Thread: Death of 2-year-old signals need for more cultural understan

http://www.theindependent.com/stories/0 ... al27.shtml

Death of 2-year-old signals need for more cultural understanding

By Mike Bockoven
michael.bockoven@theindependent.com
Publication Date: 08/27/06

Irma and Fernando Cabral still aren't sure what happened to their daughter, Axtziryg.

They know she's in the ground, returned to her native Guadalajara, Mexico, delivered almost two weeks after her death in Omaha.

They know that, before she died, she had a fever for about a week. And although several doctors examined her, the dire nature of Axtziryg's condition wasn't clear until her tiny face turned purple, her breathing became labored and her heart stopped twice on an emergency room table in Grand Island.

They know their family, considering making a home in Grand Island, is shattered and in pain, with Irma battling depression and Axtziryg's siblings, especially her big sister, unsure what to do with themselves now that their little sister with her big, black curls no longer plays and laughs in their home.

The Cabrals know they're battered and upset, trying to figure out where blame should be assigned.

But they still aren't sure what happened to Axtziryg.

"They were told she had liver problems, and they were told an infection in her brain (killed her)," said Claudia Aguilar, immigrant advocate for Hope Harbor. "He (Fernando) feels upset about it. They knew she had a fever for a reason, but they were told, 'Go home. It will get better on its own.'"

The death of a child is always tragic, but whatever medical problem killed Axtziryg Cabral, it's clear the family members, who do not speak English, weren't able to communicate effectively with the physicians working to keep her alive. It's a markedly complex problem for medical communities to deal with -- and literally a matter of life and death for patients.

In the case of the Cabrals, when 2-year-old Axtziryg developed a fever while visiting relatives in Grand Island, they eventually sought help from Hope Harbor. Aguilar suggested the emergency room at St. Francis Medical Center, where the family took her three times in three days before Axtziryg was transferred to Children's Hospital in Omaha. She died there five days after her second birthday on July 25.

Fernando Cabral, with Aguilar acting as an interpreter, said many questions linger about his daughter's death, including why she wasn't initially hospitalized, why it took more than a week for her body to be sent home, and whether the family made a good decision in donating Axtziryg's organs after she died.

"They want to know if it was worth it, and they want to know what else could have been done," Aguilar said. "He said they saw a different doctor each time, and he feels they should have run more tests."

To add to the family's grief, they were told to return to Guadalajara as soon as possible after Axtziryg died so they could receive her body. It arrived at their home on Aug. 5.

The Cabrals' plight, while heartbreaking, underlines one of the most difficult issues health care providers around the country deal with on a daily basis -- namely, how to convey important medical information across significant linguistic and cultural barriers.

Maria Heinze, a health educator at the Central District Health Department and former physician in her native Mexico, said the language barrier presents a challenge, but the cultural barrier can be either overlooked or misunderstood.

Specifically, in some Mexican cultures, the role of physicians varies significantly from the role of physicians in the United States.

"I don't want to generalize, but most from our culture traditionally don't want things explained to them," she said. "They feel they wouldn't understand and don't want to make a decision. That's the doctor's chore."

Heinze cited one instance during her time as a medical interpreter when a doctor gave a patient several options for care, and the patient was so offended that she walked out of the room. The reason, Heinze said, has to do with the authority doctors often wield in Mexico, where treatments and diagnoses are seldom, if ever, questioned. When given a choice of treatment options, it can create a jarring experience for patients used to a different way of doing things.

Her point is that working with people from a different culture requires an understanding of how that information might be received.

"Sometimes we want to approach everything from our point of view," she said. "Everybody does it, it's easy to do, but different people have different ways of doing things."

Candy Houdek, manager of interpretive services at St. Francis Medical Center, agrees. She said the most common points of contact between her department and most non-English-speaking immigrants are in the emergency room and the birthing center.

During times when interpreters are not on staff, there is a "language line" through which interpreters are available 24/7. But she said there's no handbook explaining how someone's cultural background comes into play when that person goes to a hospital.

"You really have to take it on a case-by-case basis," she said. "I've found the older generation have stronger beliefs than the younger generation, by comparison, but it's different with every person."

The interpreters work with doctors to help them understand cultural issues that might cause a problem in getting across information, Houdek said, although some issues are more complex than others.

It's not the complexity of culture but the complexity of language that represents another, sometimes more substantial, barrier, said Odalys Perez, executive director of the Grand Island Multicultural Coalition. For some, Spanish translates to English, but translating medical speak into any language constitutes a more substantial challenge.

"If you take my car to the mechanic, I don't care what language he's speaking, I'm not going to understand it," she said. "Some people feel the same way about doctors. They think, 'I won't understand, so why try?'"

In the case of the Cabral family, one reason they didn't understand was how fast Axtziryg went from a slight fever to convulsions and other severe symptoms. While they search for answers from afar, Aguilar said they're not sure any number of answers will provide a reprieve from the grief they've experienced.

"Right now, it's her sister who is having a hard time," Aguilar said. "They were very attached to each other. She's still depressed and shocked, and there's nothing they can do to help her feel good.

"It happened so fast," she continued. "They're still shocked and are trying to figure out what happened."

Very interesting that they want to blame someone for this tragedy. Very interesting that these overworked doctors didn't have the time or training to accommodate yet another culture.

Seems to me that the parents should have taken their children their own local doctor before traveling for vacinations, etc.--the kind of vacinations one must get before going to a third world country (which is what the US is becoming). Seems to me the parents should have researched potential medical facilities before traveling. The parents could have learned some English before risking their child's safety by traveling to a foreign country.

Yes, it is very sad that the child is dead and that the family hurts and misses her. It is very sad that the family didn't see (and pay for) a private doctor to make initial assessment, and hospitals are so overwhelmed treating illegals that they were unable to do a complete diagnosis.

Personally, I wouldn't want to be the mother of a child receiving a donated organ from a donor, where the doctors don't know the cause of death. If something goes wrong with the child who receives a transplant, now who can this mother blame?

Can anyone say law suit I would bet my last dollar that is what will soon follow.