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Multicultural Issues in Pediatric Practice

Sara B. Kinsman MD1
Mitchell Sally BA2
Kenneth Fox MD3
 1 Section of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA.
2 The Gene Therapy Center, University of North Carolina, Chapel Hill, NC.
3 Department of Social Medicine, Harvard School of Medicine, Children's Hospital, Boston, MA.

A Gap?

NT, an 11-year-old Vietnamese female, presented to the adolescent clinic with a 1-month history of dysfunctional uterine bleeding. She was accompanied by her older sister and grandfather. Although her grandfather was the most proficient English speaker in the home, the older sister was asked to help translate questions regarding her younger sister's menstrual and sexual history. The most likely diagnosis appeared to be anovulatory dysfunctional uterine bleeding. The appropriate laboratory evaluation was undertaken to exclude other etiologies, and oral hormonal therapy was prescribed to stop the vaginal bleeding. To assure that the patient understood the need for hormonal therapy, the health-care team asked if the grandfather could be present when directions for the medications were reviewed. The patient agreed. She asked no questions as the treatment plan was discussed.

One week later at a follow-up visit, the patient continued to experience vaginal bleeding and admitted to not having taken her oral contraceptive medication. She was admitted to the hospital with a significantly decreased hemoglobin level. During her hospital admission, nurses noted that the patient was pleasant and congenial, but she refused to take the hormonal therapy and secretly would hide the medication in her mouth so that she could throw it away later.




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L. C. Smitherman, J. Janisse, and A. Mathur
The Use of Folk Remedies Among Children in an Urban Black Community: Remedies for Fever, Colic, and Teething
Pediatrics, March 1, 2005; 115(3): e297 - e304.
[Abstract] [Full Text] [PDF]


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