Somalian patients

[Zhlake]

I am wondering if any of you have experience with Somalian culture and childbirth. I work LD/postpartum/nursery and our small town has had a huge influx of Somalian workers. This transition has been very rocky in our unit, even though we are very accustom to working with other cultures (nearly half of our deliveries are hispanic). I am trying to do some research, but am not finding much. Any input appreciated!

[deehaverrn]

Okay, so for the Muslims to sneer at us, come into other pts rooms, act like we should wait on them(and yes I did calmly explain what was expected and show the other women where the cups,ice, drinks,etc were),

I in no way, condone any of the philosophies of the white supremicist groups like the KKK nor any other racist organization. I am merely saying that if we change our policies for one group we should change for everyone. It is in fact, against the law in THIS country to discriminate on the basis of sex. And some of my male co-workers do feel that they are unfairly treated. Question, is it only okay to exclude men from the room if there is a bonafide religious objection? Because it has become more and more common lately for other women to simply request this as their preference, so should we NOT honor their wishes, or would this be discriminatory to them? (kind of a reverse discrimination)

As far as Muslims looking down on our profession, I had a long discussion about this with a Pakistani (muslim) doc, who admitted it was absolutely true. The reason we had the discussion was that I had a problem with how he treated me as a coworker, and also our patients. He had a male chauvanist kind of attitiude. One thing he thought was that I should follow his orders no matter how I questioned them or how they might impact the rest of our unit (in the case of adding on inductions despite having no nursing coverage). He also felt that women admitted in labor should be on absolute bedrest, take epidurals ASAP, and he preferred to do a cesarian delivery if at all possible.

I have met people of all races who are what I consider to be racist, its not just a "white" issue. In fact, some of the most racist people I have met have not been white. I grew up moving around alot, and have lived in many other states and countries, so I have been friends with many different types of people. As far as religion goes, I believe that my religion teaches me to love others, but not to agree with them necessarily.

I guess we can't treat as terroristic, a culture that believes in mutilating young girls, or in keeping them ignorant, or in stoning women because they weren't fully covered,.

I try to treat my patients with respect. However, no matter WHAT culture they come from, I deserve to be treated with respect also. All your "diversity" and "cultural awareness" training will not convince me that I do not deserve that. If I went to a muslim country to live I would expect to be treated the same way.

This is America. Let's face it, if you don't learn English, your choices will always be limited. This is the land of opportunity, so I think people who come here should embrace that. I think our cultural differences can be beautiful and should be celebrated but not in a divisive way, and NOT by treating some as more important than others. There is a saying that "our strength is in our diversity" which I don't think is necessarily true. Note all the problems in the Japenese educational system..oh wait, they have one of the best in the world, but how can that be...they're pretty homogenous ?!

[anne74]

Whenever I think about issues like these, I always try to put myself in the shoes of others. I have traveled overseas a decent amount and I enjoy other cultures and their differences. Every time, I have always felt it my duty to honor and respect the cultures of the country I'm visiting. In fact, before I go, I try to learn their culture so as not to offend them. I don't want to be an "ugly American".

So I have to ask, why do so many immigrants not do the same when they come here? Why do they get so upset with us if we can't always accomodate them? I think you should try to accomodate everyone if possible, but why do they get so upset, appauled, shocked when it can't be done? If I was visiting some other country and needed medical attention, I wouldn't be surprised if I didn't get the same attention as if I was in the U.S. Probably because I would realize - hey, I'm not in the U.S.

Isn't that part of the risk you take when you choose to go somewhere outside of your native country? Maybe you don't like that it's different than what you're used to, but you shouldn't be surprised by it. And you shouldn't demand that the hospital immediately change to accomodate your personal preferences. Now that you're in a different country with a different culture than your own, you may need to be a little flexible.

[imenid37]

Okay, so for the Muslims to sneer at us, come into other pts rooms, act like we should wait on them(and yes I did calmly explain what was expected and show the other women where the cups,ice, drinks,etc were),

I in no way, condone any of the philosophies of the white supremicist groups like the KKK nor any other racist organization. I am merely saying that if we change our policies for one group we should change for everyone. It is in fact, against the law in THIS country to discriminate on the basis of sex. And some of my male co-workers do feel that they are unfairly treated. Question, is it only okay to exclude men from the room if there is a bonafide religious objection? Because it has become more and more common lately for other women to simply request this as their preference, so should we NOT honor their wishes, or would this be discriminatory to them? (kind of a reverse discrimination)

As far as Muslims looking down on our profession, I had a long discussion about this with a Pakistani (muslim) doc, who admitted it was absolutely true. The reason we had the discussion was that I had a problem with how he treated me as a coworker, and also our patients. He had a male chauvanist kind of attitiude. One thing he thought was that I should follow his orders no matter how I questioned them or how they might impact the rest of our unit (in the case of adding on inductions despite having no nursing coverage). He also felt that women admitted in labor should be on absolute bedrest, take epidurals ASAP, and he preferred to do a cesarian delivery if at all possible.

I have met people of all races who are what I consider to be racist, its not just a "white" issue. In fact, some of the most racist people I have met have not been white. I grew up moving around alot, and have lived in many other states and countries, so I have been friends with many different types of people. As far as religion goes, I believe that my religion teaches me to love others, but not to agree with them necessarily.

I guess we can't treat as terroristic, a culture that believes in mutilating young girls, or in keeping them ignorant, or in stoning women because they weren't fully covered,.

I try to treat my patients with respect. However, no matter WHAT culture they come from, I deserve to be treated with respect also. All your "diversity" and "cultural awareness" training will not convince me that I do not deserve that. If I went to a muslim country to live I would expect to be treated the same way.

This is America. Let's face it, if you don't learn English, your choices will always be limited. This is the land of opportunity, so I think people who come here should embrace that. I think our cultural differences can be beautiful and should be celebrated but not in a divisive way, and NOT by treating some as more important than others. There is a saying that "our strength is in our diversity" which I don't think is necessarily true. Note all the problems in the Japenese educational system..oh wait, they have one of the best in the world, but how can that be...they're pretty homogenous ?!

I hope you don't hink I was trying to slam you. I agree that it is frustrating. I do not think that people who get frustrated w/ having some of these patients of different cultures are racist. I think you can try to please them to some extent. You can't always succeed because some of their requests are not in keeping w/ the policies and facilities we have in place. We are so "customer service" crazy that we have to try to please everyone all the time. It is not possible. There are some concessions to be made, I am sure. I do think this is yet another case where nurses are expected to do something they can't necessarily do. I don't think anyone wants the patients to be treated as more important. I think that the patients are demanding nursing care which in our culture is not deemed therapeutic. In other words,we want to see the woman care for the child. We want her independent. We want her OOB. This is where some education could help and where a liason could help. These women would know, you will be getting OOB. You will be doing this so you don't get a blood clot and die, etc. I once dragged a Middle Eastern woman post-C/S to the bathroom who refused to get OOB to void. She demanded a bedpan or truly wanted the Foley back in. She voided more than 1000cc because it spilled ove the sides of the hat. Her physician who was from the same country told the woman in America, you get up, you are not having a catheter because this is what is healthy for you. We used to teach moms breast massage. One of my patients was having her breasts massaged by her mother.She also did not want to get OOB. The breast massage is odd to us. The not getting OOB is truly not healthy, though I know their female support people from the same culture will often tell them differently.

[anne74]

You know - that's so interesting about the Pakastani doctor. We have a new Pakastani resident who is incredibly rude and disrespectful to us nurses. I work in the recovery room, and he brought a fresh post-op patient out. They're supposed to give us report on the patient right away - instead, he stood there next to the patient and finished up his paper work - even after I asked him to give me report four times, over a period of 30 minutes! Everytime I asked, he just looked up at me and gave me a dirty look - like how dare I bother him! Now that the patient was out in the recovery room, he was under my care and I can't properly take care of a patient if I don't have any background or report! So eventually I assessed the patient myself and then started going through his other paperwork to get the information - all while he was still standing there. Then when he finally gave me report, he asked, "why do you need to know that?", etc.

Then he began verbally shouting out orders - I told him I would do it if he wrote them down. He responded "I'm TELLING you to do them!" I didn't do anything until he finally wrote it down, and he was so mad - like I really inconveinced him. So I went to his superior - an American female - and she supposedly had a talk with him. He's a bit better - at least he gives report now in a decent amount of time. But he's still incredibly rude - not just to nurses but any females. So maybe that explains where it's coming from. Sorry dude - you may come from a culture that disrespects women, but you're in my neighborhood now - and that don't fly here!

[SharonH, RN]

You know - that's so interesting about the Pakastani doctor. We have a new Pakastani resident who is incredibly rude and disrespectful to us nurses. I work in the recovery room, and he brought a fresh post-op patient out. They're supposed to give us report on the patient right away - instead, he stood there next to the patient and finished up his paper work - even after I asked him to give me report four times, over a period of 30 minutes! Everytime I asked, he just looked up at me and gave me a dirty look - like how dare I bother him! Now that the patient was out in the recovery room, he was under my care and I can't properly take care of a patient if I don't have any background or report! So eventually I assessed the patient myself and then started going through his other paperwork to get the information - all while he was still standing there. Then when he finally gave me report, he asked, "why do you need to know that?", etc.

Then he began verbally shouting out orders - I told him I would do it if he wrote them down. He responded "I'm TELLING you to do them!" I didn't do anything until he finally wrote it down, and he was so mad - like I really inconveinced him. So I went to his superior - an American female - and she supposedly had a talk with him. He's a bit better - at least he gives report now in a decent amount of time. But he's still incredibly rude - not just to nurses but any females. So maybe that explains where it's coming from. Sorry dude - you may come from a culture that disrespects women, but you're in my neighborhood now - and that don't fly here!

That's interesting because over the years, I have been insulted by many a White doctor. Is it their culture to disrespect women or look down on nurses or are they just individuals who happen to be jerks? Any explanation for that?

[anne74]

Actually, I've never been treated like that before by a doc- not to that extent. Sometimes a doc may be short, because they're busy or whatever, but this was blatant disrespect. Out of the numerous docs I've dealt with - from numerous backgrounds - this guy stands out with this attitude that I've never seen even from other doctors, let alone men in general. I was just looking for some explanation for him to have this very consistent and deliberant behavior with all female nurses.

Sure, I think part of it is he's a jerk, but I thought it was interesting that someone mentioned that Pakastani's had this attitude toward nurses- the shoe seemed to fit the foot.

By the way - the other day, he also went on a rant about how he would never marry an American woman, because if they got divorced she would steal all his money, and also that American women were too demanding. Whoa!

[imenid37]

That doc sounds like the top prize in the "Win a date w/ a Complete Jerk" Contest. In America, we can make our own money thanks! No one wants his. Maybe thinking women are a theat to his manhood. Again, I find rudeness very hard to deal with. Maybe I should run a charm school for chauvanistic young immigrint docs. I'd have plenty of customers. It should be a pre-req before practicing in this country. I think you can meet the people of different cultures halfway BUT I think there should be limit setting with an explanation beforehand whenever possible.

[CHATSDALE]

i have never seen a woman christian, jew, muslin who thought that haing a male md/nurse was the same as having intercourse with them

i have known a lot of mds from other countries who could hardly make themselves understood and they would get angry if someone asked them to repeat something learning a different language is more difficult for some people than others..i have know multilingual people and they can find another language easier to learn i know a nurse that was raised by grandparents who spoke french at home, she went to school which was of course in english and then her mother married a cuban..she was a blessing when you get a pt that couldn't speak english

i don't know what you do when a female md is not on call and one of her male md is covering..

and yes it is discrimination to not allow a male to do his job and it is hard on the females he is working with to have to take up the slack

no patient should be moved to a semiprivate room because someone else decides they have a right to the private room

[jawharah, ADN, BSN, RN]

The nurses being seen as INFERIOR thing...CULTURAL! Being Somali, anyone in my community I tell I want to study nursing congratulates me and encourages me. Most Somalis really encourage healthcare education.

[queenjean]

As far as Muslims looking down on our profession, I had a long discussion about this with a Pakistani (muslim) doc, who admitted it was absolutely true. The reason we had the discussion was that I had a problem with how he treated me as a coworker, and also our patients. He had a male chauvanist kind of attitiude.

Do you honestly believe all Muslims are the same? Just like all Christians, right? You can't find a male chauvanist pig doc who is Christian? Can't find any Christians who treat women/children/the poor/homosexuals/other races/other religions as second class citizens?

I'm sorry, but maybe your attitude precedes you. I have never had any more issues with working with Muslims, Jews, or completely out-there sects (ie cults) of Christian religions than I have with "Americans." Give me an entourage of Muslim women over a pissy American with an over-developed sense of entitlement, who continually reminds me that her husband/brother/best friend/uncle is an attorney or knows our hospital CEO, and who will have my job because she still felt pain after her epidural was administered, or because her coffee wasn't hot enough, or because we couldn't run out and get her Starbucks, or because we woke her up in the middle of the night so that she could feed her baby, or because god forbid we expected her to change her baby's soiled diaper, or because we moved her to a different room at 3am, or because I didn't bring her pain medication three seconds after she called for it, or because 24 hours after her c-section I made her get up and walk.

Annoying patients come in all shapes, sizes, colors, and cultures. Treating them with respect is sometimes difficult, but to do any less demeans YOU, not them.

You say they should pick up a book and learn English. Many of them can't read in their own language due lack of educational opportunities in their own countries; how can they pick up a book and learn English? Where do they get to practice it?

I've lived in foreign countries, and learning the language was hard. When I was around fellow English speakers, it would be stupid to try to speak the other language; English was easier and we could express ourselves more fully. In times of stress and physical pain, I always revert back to my native language. I couldn't hardly even think in the other languages when I was in physical or emotional pain, even when I was fluent or proficient in them.

It sounds like your unit is understaffed and ill-prepared for stressful situations, be they cultural driven or otherwise, and that this exacerbates your annoyance of these cultural groups. It also appears the docs have not prepared the patients in the least for what is expected of them postpartum.

Instead of griping about it, why not do something about it? Can you not find one nice, literate, English-speaking Muslim among the bunch who will write up a small pamphlet on what the woman should expect during labor, birth, and post partum in the hospital (if they all come from one linguistic group)? Something that can be distributed and discussed at physicians offices in the prenatal period, and during the preadmission appointments, assuming your hospital does those. What about recruiting doulas from that cultural group, who could educate you and your staff on their culture and how to make culturally sensitive adjustments in your care, as well as educating the women of that group in regards to the American way of birth and the accompanying health care system. If there is such a lack of education in such a huge group of people, can your floor or your education department not work with leaders in these cultural groups, to provide them with more education about the role of hospitals, nurses, and family/friends in pregnancy, birth, and postpartum? Maybe reaching out to them instead of silently resenting them will be more productive for you and your coworkers in the long run.

And finally, if people have boundaries established and these are overstepped, why are they tolerated? If family members are yelling down the hall at 3am for water, they are instructed not to yell, and they continue to do so, where is your security? If someone is disruptive after I have told them the expectations of the unit, and they continue to be disruptive despite one or two polite warnings, they get the boot. You are right, you don't have to put up with that sort of disrespect.

I am sorry you are so put-upon and so resentful of apparently several cultural groups. I hope you can put all that energy into some connections and activities that will make for a more positive experience for those women AND for the staff on your floor (and probably your whole hospital--if your floor is having problems, your entire hospital probably is, too--or are they? Maybe some collaboration with other floors or even other area hospitals is in order, to see how they handle this situation).

Good luck. As you are well aware, culture runs deep and behaviors and beliefs aren't going to change in a year or even much in a generation. But it sounds like even small positive changes would make a huge difference in the atmosphere of your floor.

[Elvish, BSN, DNP, RN, NP]

Thank you so much, queenjean. My thoughts EXACTLY!

[jenrninmi, MSN, RN]

My interactions with women of Islamic faith have all been pleasant and I have been treated with much respect and as a professional in nearly every case, by both male and female family members. I guess I have been lucky? I have never gotten the sense I was "low class" from any of my patients of Arabic/African origin yet.

Same for me.