Unit 4: Ways of Knowing

Our readings about health literacy and the imperative barriers to it has given me a lot of food for thought.  It’s made me quite reflective of my work and responsibilities as a healthcare provider in respects to making sure my patients are fully aware of their health status. 

The most recent epiphany occurred to me last week that there is still a very real and strong cultural barrier and resistance to healthcare, especially in my own culture, the Hmong.

This particular story is of a relative who was hospitalized for a stroke.  His blood pressures were normal with some mild elevation in his LDL, nothing too alarming.  He was started on a statin, ASA and Plavix.  However, on a routine transthoracic ECHO prior to discharge there was a small patent foramen ovale (PFO) found that could possibly have been a contributing factor to his stroke.  Naturally, the attending neuro team was concerned and subsequently ordered a transesophageal echocardiogram (TEE) and Cardiology consult, to be done the next day.

Nonetheless, there was quite some resistance with going forward with more testing.  The reasoning being fear and annoyance of the medical staff finding more issues with the patient.  Also, stating that the hospital was purposely finding more tests to do, to keep them in the hospital longer in order to collect more money.  He even stated that health care providers “don’t know what they’re doing”.

…So, I have to take a step back and hold my breath because now I’m getting a little offended by their comments. And yes, they know I’m a nurse.  The NP discussed her concerns utilizing an interpreter and myself to re-explain their concerns and the reasons for their recommendations for further testing.  Initially, the patient and his son was adamant about refusing further testing and resolute on being discharged home.  However, they did become agreeable to waiting for Cardiology’s input about the PFO.  Cardiology was luckily on the floor and was able to review his chart and see him.  They weren’t too concerned and was okay with him going home but recommended following up for an outpatient TEE.

The Asian culture, like all other cultures, is unique and has their own philosophy on healing.  As described in our text, there are four common values that are strongly reflected in the Asian culture as a whole, that being: “male authority and dominance, saving face, strong family ties and respect for parents, elders, teachers and other authority figures” (Kitchie, 2014).

 As a Hmong nurse, I hope to use my medical knowledge to teach the Hmong people of the necessity of healthcare maintenance and prevention and to seek out professional help earlier rather than waiting until a person is acutely ill or septic.  As I read the book, even my own experiences within my family concurs with the books statement that medical intervention is usually sought out in an emergency or dire situations, often almost being too late for the patient.

I live these issues everyday with my elder mother-in-law with her herbal medication cures and non-DEA approved medications that she purchases at Asian markets.  Even tonight, I received a message from my siblings that my mom is very sick and has been having fevers, chills, weakness and vomiting since last week Friday.  I called my Dad right away for an update and learned that my Mom has not improved, she probably had a UTI that’s now pyelonephritis, but they were going to wait until tomorrow to go to the ER. Oh boy, luckily I was able to iterate the severity of her condition and need for IV hydration and IV antibiotics before things got worse and that things were only going to get worse without medical intervention.  Thank goodness my dad took her to the ER tonight and she is still currently receiving treatment.

This is why it is so important to bridge the gap between healthcare literacy and different cultures.  An easy UTI could have been treated when minimum symptoms were present.  And truth be told, with a much smaller medical bill too.