Doctors learn of religious remedies
It was heartbreaking to begin with: the case of a terminally ill infant.
But it turned professionally and personally wrenching for the medical team and Dr. Sean Palfrey, a professor of pediatrics at the Boston University medical center, when the family of African Muslims said they wanted to perform a ritual traditional to their culture. They wanted to apply a heated object to burn tiny points on the baby's back.
The medical team recoiled but agreed, recalled Palfrey, as long as the child received a local anesthetic and the procedure was done under hospital supervision to prevent infection.
As it turned out, the child died before the procedure could be done. But the case is an example of the difficulty that can emerge when different cultures clash in the medical arena. Immigrants often bring healing traditions, usually religion-based, that are alien to American doctors.
But some doctors are reshaping their practices and attitudes to respect their patients' cultures. That effort at accommodation, called medical pluralism by some, arose not just out of doctors' kindness but medical need, documented in "The Spirit Catches You and You Fall Down." The book told a true story of a Hmong girl who was suffering seizures and became sicker after American doctors plucked her from her loving Laotian family because of the family's insistence on using traditional, spirituality-based therapies.
"Medical training these days has moved in the direction of looking for ways to integrate the very important physiological analysis [with] the patient-centered view of what is going on," said Linda Barnes, director of the six-year-old Boston Healing Landscape Project.
The project, run by the pediatrics department at the Boston University School of Medicine, logs information about immigrant religious and cultural traditions for use by local doctors and medical students. It also strives to educate members of the medical community on how their beliefs might color treatment strategies.
Medical schools across the country are increasingly incorporating such lessons into their curriculums, said Barnes, a medical anthropologist with expertise in world religions. They do so for good reasons.
"If the doctor is pursuing only his or her interpretation of what's gone wrong and if that radically differs from what the patient and family think is going wrong, it may be much harder to persuade the family that the most serious aspects of the [illness] are being addressed" by medicine, she said.
Total reliance on religion over medical care can be dangerous, but "it's more common [for immigrants] to mix and match" the two, said Barnes.
Last month, she, Palfrey, and the healing project's Lance Laird, a specialist in Islam, met with three pediatric residents at the BU medical center to introduce them to the project's vast online library of resources about different nations and cultural traditions.
One of the residents, Julie Herlihy, said she had worked with patients in Africa, where people would go to a traditional healer if conventional medicine failed and vice-versa.
"I felt so often that I wished that there were a resource for this," she said. "I don't know why this is, but there was always this antagonistic interface between the two systems that really disserved the community."
Accommodating traditional customs, by contrast, can make patients more comfortable and willing to accept Western medicine, which can aid recovery.
Barnes said she received a query last week from medical interns whose patient, a Cambodian man who had immigrated to Los Angeles 30 years ago, was suffering a high fever and rash. Cambodian friends blamed the illness on a curse from his dead parents, and the man wanted to create an altar in his hospital room with a lighted candle for a forgiveness ceremony. The hospital frowned on this and said an open flame was dangerous.
After Barnes offered several suggestions, one of the interns wrote back and said the situation was resolved by finding a safe room in the hospital where he could light a candle and burn incense. The man, though still very sick, "seems much more at peace and . . . trusts me" as a result, the intern wrote.
For those inclined to dismiss immigrant religions as superstition, Palfrey offers a cautionary tale. A fundamentalist family had a newborn who developed seizures. They prayed for two weeks for a cure before taking the baby to doctors who diagnosed meningitis. By then the child had suffered devastating neurological damage. Should the family be reported for child neglect for waiting before getting him medical attention?
"This family had done its absolute best to do what it felt was the appropriate care, . . . loved the child desperately, and was going to take care of the child no matter what its outcome was," he said.
After consulting lawyers and state officials, the medical team decided not to pursue a charge - a decision most doctors would not have made, he believes.
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