South Asian Hindus and Health Care

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					“Health Care & World Religions”
UNIITE’s 2006-07 series on cultural
 competency for health care

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 family
Ramesh: goes to USA in ’90 as
computer programmer
Upon settling down in a couple years,
Ramesh brings his mother to live with
Lakshmi communicates only in Hindi
  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 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
  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 floor
After 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 taboo
Nurse thinks that Lakshmi isn’t hungry and that
she’s 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 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 visit
Ramesh 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 home
Nurse 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
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 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
 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/clinics
 Knowledge of demographics and of the
 religious traditions of local populations--
 For example, in St. Cloud: Native
 Americans, Hindus, Buddhists, Muslims,
 Jewish, Mormons, Jehovah’s Witnesses,
 Baha’is . . .