Module 7- (1) Chapter 20 CASE STUDY: PANAMANIAN CHALLENGES TO CARE
PANAMANIAN Leticia Maria de Isaacs Blancas y Chamorro, age 35, is married with four children, ages 15, 12, 10, and 6. Her husband, Omedo, works on a banana plantation distant from their small orange and banana farm in rural Panama; he makes it home only every other weekend. Leticia has been overweight since the birth of their first child and has never seen it as a problem. Approximately 3 months ago, she began losing weight, even though she was eating her usual diet and drinking a lot of carbonated beverages. She also has a rash on her arms and legs for which she has been using a poultice made from eucalyptus that helps the itching but does not clear up the rash.
Because going to the bathroom several times during the night was interfering with her sleep, Leticia sought advice from her mother. Her mother suggested a trip to the local botanica for herbs that a cousin used several years ago for the same condition. After trying the herbs for 2 weeks without improvement, she sought advice from a local curandera, who recommended guanabano and ginseng because Leticia was also having frequent bowel movements that she attributed to parasites. The curandera also recommended an antibiotic that did not require a prescription. Leticia obtained the antibiotic from the farmacia (pharmacist) and took it for 5 days, with no apparent improvement. In fact, her diarrhea and thirst worsened.
Leticia left her children with her younger sister and mother and took a bus 42 miles to a city with a physician. The physician wanted to admit Leticia to the hospital for a few days for a more complete health workup for diabetes mellitus. However, Leticia refused, saying that she needed to return home to her children. The physician reluctantly gave her an oral hypoglycemic prescription and an instruction for a weight-reduction diabetic diet and encouraged her to return in one week. Leticia agreed to return if her husband came home that weekend with money so she could afford a second bus trip to the city. She also stated that if she could not return the following week, the curandera, whom she has know since she was an infant, would help her.
You are a public health nurse (health worker) who lives in the same town as Leticia and have heard of her health problems being discussed at local stores. You plan to make a visit to Leticia and offer advice if she will see you.
PANAMANIAN Case Study Questions
- Leticia has a rather long name. What is her married name? What is the family name of her father? What is the family name of her mother?
2. What might you do to build a trusting relationship with Leticia before giving her health advice?
3. Which advantages might there be in visiting Leticia in her home?
4. Which disadvantages might there be in visiting Leticia in her home?
5. What do you think has caused the rashes on Leticia’s arms and legs?
6. Would you encourage or discourage Leticia from using eucalyptus on the rashes?
7. Would you encourage her to take antibiotic and herbal medicine recommended by the curandera along with the hypoglycemic prescription?
8. What do you think might happen if you advised Leticia to refrain from taking the antibiotic and herbal medicine recommended by the curandera along with the hypoglycemic prescription?
9. How might you help Leticia integrate the care recommended by the physician and curandera?
10. Would you discourage Leticia from seeing the curandera completely?
11. Leticia tells you that she does not want to lose any more weight because her husband likes her being “stout.” She eats a “traditional” Panamanian diet, which is high in fat but replete with fresh fruits and vegetables. Which dietary recommendations would you make to negotiate an acceptable weight and still maintain control of her diabetes?
12. If Leticia agrees to be admitted to a hospital for treatment, would she be admitted to a Social Security hospital or a Ministry of Health hospital?