Think Cultural Health Case Study: Culturally tailored health care in obstetrics

Aisha Anderson has made an appointment to
see her primary care doctor at the recommendation of her OB/GYN. She’s looking to find out more about lowering
her high blood pressure. Aisha experienced problems during her first
pregnancy related to her high blood pressure and she
reveals during the appointment that she may be pregnant again. Aisha seems to have mis-perceptions regarding
the impact high blood pressure can have on her and her health. Dr. Roberts discusses with her the importance
of controlling her blood pressure particularly during a pregnancy and some steps she can
take to begin doing so. Some topics addressed during this video include: The importance of prenatal care. Mis-perceptions regarding high blood pressure
as it pertains to race and age. The importance of support systems and community
resources. Respectful history taking. Good morning Miss Anderson, it’s good to see
you again. Hello. The last time you were here, you just learned
you were pregnant! How was the rest of your pregnancy? Um not so good. I started getting headaches and then uh…felt
nauseous and then I was told that I had high blood pressure. Then my son came early, after sixth month,
and then he had to stay in the hospital for 12 weeks after that. How is your son now? Well he’s okay now, I have a therapist that
comes to the house to help me take care of him once a week. That’s good to hear. I’m glad you have some support. I’m sure this has been a difficult experience. Now, what can I do for you today? Well, my OB/GYN says that my blood pressure
is still too high and that I should see my primary care doctor on advice on how to get
it down. I think I probably had high blood pressure
before I got pregnant and didn’t know about it. Um I think that’s why my son was born early. Well your high blood pressure certainly could
have been a reason for your son’s premature birth. High blood pressure or hypertension negatively
affects pregnancy both for the mother and the growing baby if it’s not treated. Yeah, and now I’m starting to feel the same
way I felt when I was pregnant and getting… headaches and having to sit down all the time
because I was dizzy. It’s good you came to see me today. Let’s start by checking your blood pressure
and then we can discuss your options for keeping it under control. The first thing we need to talk about is how
to keep your blood pressure under control. There’s a lot of people in my family that
have high blood pressure and there’s a group at my church but I’m too young… Too young? Well, it’s not something that I need to worry
about at my age. High blood pressure can strike a person at
any age and it’s very common for African Americans like yourself. Blood pressure is a measure of how the heart
contracts. Diseases like kidney failure, congestive heart
failure and strokes all begin with high blood pressure. And as you know, high blood pressure may affect
your children as well, that’s why keeping it under control is really important. Okay, but I don’t have money for medications
and stuff like that. That’s okay, I encourage you to check out
the group at your church and I know that Applewood Clinic around the corner offers a low-cost
program too. I can get you additional information about
those programs if you’re interested. Yeah, I’ll check it out. That’s good to hear. I think you will really benefit from those
programs because they will inform you about healthy living choices aimed at controlling
your blood pressure. Now, I want to go back to what we were talking
about before with your pregnancy and labor experience. Are you planning on having more children in
the future? Uh I know, I need to take care of myself and
my son, but… I think I might be pregnant again. Do you use contraceptives? I’m not on the pill. My doctor said the pill was a bad idea
for someone with high blood pressure. That is true. How about condoms, do you use them? No, my boyfriend doesn’t like to use them. Thanks for sharing this with me. It’s important I get a complete picture. Let’s start by having you take a pregnancy
test and once we figure out if you are pregnant we can discuss some options for safe blood
pressure control throughout your pregnancy. We can also discuss ways to prevent unplanned
pregnancy in the future, that won’t affect your blood pressure. Are you interested in learning about these
treatment options? Yes, thank you. Please consider these self-guided questions: How would you address health-related mis-perceptions
with a patient of a different cultural background? What local resources could you refer a patient
to? Did you notice how Dr. Roberts created a safe
space for Aisha to answer questions as she took her medical/social history?

Daniel Yohans

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