In keeping with its humanitarian traditions and international commitments, Canada accepts about 14,500 refugees each year. For several hundred of these, St. John’s is the gateway to a new home and a new life. Many of our health care providers at Eastern Health come from other cultures and contribute much to the care we provide.

Diversities and Dilemmas

This new reality also brings us a lot of diversity with regard to those we serve – patients, long-term care residents and clients. Sometimes, we are faced with unique challenges because every culture has beliefs about health, disease, treatment, and health care providers. These new Canadians bring their beliefs, and the practices that accompany them, into the health care system. This can, at times, prove challenging for both health care professionals and new Canadians as they try to navigate their way through an environment that is unfamiliar.

Imagine this hypothetical scenario: a young woman being brought in by paramedics from an automobile accident. She is bleeding from somewhere under her clothing and the first thoughts are to cut away her clothing so that they can examine her. She speaks very little English and is extremely distraught that a male nurse and paramedic are in the room as she is being exposed.

This could describe almost any young woman who is vitally concerned with her own modesty, but  suppose it is a young woman who has recently emigrated here from a country with very different customs, values and religious beliefs. That changes the situation. It becomes more apparent that her cultural values can adversely affect her health care situation – as she struggles to remain covered and delays a diagnosis and treatment.

A Different Approach

Just as we wouldn’t classify all diabetics into one category and expect that they will all react to a specific diabetic regimen in the same manner, we cannot lump all people of one culture, race, or religious belief into one category. Health care needs to be individualized for each patient, and in doing so, we need to take into account all aspects of this person, what they believe and what their background is.

Now imagine a young woman who is a new resident of Newfoundland and Labrador. She has not attended school and is illiterate even in her own language. Prior to moving to St. John’s, the young woman and her family spent several years in a refugee camp. Diagnosed with a mental illness, she finds herself seeking help in one of Eastern Health’s facilities. Interpreters are needed for health professionals to communicate with the young woman and her family.

Mental illness carries stigma in this family’s culture and the family fears their daughter’s diagnosis may mean she is no longer marriageable. They also worry that they should not have brought someone who has mental illness into the country. They appear to have great difficulty understanding and retaining information about their daughter’s health status; it’s unclear whether the parents are able to make certain health care decisions for their daughter.

So – how are health care providers to determine the best interests of such persons and to choose the way forward to ensure that her best interests are appropriately provided for?  In cases such as these, they could turn to Eastern Health’s Ethics Consultation Service for guidance.

Discussions, Decisions and a New Direction

Ethics consultations provide a safe environment and non-judgmental process for open and honest discussion with a group of professionals (i.e. ethics facilitator, professional ethicist, members of the patient’s/client’s care team) who will bring a variety of viewpoints and information to assist with this kind of decision making. An ethics consultation helps participants discover different perspectives on an issue or problem and explore the ethically-right options.

In the first case, Eastern Health’s ethics service has determined that,

• In situations where there is a male and female health care professional with the same credentials – and when both are able to provide care – then the female health care professional will attend to the female patient whose religious beliefs and values would impact on her care.
• Likewise, where the on-call physician is female and not otherwise engaged, or likely to be immediately engaged in providing care to another patient, then the female on-call physician will provide medical services to the patient requesting a female physician.
• Eastern Health can also work with specific community groups to arrange for selected members of the community to provide patient support roles, accompanying female patients who need services from non- male health care professionals.

In the second instance, a list of recommendations would likely be crafted to guide the health care team in providing needed care.  They would likely suggest that:

• an interpreter be arranged, and
• discussions be held with the young woman and her family to determine their understanding of the diagnosis and treatment plan. The overall plan would show respect for cultural beliefs while ensuring that quality care is provided, in accordance with the best interests of the patient needing that care.

The world is coming to our shores and walking through our doors here at Eastern Health! Working together we can meet the challenges and provide a standard of care that is second to none.

Eastern Health’s Ethics Consultation Service is offered by the Pastoral Care and Ethics Department. ■

This story was written by Paul Grimes, a Pastoral Care Clinician with the Health Sciences Centre in St. John’s.