; Lakshmi still doesnt eat much although now shes very hungry The food is too bland for her taste, so Ramesh requests permission to bring food from home Nurse responds that this would go against hospital policy...

11. Analysis of Case Story: 4 Identifiable Barriers 1. Gender-appropriate physical exam 2. Language 3. Food 4. Spiritual care

12. 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

13. 1. Female physical exam For a traditional South Asian Hindu female, it is inappropriate to be examined by a male physician

14. 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 purposes If adult family member is willing to remain with patient for duration of hospital stay, in some cases this might resolve the problem of translation/interpretationdespite confidentiality requirements

15. 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

16. 4. Spiritual Care Chaplains need to have adequate understanding of the principal faith traditions of area populations served by area hospitals/clinics Knowledge of demographics and of the religious traditions of local populations-- essential For example, in St. Cloud: Native Americans, Hindus, Buddhists, Muslims, Jewish, Mormons, Jehovahs Witnesses, Bahais...