Learn cultural practices of the population you serve

Language barriers, beliefs can be barriers to care

When Jane Cavanaugh, RN, CCM, CPHQ, nurse case manager for Blue Cross and Blue Shield of Minnesota, began managing the care of a Vietnamese woman with lung cancer, she researched beliefs of the Vietnamese culture and tailored her care management plan around them.

The St. Paul-based health plan has internal triggers for referrals to case managers. In the case of the Vietnamese woman, the referral to case management was triggered by a 12-day length of stay.

The patient was discharged to a nursing home that did not have easy access to a medical interpreter. The husband, who also spoke no English, could visit his wife only after work.

"There was a language barrier and problems with communication during the discharge process and during the nursing home stay," Cavanaugh recalls.

Before the patient was discharged, Cavanaugh called the hospital social worker to arrange a meeting with the patient, the family, the doctor, and a medical interpreter who went over the post-discharge plan of care.

"There was a tremendous communication deficit when it came to medications and which one she should take when. We discovered that it doesn't work to discuss colors of pills with the Vietnamese because the blue and green both translate to the same word," she says.

Cavanaugh arranged for home health with an interpreter present. She called the family with the help of an interpreter to remind them of meetings.

The woman was afraid to go through chemotherapy treatment because she was afraid she'd use up her health insurance benefits and there would be nothing left for her husband.

Cavanaugh spent a lot of time explaining Western medical treatment to the family and eventually persuaded the woman to undergo chemotherapy treatment.

For instance, she resisted having blood drawn because of concerns that if a fluid was removed from her body, she would suffer a loss in this life as well as the next.

Using an interpreter, Cavanaugh explained that blood is naturally replenished.

Because the woman's cultural beliefs would allow her to ride in a car only with her husband, Cavanaugh was able to get a specific Friday appointment with an oncologist so she could be evaluated for chemotherapy when the husband was there. She arranged visits for treatment around the husband's work schedule.

Cavanaugh found her motivational interviewing training helpful when dealing with the Vietnamese population.

"To them, saying 'no' means life is in disharmony. I had to ask them open-ended questions," she says.

Many Southeast Asians believe that good health is achieved by harmony between two opposing forces. Their traditional remedies are used when they feel things are out of harmony, she says.

Although the Vietnamese woman's condition was terminal, Cavanaugh was able to help her through the health care maze, taking her cultural beliefs into account.

When the woman's condition deteriorated, Cavanaugh worked collaboratively with the hospital social worker to find a facility that had a Vietnamese-speaking staff member.

Cavanaugh works with an employee group that includes Spanish, Cambodian, Vietnamese, and other immigrant populations and tailors her case management techniques to each member's cultural beliefs.

Members get better care and better health outcomes if you understand their health care practices and their cultural structure, she adds. "It is incumbent on us to be respectful of people's traditional cultures and medical beliefs as we reach out to them."