I know confidentiality is considered one of the most important things in medicine, but I learned from a friend working in another country how we in the west treat confidentiality, isn't necessarily right for everyone.
My friend is from Zimbabwe, but works with me here in Europe, and she told me what is was like when HIV really got hold of her home country. She describes how all the parents died, and the grandparents were left raising the grandchildren - she banded some of these grandmothers together and now has a charity helping children.
Anyway, she was saying that even when the WHO and other powers made effective medication free for many people in third world countries like hers, people kept on dying, when they shouldn't, especially young men.
She said a lot of the doctors treated patients like they would in the west, and when they first told a young man he was HIV positive, they would tell him in utmost confidence, and outline his treatment plan, and how to take his meds and when to have follow-up appointments and when to get extra help.
The men would leave, not take their meds, and eventually die.
My colleague and friend said confidentiality is different where she is, and you would never tell a young man or woman such a diagnosis, and would automatically involved the whole family. You wouldn't even ask if the family should be there, you would automatically tell them all to be there. Then the patient with HIV became not just a family issue, but a community/village one, and the outcomes suddenly reversed and people stopped dying. It also made a huge difference in stopping parents passing on the virus to their children.
I know in the west, to do something like this goes against everything we're taught. And I'm not saying one is more right than the other, as that is not the issue, but it was really interesting to hear such a significant cultural difference.
Anyway, I'm sure I'll be picked to pieces for this. But I genuinely think it quite fascinating and hope someone out there does to.
Are you old enough to remember the early days of the AIDS epidemic when people lost their families, jobs, homes, partners and friends when their diagnosis of HIV positive was revealed?
This had a lot to do with the creation of privacy laws.
If a person who has HIV chooses not to take their medication, that is their choice. If a person who has HIV chooses not to reveal status to family and friends, their choice. There are some western laws regarding knowingly spreading HIV to unsuspecting partners.
The education needs to be clear, concise, and followed up on. Otherwise, it is such a violation of privacy to involve entire communities in the diagnosis of an individual with HIV. Unless the individual themselves want this kind of intervention. And the choice should be theirs to make.
If a person who has HIV chooses not to take their medication, that is their choice. If a person who has HIV chooses not to reveal status to family and friends, their choice. There are some western laws regarding knowingly spreading HIV to unsuspecting partners.
The education needs to be clear, concise, and followed up on. Otherwise, it is such a violation of privacy to involve entire communities in the diagnosis of an individual with HIV. Unless the individual themselves want this kind of intervention. And the choice should be theirs to make.
Um, you seem to be missing the point, and instead imposing what you think it right, imposing your values on a group of people who generally do things differently.
You call it a 'violation' which in effect is saying that your way of interpreting/doing things is the correct way, when I actually posted this simply as an example of how different people view confidentiality. I was hoping to avoid even mentioning what is right or wrong.
Um, you seem to be missing the point, and instead imposing what you think it right, imposing your values on a group of people who generally do things differently.
You call it a 'violation' which in effect is saying that your way of interpreting/doing things is the correct way, when I actually posted this simply as an example of how different people view confidentiality. I was hoping to avoid even mentioning what is right or wrong.
In the US, we don't have the ability to "impose" anything on our patients or their families, regardless of their culture. We have to follow the law. What you are describing isn't even an option here. So it's not even worthy of debate really.
In the US, we don't have the ability to "impose" anything on our patients or their families, regardless of their culture. We have to follow the law. What you are describing isn't even an option here. So it's not even worthy of debate really.
There is nothing to debate, what don't you get. I simply shared this anecdote, because it was quite an unusual/different perspective from what we here in the west see things. That's all. Maybe try and open people's mind up to the fact there is a bigger wide world out there, and that there are different ways different cultures do things.
There is nothing to debate, what don't you get. I simply shared this anecdote, because it was quite an unusual/different perspective from what we here in the west see things. That's all. Maybe try and open people's mind up to the fact there is a bigger wide world out there, and that there are different ways different cultures do things.
We're not idiots. We are well aware that there is a bigger wide world out there and that people see things differently and do things differently. And?
I actually thought the original post was decently written and thought-out. Under normal circumstances, it could provoke some good discussion. However, I think the OP has burned so many bridges with his/her bizarre behavior that the benefit of the doubt has long since been extinguished.
I actually thought the original post was decently written and thought-out. Under normal circumstances, it could provoke some good discussion. However, I think the OP has burned so many bridges with his/her bizarre behavior that the benefit of the doubt has long since been extinguished.
The thing is, what the OP related could happen here WITH the permission of the patient. So other places do things differently. And? Yes, we can be sensitive to the patient's culture and involve family and his community to the degree that he allows. But what are we to take from the fact that in the example he provided, the patient has no say in the matter? Yep, other societies view confidentiality completely different from us in the west. It's not like we could ever say "you know, in certain circumstances, that could really be a good thing. I think I'll be open to that if the situation ever presents itself." No, we can't. All we can do is understand the frustrations of our patients' families if that is what they are accustomed to at home. But if they are HERE, they will have to accept our laws, if not embrace them. If we travel to foreign lands, we need to be prepared for differences in laws and policies in the event WE become a patient. But I think most people understand that different cultures and different nations have different laws, different customs, and different perceptions.
I actually thought the original post was decently written and thought-out. Under normal circumstances, it could provoke some good discussion. However, I think the OP has burned so many bridges with his/her bizarre behavior that the benefit of the doubt has long since been extinguished.
What's sad, is all my stories really happened, and some are definitely unusual, but overall I didn't think much of it would be such shock, or people consider things weird. If you think about it, all the controversy began over a catheter.
Specializes in M/S, LTC, Corrections, PDN & drug rehab.
What's sad, is all my stories really happened, and some are definitely unusual, but overall I didn't think much of it would be such shock, or people consider things weird. If you think about it, all the controversy began over a catheter.
But you were a new poster, who came out of nowhere with this ridiculous stories. Instead of just lurking around or replying to posts, you started these threads that were outlandish & stirred up quite a bit of drama.
I don't know about you, but if I go somewhere new I like to listen & put my feelers in to figure out culture & personality of everyone. I don't just jump in head first, but that's what you did & you pretty much ruined your reputation. Because now every time you post a thread everyone expects a drama filled novela.
But you were a new poster, who came out of nowhere with this ridiculous stories. Instead of just lurking around or replying to posts, you started these threads that were outlandish & stirred up quite a bit of drama.
I don't know about you, but if I go somewhere new I like to listen & put my feelers in to figure out culture & personality of everyone. I don't just jump in head first, but that's what you did & you pretty much ruined your reputation. Because now every time you post a thread everyone expects a drama filled novela.
bagladyrn, RN
2,286 Posts
Are you old enough to remember the early days of the AIDS epidemic when people lost their families, jobs, homes, partners and friends when their diagnosis of HIV positive was revealed?
This had a lot to do with the creation of privacy laws.