Middle of Everywhere - Mary Bray Pipher [45]
Although there are some praiseworthy exceptions, many of the doctors who will take Medicaid are overworked and schedule short appointments. Many newcomers feel rushed and, especially if a translator is involved, there isn't time to handle things. They feel rebuffed by a doctor who doesn't take the time to visit.
Many refugees must have their children interpret for them. It's convenient to use kids as translators but not generally a good idea. Kids often don't know the words for medical terms, and having them translate upends the family hierarchy by putting them in a position of power and responsibility.
Gender issues complicate the situation. Many women come from cultures where only their husbands will ever see or touch their bodies. Many will not go to a male doctor and our city doesn't have enough female physicians to meet their needs.
The book The Spirit Catches You and You Fall Down by Anne Fadiman tells of the great cultural misunderstandings that occurred between a Hmong family and American doctors. For example, each believed that the other ate human flesh. When the Hmong asked for the placenta, which they bury as a "soul jacket" under their hearths, the American health professionals thought this was so the Hmong could eat it. The Hmong, who knew that doctors cut open their people during surgery, thought that the doctors removed internal organs and ate them.
Serious mistakes happen when people are not bicultural. Vietnamese parents who have used coining, which is rubbing their children with hot coins to draw out fevers, have been arrested for child abuse. In many traditional cultures, there is the belief that to predict something is to wish it. To say "You will die if you do not get treatment for cancer" is tantamount to wishing for that.
Of course, our medical practitioners predict and diagnose all the time. A man from Iran wanted to sue his doctor because the man had told his mother she had cancer and would hot live much longer. He said, "In Iran we would never handle it that way. The doctor would merely tell family members to be very good to their mother. He would say that she was fine, just be good to her."
Because of language differences and cultural misunderstandings, some diseases are missed or misdiagnosed. A Croatian child who had significant learning disorders wasn't identified because his language skills were not good. All his teachers just thought he was quiet. A Caribbean woman was diagnosed as psychotic because she spoke with her dead husband at night. However, in Caribbean culture people believe in ghosts, and many non-psychotic people converse with them.
Women who have been raped are often ashamed to speak of it. In some parts of the world, if a woman has been raped, she and the rapist will both be executed. Even in less-punitive cultures, women who have been raped are regarded as unmarriageable. So rape is kept secret, which means such women who have been raped don't receive physical or psychological care.
Many new arrivals come from places with unhealthy diets, bad water, and no preventative health care. After years of neglect, their teeth are often in terrible shape. Refugees may have chronic health conditions. They also may have been bombed, tortured, or hint while escaping. Many have untreated injuries from work or prison. Women often have gynecological problems caused by female genital mutilation.
Many newcomers are from areas with absolutely no public health information. They do not know that alcohol can be addictive or that cigarettes cause cancer. They may not know how to cook or understand even basic information about a healthy diet. Some new arrivals have never seen a toothbrush; they do not know what germs are or that it is important to wash their hands.
Many people who have been tortured have injuries they are ashamed to discuss. An older Vietnamese man had a very bad shoulder. He had been yoked like an ox to a plow for