Case Study

Read the case on textbook page 169, and answer three case questions on page 170 one by one.

Case Study: ^

This case focuses on a low-income, non-English-speaking Latino patient and family. As you read this story, pay special attention to issues involved in medical decision making, such as gender roles and values and interest in treatments outside of traditional Western medicine based on culturally constructed folk illness beliefs.

When Alejandro Flores was born, his parents were ecstatic and very proud. Alejandro was their first child born in the continental United States, in a world far away from their traditions and family in Puerto Rico. The Flores family had worked very hard to move to the northeast a year before Alejandros birth, and they felt that his arrival helped connect them with their new home.

It is 4 years after Alejandros birth, and the Flores family has grown even larger. There are now five children (three older than Alejandro and one 20-month-old baby) and Alejandros grandmother living in the same apartment. Alejandros mother, Seora Flores, takes care of her family as best she can, and she feels lucky to have her mother there to give her advice and a helping hand. Seor Flores works very hard as a custodian at a local school to provide his family with enough income. He has picked up a little English at work, but only Spanish is spoken at home.

Serious asthma problems run in the Flores family, and Alejandro is no exception. Although he looks healthy, Alejandro has had severe asthma for several years. When he was 2 years old, a series of awful wheezing episodes sent him to the hospital multiple times. His parents do their best to care for him, but they are both spread pretty thin and have limited time available. To help with Alejandros asthma problems, the Flores family recently relocated to a new apartment that has air conditioning, and Sr. Flores has limited his smoking to outside on the patio. The family has two dogs, which could be a problem, but they just couldnt see getting rid of two loved members of their family.

Alejandro also takes a lot of medications for his asthma symptoms. His parents have been taught about asthma and have been given an asthma action planall in Spanish. They were told to call the clinic if at any time Alejandros symptoms worsened. Despite these actions, Alejandro still continues to have heavy wheezing and a tight cough, especially at night.

With Alejandro continuing to have asthma problems, Sra. Flores became skeptical that the medications were not working. Under her mothers guidance, she took Alejandro to an espiritista (incuranderismo, the Mexican American healing system, an espiritista is a healer who serves as a medium for exorcisms and is adept at facilitating the help of benevolent spirits and removing malevolent spirits that surround the client). Sra. Flores took the espiritistas advice and stopped giving Alejandro all of the prescribed medications. She began giving him an herbal tea that she believed, along with prayer, would take Alejandros asthma symptoms completely away.

Alejandro and his parents attended their regularly scheduled visit to the clinic to see if the new medications were helping to control Alejandros symptoms. This is the second visit since Alejandros last hospitalization 6 months ago. Sra. Flores has not contacted anyone at the clinic about Alejandros asthma getting worse, so the clinic staff assumes the best.

There are several issues to consider about this case:

1. Why might Sra. Flores have chosen to consult an espiritista rather than call the clinic when Alejandro was not getting better?

2. Do you think traditional Latino gender roles might have some effect on this child and familys experience with the health care system?

3. How might it be possible to incorporate alternative folk remedies with mainstream Western medicine in developing a treatment plan for Alejandro?